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Ambulance Fees Worry Volunteers

A Fairfax County proposal to charge residents for ambulance rides has local volunteer fire departments worried. Although a fee would raise money for the county, officials at Centreville and Fair Oaks fire stations say it could well prove disastrous to residents and the volunteer fire departments alike.

"I'm concerned that there are people who won't dial 911 [in an emergency]," said Pete Kirby, chief of Centreville Station 17's Volunteer Fire Department. "Or people who'll dial it and — in response to them asking if there's a fee and finding out there is — will refuse ambulance service."

What's currently proposed is $300 for a basic ambulance ride, $400 for an Advanced Life Support (ALS) I ambulance (three or fewer medications administered en route to the hospital) and $550 for an ALS II (more than three medications). In addition, patients would also be charged $7.50 per mile traveled from pick-up site to hospital.

Patients wouldn't receive a bill; instead, the cost would be charged directly to their insurance. And the federal government would pay the fee for Medicare and Medicaid patients. But Kirby said medications given during the ambulance ride are presently charged to the patient's hospital bill, and he wondered if the proposed fees would affect this procedure.

"If the county only charges against insurance, how long before the insurance company decides it doesn't want to pay?" he asked. "And would the increased cost be passed on to the insured?"

He and his wife Lauren, president of the Centreville VFD, also fear the impact an ambulance fee could have on the department's fund-raising campaign. She said the county's considered a fee, from time to time, but this is the "most serious look" it's taken at the issue. And, she added, "We think it's going to really cripple the volunteers' ability to raise funds."

Pete Kirby said Station 17's fund-drive campaign is one of its largest sources of income. "We rely on the generosity of the community we serve to raise the funds necessary to pay down our [building's] mortgage, operate our department and purchase new equipment," he said. "We just bought two ambulances at a cost of $153,000 each."

Although the county proposes reimbursing the volunteer stations $10,000 each toward their income loss, said Lauren Kirby, "That's a drop in the bucket, compared to what we'd lose in fund-raising." And proceeds from the fee, she said, would go into the county's General Fund, rather than come back to the fire departments.

Furthermore, said Pete Kirby, "If a fee is approved, people may feel it's redundant that they have to make a donation and pay an ambulance fee, too." So in Centreville VFD's fund-drive letter going out April 1 to 29,000 residents, a survey will be enclosed to determine what they think about the fee proposal.

"WE WANT to see how it would affect their giving to the department and their willingness to call for an ambulance if they knew they were going to be hit up for a big charge," explained Lauren Kirby. She's also worried about the residents' well-being.

"What about children, the elderly and chronically ill people who use ambulances all the time?" she wondered. "And what are the potential effects to people who wait and don't call for help, right away — or who don't have insurance or haven't met their deductible?"

"You only have about four minutes if you're in the middle of an emergency situation," continued Kirby. "So if people call a friend or a taxi, instead, they might be putting their health at risk. And God help [the county] on liability. If someone has a serious problem because he waited and didn't call 911 because of the fee, who has the liability for it?"

Jonathan Wood, chief of the Fair Oaks Volunteer Fire Department (Station 21), also has questions about how the fee would be billed and how information about the incident precipitating the ambulance ride would be collected. "What are the mechanisms of capturing all this information in the field and being able to bill it?" he wondered. "How, exactly, would it be administered?"

"When the call's being run, there's a lot going on," he continued. "It could be 2 a.m., pouring rain and the person's in a ditch. And if that person's unconscious and we don't know who he is, they'd have to get the information from the hospital. [Then], both field and hospital personnel would be involved in the administration."

And like the Kirbys, Wood also worries about the public's response to the fee idea. "We're an independent corporation and have to raise money," he said. "And since there's not really a good, comparable jurisdiction that has both volunteers and paid personnel, there's a concern that there'd be some backlash from the community we serve."

He has no data that would gauge public reaction, but — since volunteer fire department donations are dependent on the community's good will — he said, "We're sensitive [to this issue]."

THE COUNTY projects the fee will yield $3 million-$6 million annually. However, said Wood, "If we lose $2 million in fund-raising or if it costs that much in administration, [is it worth it for the amount the county makes]?"

Right now, he said, "I'm cautious about all the details and the possible negative impact — and the benefits — a fee could have. We want to understand all the ramifications and how a fee would affect our ability to raise funds."

At Station 21 in Fair Oaks, said Wood, the volunteers own 100 percent of the ambulances — EMS (Emergency Medical Services) vehicles. Countywide, he said, the volunteers own about 50 percent of the county's ambulance fleet.

"The vast majority of the money we raise goes toward vehicle purchase — including EMS vehicles" — thereby saving the county from footing that expense, he said. "So if there's an inability to raise that level of money, then Fairfax County would have to make up the loss."

Meanwhile, Pete Kirby's department plans to meet with Supervisor Michael R. Frey (R-Sully) and to also make the volunteers' position known to the entire Board of Supervisors.

"I'd be curious to find out what caused such a spike in the $200/ride the Board was considering last year," he said. "We've had fire service in this county since 1903, and to suddenly say we need to charge for an ambulance ride — I'm not sure what the problem is that we're trying to resolve by charging for ambulance service."