If you live within the city of Houston and call 911 for a minor medical emergency, the fire department will show up and handle the situation. So long as the patient is in no immediate danger and alert enough to make medical decisions, they’ll leave. As taxpayers, many expect this service and don’t expect to be charged for it, but if some city officials have their way that may change.
At the city council’s recent budget and fiscal affairs meeting, Houston Fire Department Chief Sam Pena laid out a proposed new fee schedule that would increase current charges and assess three new fees for fire department services. The changes stem from a half-million dollar tax-funded performance audit, the PFM report, that provided no recommendations for cuts but a slew of new taxes.
Here’s a breakdown of the proposed fee schedule:
|Transport||Cost for a patient to be transported from one location to a medical facility.||$1104.65||$1876.40|
|Field Terminations||Cease Resuscitative Efforts||$0||$365|
|On-site Treatment||Therapeutic care w/o transport (e.g.: diabetic call only requiring insulin shot)||$0||$175|
|Lift-assist||Lifting, repositioning, or picking someone off of the floor||$0||$175|
The biggest cost increase, at 70 percent, is the transportation fee. Pena says it’s based on a 2016 analysis that determined the proposed amount was the exact cost of service. The other fees, according to Pena, don’t make up the entire cost of the service but recoup a portion. The increase is expected to mainly affect self-pay “customers” and private insurance.
According to Pena, more than half of the calls, 53 percent, are Medicare or Medicaid (CMS) patients, 33 percent are self-pay, and 13.5 percent are commercial insurance or third-party. The field termination cost would be reimbursable except for self-pay, or non-insured callers. Callers who receive treatment and no transportation won’t be reimbursed if they use Medicaid/Medicare and may or may notbe reimbursed if they have private insurance.
But the biggest question is why the services are so expensive to begin with.
According to Council Member Brenda Stardig, Chair of the Public Safety Committee, and reaffirmed by the chief, many of these calls are “all-hazard responses.” That means both a fire apparatus and an ambulance will show up to fill the request — a seemingly unnecessary expense for someone needing help to get out of the tub or off of the floor, or those suffering from a minor medical emergency. That’s not even considering the wear and tear on HFD’s already battered fleet.
According to HFD data, the collection rate for fees in fiscal year 2016 was 41 percent and dropped to 39 percent in the following fiscal year. HFD has an estimated $120 million in current uncollected costs for those two years and no recourse to compel callers to pay those fees. The outstanding debt, according to Stardig, cannot legally be written off, so if the fees increase, the amount of debt on the city’s books will increase at a faster rate with no solution to tackle it. Also, with increased fees, the likelihood of nonpayment for self-paying callers goes up. Taxpayers are currently subsidizing the difference in costs from the current fee schedule, but the amount taxpayers will owe will only go higher with increased fees.
In comparison to Texas’ other major cities, Houston’s costs for services appear to be higher than average.
San Antonio charges a flat fee of $950 for transportation plus $12 per mile (Houston’s per mile rate is $14.36), nearly 50 percent less than Houston’s proposed fee. For any non-transportation medical service call in San Antonio, the city charges a flat rate of $100, and the fee to transport a deceased person to the morgue is $70.
Austin’s maximum transportation charge is $901 with a $13.50 per mile fee. MedStar, the governmental EMS agency created by Fort Worth and 14 other nearby cities, says their average ambulance trip costs about $1,500. The cost in the city of El Paso for EMS service is a base rate of $785 with a $15 per mile additional fee. The average charge in El Paso is $869.94.
A cursory review of costs in similar-sized cities in Texas shows that Houston’s fees are already among the highest and, if approved, the new fee schedule will be the single highest in the state.
The purpose of the increase is allegedly to target habitual abusers of HFD services — those, for example, that call on a weekly basis for help getting someone out of bed. One could argue taxpayers can’t abuse a service they fund entirely, but if that’s the reason for the increase, HFD should tier the fees and only charge after the third or fourth calls as is done with false alarm calls as suggested by Council Member Knox.
Additionally, many nursing homes prohibit employees from picking up patients after falls. The bill for the HFD service would be charged to the individual, not the nursing home that habitually calls for the service, so this increase wouldn’t do anything to alleviate excessive calls but rather burden the patient.
Fire departments, like police departments, aren’t meant to be used as revenue streams. The revenue they generate isn’t meant to cover their costs. That’s what taxes are for. It’s a problem for the city, not the taxpayers, that the fire department needs to increase fees to cover costs. If that’s going to be the case, why not privatize the entire department and have all costs, employment plus costs of services, built into overall service costs? Then charge users and refund taxpayers the share of their tax dollars that goes to fund the fire department.
This is really just another attempt by the city to get more funding and continue to feed the beast. While the city may be able to turn other services into generous streams of revenue, taxpayers shouldn’t have to be concerned about costs for utilizing a service they are compelled to pay for anyway.