March 18, 2008 — The ambulance service in Lassen County is losing money because the state of California doesn’t pay its fair share. “We essentially lose just under $300,000 a year,” said Klark Staffan, vice president of the nonprofit Sierra Medical Service Alliance ambulance company. “Medi-Cal is the problem.”

Staffan spoke during a 6 p.m. meeting on Tuesday, March 11 at Jensen Hall, held to discuss the future of fire protection and emergency medical services in Lassen County. Staffan was the first speaker because his son was on short leave from military service in Afghanistan and was scheduled to return to service the next day.

“If we could simply get reimbursed by state Medi-Cal at a rate that covers our costs, I wouldn’t be standing here before you today saying, ‘Gee, we’ve got a problem,’” Staffan said.

MediCal pays less then 20 percent of actual costs. It pays about $199 per ambulance transport, according to Staffan’s financial report. Each transport costs SEMSA $805, the highest ambulance service rates in the state.

SEMSA stations three ambulances in Lassen County 24 hours a day, staffed by nine paramedics and nine emergency medical technicians. Those fixed costs, combined with the lower transport volume compared to more urban areas, equal substantially higher rates than the statewide average of $562 per call, Staffan said.

Despite constant pressure from the California Ambulance Association lobbying in Sacramento, the legislature refuses to increase Medi-Cal reimbursement. Instead, Governor Arnold Schwarzenegger’s 10 percent across-the-board budget cuts will further reduce Medi-Cal reimbursements, Staffan said.

To compound the problem, federal Medicare payments cover only 67 percent of actual costs. Local prisons were paying the Medicare rate until SEMSA negotiated a contract for a rate that covers SEMSA’s actual costs “plus a little bit more,” Staffan said. When that contract expired, SEMSA renewed it verbally. Staffan said he’s waiting for a signed copy of the written contract from Sacramento.

Insurance companies and private pay sources are starting to lobby for legislation to stop having to pay higher transport rates to make up for underpaying state and federal programs.

“If that passes, ambulance services will go out of business very quickly,” Staffan said.

Staffan said raising rates would just increase SEMSA’s bad debt. He said industry wide ambulance companies collect 55 cents for each dollar billed. In Lassen County, SEMSA collects 36 cents for each dollar billed.

SEMSA needs a $289,000 a year subsidy, Staffan told the County Emergency Medical Care Committee in October. Last week, he said the company isn’t putting away any money to replace the ambulances and warn out equipment every five years.

Susanville Fire Chief Stu Ratner, a member of the EMCC, said the committee is dedicated to finding a solution to the ambulance funding problem. The Board of Supervisors held the meeting to take information about ambulance and fire issues in the county.

Fire districts face similar funding problems. Though many people spoke about the ambulance and fire issues, the board took no action.

However, County Emergency Services Director Chip Jackson said it is much better to start talking about the issues now than wait and have to manage problems during a funding crisis. He said the various fire districts may work out joint powers agreements to share the costs of liability insurance, training and worker’s comp, among others.

“We couldn’t have had that meeting 25 years ago without a fistfight,” Jackson said.