EMS billing change could mean more than $400,000 in city revenue

Fire Chief Louis LaVecchia believes the city will improve its emergency response services if it switches its billing process, a move that could see the city bringing another $400,000 or more into the city coffers each year.
That money, he said, could pay for additional life-saving equipment.

The issue came up at Monday night’s Board of Aldermen’s meeting when the aldermen voted 8 to 6 along party lines to let the chief get bids from companies that would handle billing for emergency medical services that city firefighters provide.
Currently, American Medical Response (AMR) provides and bills for emergency medical services and ambulance transportation to area hospitals.
But LaVecchia said Monday night that Milford could be charging for some of those services because a city paramedic responds to Milford’s emergency calls if advanced life support is required.
The way it works now is this: When a Milford resident calls 911, the 911 dispatchers determine the seriousness of the call, and they dispatch the appropriate responders. The first responders are from the closest fire engine, and they provide basic life support. A Fire Department rescue truck will respond with paramedics when advanced life support is needed. AMR, with paramedics, also responds, as well as police. Most of the time the Milford paramedics arrive ahead of AMR paramedics, and begin advanced life support. On serious calls, the Milford paramedic will stay with the patient in the ambulance to the designated hospital.
AMR bills for the life support services, which are about $850, and the ambulance transportation, which is about $550.
However, Milford could be charging for the life support services rather than AMR, Chief LaVecchia said, because the city has its own paramedics. Instead of contracting for an AMR ambulance with paramedic service, the city could use AMR just for ambulance transportation and basic life support services.
That would allow the city to bill for its emergency medical services, and that could amount to $400,000 a year, according to LaVecchia. Other officials have said that figure could be much higher, perhaps approaching the million-dollar mark.
Mayor Ben Blake has been trying to make this change in the billing process for several years, starting when he was an alderman.
He pushed it again this year during the annual budget process. Blake said it makes sense because it’s simply a matter of changing who gets paid for services — AMR or the city.
People in Milford who have medical emergencies already are billed for the services — or in most cases their insurance companies are billed, Blake added. That means that residents who call 911 won’t see much change at their end. LaVecchia said, however, there might be two bills where there once was one: a bill from AMR for the ambulance ride, and then a bill from the city for the medical services.
Blake and LaVecchia emphasized, though, that it’s usually insurance companies that have to deal with the bills.
“It would be a shift in who collects the money,” Blake said.
Medicare patients would be an exception — their bills would continue to go only through AMR because Medicare will pay only one service agency.
Republican aldermen objected to Monday night’s proposal to get bids from a third-party company to do the billing if Milford starts charging for its emergency services. The Republicans said they wanted more details before moving forward.
Republican Alderman Paula Smith said, “This is not an insignificant change.” She said she understands it is a multi-step process, but she wants to know what those steps are. She and other Republicans said they want to know if the change means Milford will need to hire more paramedics or firefighters, and what the change will mean to AMR.
She made a motion to table the vote, but that motion was defeated along party lines.
LaVecchia said it’s too early to say if the city will have to hire more paramedics in the future. He also said the contract with AMR ended in 2011 and the city has been operating without a contract. So changing the level of service requested from AMR shouldn’t be a problem, he said.
LaVecchia hopes that by billing for services, the Milford Fire Department will start bringing in revenue that will allow the department to buy needed equipment “that will enhance the system.”
Currently, for example, the city has auto chest compressors on four of its fire trucks. They cost about $12,000, and the chief would like to get five more so there is one on each fire engine.
The city hasn’t voted yet to change the billing process. Blake said it is a multi-step process, and the aldermen will have to vote again as the process moves along.