I just read an article on JEMS.com that's got me concerned. Since I'm a blogger, I thought that I'd share it with you. It's kind of what I do.
The article concerns a city in Illinois that wants a fee increase for their fire-based ambulance service. At first it looked like just another city wanting to increase its charges for providing transports. That’s hardly newsworthy for ambulance services in Illinois these days as they’re mostly all trying to recoup more expenses.
However, read the story and try and see if you see what I saw: “Ambulance Fees May Jump 25% in Elgin”.
It’s way at the bottom. Did you see it?
Here’s what sets me off:
“A new charge for refusing advanced life support upon the arrival of emergency responders also is proposed. For nonresidents, the charge would be $400 each time. For residents, the charge would be $300 after the third occurrence in a 12-month period.”
A new charge for refusals? According to this if you’re not a resident of the city, have a minor fender bender that someone calls an ambulance for, and sign a refusal of care form, you’re going to get a $400 bill. What if it’s not auto-related and you slip and fall on some ice and someone calls? Is that worth $400 if you’re not hurt and an ambulance shows up? This sounds to me like every time someone plays "Cell phone hero" and calls 911 for something where nobody is hurt the service is going to get paid. Sure, it'd be nice for the ambulance service… but I don't think it's fair to the poor people getting the bill.
What about if you see an ambulance down at the local coffee shop and they ask you how you’re feeling… is that worth $400 too if they ask you for your autograph?
I can see what they’re probably trying to do. They’re probably trying to crack down on their system abusers by making them financially responsible. I support a lot of those efforts if they’re well thought out. This one is not. This isn't neccesarily a case where someone is getting something for free and should be charged for it. According to the article, this fee would apply to all refusals of care regardless of whether or not any services were provided.
I am a fan of treating and releasing patients in certain circumstances and I've written a few published articles on the topic, like this one regarding treatment coverage for hypoglycemic diabetics we sweeten up then sign off, and also this one that covers a procedure that I call the "Enhanced Refusal". I agree that both of those circumstances should be covered by a fee. I believe that if EMS provides a necessary service to someone that we should be able to recoup our costs and make it worth our time. This is not one of those cases.
Think of it this way. This is akin to you telling your neighbor you think your air conditioner is on the fritz in a casual conversation. Your neighbor, being a helpful person calls a heating and air conditioning contractor without your knowledge. The contractor shows up at your house to your surprise, and when you tell him your air conditioner is just fine and you don't need any repairs he charges you $400 for his time.
You'd be outraged and wouldn't pay it.
Of course I know that this most probably is not the line staff proposing this change. This one has all of the hallmarks of some uninformed bureaucrat all over it.
I will not be signing one of that ambulance service’s refusal forms. I suggest you don’t either.
Is anyone else doing this?