On Tuesday, the San Diego City Council approved major changes with how the city’s ambulance service, AMR, transports and charges patients who call 911.
The City of San Diego has a contract with AMR, the parent company of Rural/Metro, through 2020. The City Council approved changes to the contract that include:
- Reducing the number of emergency zones the city is divided into from eight to four
- Increasing the rates transported patients are charged by 24% over the next few months
- Allowing AMR to leave its contract with the city early if the city can find a new ambulance service provider.
The City of San Diego has been keeping a close eye on AMR’s ambulance services, specifically response times in different neighborhoods across the city, since January. The year began with the city’s Chief Operating Officer sending AMR a list of demands to abide by in order to avoid having its contract with the city terminated.
To read more about the list of demands, click here.
This came after reports showed AMR was responding late to calls in some neighborhoods. According to AMR’s contract with the city, AMR is required to respond to serious medical calls in 12 minutes or less, 90% of the time in eight of the city’s zones.
Through records requests, NBC 7 Investigates found AMR did not reach that 90% goal several times last year, resulting in hundreds of thousands of dollars in fines.
San Diego City Fire Chief Brian Fennessy sat down with NBC 7 Investigates in January to explain AMR’s progress with the city’s demands.
To read more about what the Fire Chief had to say, click here.
In asking the city to reduce the number of emergency zones from eight to four, AMR and the Fire Department said the eight compliance zones and the penalty structure for missing response times, originally established in 2011, is not suited to handle the current call volume.
To see the new proposed zones, click here.
At a Public Safety Committee Hearing on October 4, San Diego Fire officials said they have seen a 22% increase in 911 calls across the city over the last four years. In addition, according to Fire officials, 30% of patients transported to the hospital did not actually need ambulance transportation.
In regards to increasing rates residents pay when requesting an ambulance, AMR said the company has been negatively impacted by reimbursement declines, increased operational costs, and recruitment challenges.
To offset the company’s estimated $7.2 million dollar loss, the 24% rate increase will be phased in, with 9% beginning immediately and an additional 15% increase going into effect January 1, 2018.
In a statement to NBC 7 Investigates, Madeleine Baudoin, the Government and Community Affairs Manager for AMR said, "We are pleased that we came to a cooperative agreement with the city. This EMS contract amendment was needed in order to improve an outdated system and address the increase in demand for emergency ambulance services. 57% of AMR patients are covered under Medi-Cal or Medicare, with Medi-Cal paying only $106 and Medicare around $500. AMR will continue our compassionate care program to assist or eliminate charges for those unable to pay."
According to AMR, the ambulance company said the rate increase would not affect payment for a majority of patients because third-party insurance companies will absorb the extra cost.
“Federal and State government payers, such as Medicare, Medi-Cal, the uninsured, and the indigent are not affected by rate increases,” AMR’s statement reads. “As common in healthcare reimbursement, the rate increase will be absorbed by third-party insurance companies.”
To read AMR’s explanation for why a majority of patients will not be affected by the rate increase, click here.
With the rate increase approved, the City of San Diego’s ambulance rates will be the fifth most expensive in San Diego County. At Tuesday’s council hearing, a majority of the public speakers voiced support for AMR and the rate increases.
To see how other cities’ ambulance rates compare in San Diego County, click here.
AMR has agreed to leave its contract with the city early if the city can find a new ambulance service provider, saying this will assist the city in implementing a new system framework. The city of San Diego will begin its search for a new ambulance service provider in 2018.
In August, Envision Healthcare, the company that owns AMR, announced the ambulance service would be sold to Koch Industries in a $2.4 billion dollar deal.