Ambulance rides for Hamilton County residents in medical distress will now be more expensive, but officials say a 10% rate increase will help stave off rising costs and retain employees.
On Wednesday, the County Commission unanimously approved a series of rate increases for the different levels of care offered by Hamilton County Emergency Medical Services. It is the first such rate hike since 2012. EMS Director John Miller, who has served in that position for three years, expects county leaders will start reevaluating those rates on a more regular basis.
"We know when somebody calls an ambulance, it's probably the worst day of their life," Miller said in a phone call Thursday. "We don't want to kick them while they're down, but at the same time, we want to operate as efficiently as we can considering the entire tax base."
— The cost of basic life support, which the county bills when a patient receives transport but no medical procedure, will increase from $1,080 to $1,188.
— The first tier of advanced life support, which applies when a patient receives basic treatment like an IV, oxygen or an EKG, will increase from $1,343 to $1,477.
— The second tier of advanced life support, which includes additional medications and lifesaving procedures, will increase from $1,484 to $1,632.
— The rate the ambulance service charges per mile will also rise from $20 to $25.
Over the past decade, Hamilton County EMS has experienced upswings in various day-to-day costs. One drug used to treat people with diabetes has increased 69% since April 2021, and the cost of epinephrine has risen 235% over the same time period. Epinephrine is used to treat life-threatening allergic reactions.
Fuel prices have also increased 10% since 2012, and a shortage of automotive parts since the pandemic has spurred a rise in maintenance costs. At the same time, demand for services has also spiked, with the number of annual calls jumping from 33,272 in 2015 to 53,507 in 2022.
Miller said the emergency service employs 164 people, which includes administrative staff, but it consistently remains 10-12 workers short. Hamilton County EMS pays emergency medical technicians $18 an hour and paramedics $22.56 an hour as a starting rate, Miller said. Most private services, however, pay paramedics about $28 an hour, he said, and hospitals often pay between $30-35 an hour.
Although ambulance services are beginning to see a scarcity of emergency medical technicians, Miller said, the most pressing shortage nationwide is among paramedics, a job that requires a longer period of training.
The county strives to pay for the service with the bills charged to people who use it, but there have been years when revenues came in just short of expenses. Between write-offs for people without insurance and the amount paid by Medicare, Hamilton County's ambulance service typically collects about 35% of what it bills customers.
"Our goal is to get as close to break-even as we can so we aren't that huge burden on taxpayers," Miller said. "I'm a taxpayer in this county. It matters to me, so we want to operate as close to budget neutral as we can."
Commissioner Jeff Eversole, R-Ooltewah, noted that the county is in the process of equipping its 17th ambulance, which was among the priorities Hamilton County Mayor Weston Wamp outlined in his State of the County address March 31. The mayor hopes this will reduce response times across the county.
"It's hard for us to keep EMTs and paramedics in those buses to be able to respond to needs," Eversole said in a phone call Thursday. "When you have a medical emergency that may be happening in Georgetown, Tennessee, and then you're having to dispatch an ambulance from the city of Chattanooga because the other three in between are in other calls, we've got to have more forethought on how we respond and how we position these ambulances and how we staff them — and that's the key."
Although he had some questions about the impact on poorer customers in Hamilton County, Commissioner David Sharpe, D-Red Bank, ultimately joined the rest of his colleagues in voting for the rate hike.
Fundamentally, Sharpe said he wants to ensure ambulances operate effectively without causing a severe financial burden on the people using the service.
"There doesn't appear to be a better solution at this moment," Sharpe said in a phone call. "For that reason, I supported the resolution, and if a better alternative comes around, we can bring that back up for conversation."