Question: You get into a taxi, they drop the flag and your fare is determined by the number of miles traveled to your destination. How does EMS determine its fees? An ambulance was dispatched to Sears at Windward City Shopping Center after my wife fainted. It was suggested that she be taken to Castle Hospital’s emergency room for evaluation. This transport was not of high priority and no sirens were used, but then we received the EMS bill for $930! Distance traveled: 5.8 miles, or $160.35 per mile.

Answer: Your bill reflects yearly 10 percent increases in ambulance service over the past several years, but we have to point out that an ambulance is not a glorified taxicab.

In addition to mileage, the transported patient is charged fees set by law, depending on the level of service, said Dr. Linda Rosen, chief of the state Department of Health’s Emergency Medical Services Branch.

“The patient, if competent, may refuse transport, in which case there is no charge,” she said. But once transported, there will be a minimum level of service charged, she said.

Current fees that took effect Oct. 15 are $775 for Basic Life Support; $870 for Advanced Life support 1, Advanced Life Support 2 or Specialty Care Transport; and $4,380 for Rotary Wing (helicopter transport). Mileage is $12 per mile.

The fees are set according to the Health Department’s Hawaii Administrative Rules, Title 11, Chapter 72, and cover 911 dispatch and response, evaluation, treatment if needed and transport to a hospital, plus mileage, Rosen said.

We pointed out that Chapter 72-31 lists fees of $375 to $450 (and a helicopter fee of $2,250), but says that fees may be increased by a maximum 10 percent on July 1 of each year.

“The Administrative Rules are indeed old,” Rosen acknowledged, but said fees have been increased “per what the rules allow, not more than 10 percent a year.”

No legislative approval is required, she said, “as the direction (for increases) is already in (the) statute.”

Rosen said she didn’t know how many increases there have been since the fees listed in Chapter 72-31 were established. We did a rough calculation at 10 percent a year, which indicated at least eight or nine increases.

“The fees have been increased most recently as often as allowed, almost every year,” Rosen said. As high as the fees are, she said the current fee schedule is “still lower priced than the average for EMS transports in California.”

Asked why the last 10 percent increase was made, she pointed out a provision in the rules that say “the fee increase shall be based upon projected revenue collected to equal no less than 50 percent of the preceding fiscal year’s ambulance service direct contract cost.”

For the 2012 fiscal year, the direct contract cost for ambulance service was approximately $65 million, Rosen said, while revenues collected were less than half that: approximately $31 million.

And it looks likely that there will be more increases.

“We will be watching the revenues collected to judge whether another increase is needed,” Rosen said. “It is possible that improved performance in this contract (which took effect in January) could push revenues beyond the 50 percent mark, but it is not likely.”

That’s because the biggest payer of ambulance fees is Medicare, which is planning to decrease its payments for ambulance service, she said.

Mahalo

To the two drivers who stopped and assisted my husband and me following a hit-and-run accident on Saturday, Feb. 16, in Kaneohe: Bert from Pearl City for calling police and staying with us until they arrived and the second driver who directed traffic around our vehicle, which was partially on the highway and could not be moved until the tow truck arrived. Thank you! — D & J

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