With the service witnessing a spike in costs, Hamilton County commissioners are considering at least a 10% increase in the county's ambulance billing rates, which would be the first such change since 2012.
"Everything we buy now is more expensive," Hamilton County Emergency Medical Services Director John Miller said in an interview Wednesday. "Plus, we need to get our pay a little more competitive."
The agency employs paramedics and emergency medical technicians.
The commissioners briefly discussed the potential changes during a committee meeting Wednesday, with some commissioners indicating they could support a more significant jump.
"If there is another number that you think we should go to, present that to us," Commissioner Gene-o Shipley, R-Soddy-Daisy, told staff. "We know we need more ambulances. We need to pay our people better, so let's get there at this time if that's possible."
As is, the proposal involves upping the fee for basic life support from $1,080 to $1,188, which EMS charges when a patient receives transport but no medical procedures. The cost of transport would rise from $20 per mile to $25 per mile.
The two rates that Hamilton County EMS charges for advanced life support would also increase. Under the first tier, patients normally receive an IV and sometimes an EKG or oxygen, according to a handout provided to commissioners. That rate would increase from $1,343 to $1,477. Billing for the second, more-intensive tier, which can include additional medications and lifesaving procedures, would increase from $1,484 to $1,632.
County officials note that existing rates have struggled to keep up with the cost of doing business, which has included the rising cost of state-required drugs that personnel use on a daily basis. The price of epinephrine, often used for severe allergic reactions, has gone up 235% since April 2021, according to numbers provided by the county, and the cost of Dextrose 50%, often reserved for people with diabetes, has jumped 69% over the same time period.
The county anticipates additional increases in drug costs because of the upcoming privatization of Erlanger Health System.
Additionally, fuel costs have increased about 10% since 2012, and staffing costs are on the rise as the county's EMS system competes with private ambulance services and hospitals for employees. Overall, the service's call volume has increased 61% between 2015 to 2022, jumping from 33,272 calls in a single year to 53,507.
"We literally cannot keep enough staff because we're in competitions with the hospitals and private services and other counties," General Services Administrator Christy Cooper said in an interview. "We're constantly hemorrhaging staff," an issue that EMS departments across the nation are also grappling with.
Miller said hospitals pay paramedics approximately $35 an hour, whereas the county's starting pay is $22.56 an hour. Most private ambulance services also pay a little higher than the county, he added, but Hamilton County EMS is more competitive when taking into account associated benefits.
Commissioner Jeff Eversole, R-Ooltewah, asked staff why they were considering just a 10% increase in rates.
"We contemplated other options," Cooper responded. "If rates were adjusted for inflation, it does kind of get us closer to the market high."
If the county boosted its rates to match the pace of inflation, staff said, the cost of basic life support would increase to $1,423, the first tier of advanced life support would be $1,769 and the second tier would be $1,955. The response fee, which EMS charges when an ambulance responds to a 911 call but doesn't transport a patient anywhere, would rise from $70 to $92.
When the county raised its rates in 2012, Cooper said, it intended to re-evaluate those fees after four years, which did not occur. In 2012, the county boosted fees for basic and advanced life support by 40-45%, bringing them up from an earlier range of $745 for basic life support to $1,060 for the second-tier of advanced life support. The cost per mile also increased in 2012 from $10 to $20.
"I would think that the next time we actually re-evaluate our pricing, it should not be an 11-year time frame," Cooper said. "In looking back over what happened last time, we need to actually keep up with our pricing and do a better job of staying on top of inflation and the markets."
Eversole said he supports an increase and suggested that county officials re-evaluate the rate change sometime in the next 12-18 months.
"We did consider additional options for our proposed increase this go-around," Cooper told commissioners. "It's a conservative step, but I'm certainly open to making that step a little larger if we see it's not meeting the need."
Hamilton County Mayor Weston Wamp told commissioners Wednesday that the rate increases would boost pay substantially enough to fully staff a 17th ambulance, a commitment the mayor mentioned during his State of the County address.
"While it's modest given the inflation over the last 11 years, we think the impacts of it would be significant," Wamp said of the rate changes, "but we would be open to ... a larger increase, or I think it would be wise to not just let a decade go by before we reconsider fee increases or changes like this one."