By Kelley Bouchard
Portland Press Herald
Copyright 2008 Portland Press Herald
PORTLAND, Maine — Each year, Portland paramedics provide about $4 million worth of emergency medical services, and each year the city is reimbursed for about half of it.
Payment of ambulance fees has come up short by an average of $1.8 million annually over the past four years, losses that are covered by Portland taxpayers.
Faced with a 2008-09 budget proposal that would eliminate 95 city jobs through layoffs and attrition, Portland city councilors have asked whether the collection rate could be boosted above a four-year average of 56 percent.
Administrators in Portland and other Maine cities say a higher collection rate may not be possible given the gap between what it costs to provide ambulance service and how much low-income and destitute people can afford to pay.
''What we bill out isn’t necessarily what’s collectible,’' said Deputy Fire Chief Terry Walsh, who oversees ambulance billing, which is done by a private company.
Portland’s firefighters union, which brought the collection gap to the council’s attention, wants the city to get more aggressive and start sending delinquent accounts to a collection agency. Winston McGill, union president, would like to see collections closer to 80 percent.
''The city is cutting 14 firefighter positions, which is taking a hard line,’' McGill said. ''Maybe it’s time for the city to take a hard stance to collect the money that’s owed to it.’'
Walsh said Portland doesn’t have its ambulance billing company refer delinquent accounts to a collection agency, and he doesn’t believe the city should.
''We’re nowhere near as aggressive as the private sector,’' Walsh said. ''We don’t want people hesitating to call us if they need help.’'
Basically, the city is willing to accept Medicaid, Medicare and private insurance reimbursements as payment in full, though it may bill users for unpaid balances. Private insurers typically cover much of the cost. On average, the city charged just under $500 for an ambulance run in 2006-07, when it made about 9,000 trips and billed for $4.4 million in services.
Councilor James Cohen, finance chairman, said he wants city staff to look for ways to improve revenue collections, but would support using a collection agency for ambulance fees only if it could be demonstrated that it would be successful.
''We have a certain population that is less likely to reimburse us,’' Cohen said. ''That is the hand we’re dealt.’'
A collection agency may not get the results that union officials expect. Maine’s largest city, with about 65,000 residents, provides free health care to about 2,000 indigent people annually, according to health department reports.
The uninsured and underinsured strain emergency medical service budgets across the state. About 20 percent of Maine residents rely on MaineCare, the state’s version of Medicaid, which is federally and state-subsidized health insurance for low-income people.
However, MaineCare and Medicare, which is federally subsidized health insurance for senior citizens, typically pay a fraction of what the city charges for ambulance services.
''Our bill could reach $1,000,’' said Bangor Fire Chief Jeffrey Cammack. ''MaineCare is going to pay us $132.77. That’s what they pay for every ambulance run, no matter what.’' Bangor and Portland, like most cities, write off the remainder as lost revenue.
Bangor’s ambulance billing is done in-house by three clerks, who send delinquent accounts to a collection agency. Still, Bangor’s ambulance collection rate is 58 percent, Cammack said.
MaineCare and Medicare users make up about 27 percent of Bangor’s ambulance cases, and about 10 percent have no insurance, he said. Portland officials were unable to provide similar data.
More affluent communities, where more residents have private health insurance, typically have higher collection rates. Scarborough, for example, collects 85 percent of its ambulance fees, said Town Manager Ronald Owens.
A clerk in Scarborough’s finance department does the billing and refers delinquent accounts to a collection agency, Owens said. Town residents with MaineCare or Medicare, or those without heath insurance, aren’t billed for unpaid balances. Nonresidents are billed, but those balances get written off if they aren’t paid, he said.
Walsh, Portland’s deputy fire chief, said the city hopes to improve ambulance collections by establishing a computer link to updated billing information at Maine Medical Center, the largest health care facility in Greater Portland.
Currently, paramedics get what billing information they can when they deliver patients to the emergency room. To get updated billing information, the city’s billing company, Comstar Ambulance Billing Service, must formally request it and wait for a response from Maine Med.
A link between Comstar and Maine Med should be established within six months, said Martha Davoli, hospital spokeswoman.