How Ambulance Coverage is Funded
TCLS is a non–profit ambulance service. Funding for our operations comes from the following sources:
Billing for Services
Billing for ambulance service is approximately 76% of TCLS revenues. The current health care coverage mix of patients served by TCLS:
| Medicare | Medi–Cal | Insured | Uninsured |
|---|---|---|---|
| 50% | 20% | 17% | 13% |
Ground Ambulance Membership
Membership fees are approximately 6% of revenues.
Your annual membership fees are a significant bolster to TCLS revenues, and help to maintain ambulance coverage.
In July of 2011, Trinity County households received a TCLS membership insert in their Trinity PUD bill. Community response has been encouraging. The PUD “stuffer” and other efforts of outreach increased membership by over 100 members that summer alone. Crews and staff very much appreciate your support of the ambulance service.
Membership is a means for individuals to support an essential community service, while receiving a service with no out of pocket expense for ambulance.
Current membership equals roughly 12% of the population we serve.
Please help spread the word!
County of Trinity
The County of Trinity supports ambulance operations with an annual contract fee and lease of the Lowden facility. As County Leadership struggles with balancing debt and preserving services, support has declined.
For fiscal year 2011/12, the Trinity County Board of Supervisors increased the subsidy from $35,000 to $55,000. This increase brings the subsidy from 5% to 8% of revenues.
The increase helps us preserve 24/7 staffing in Hayfork and Weaverville. The increase does not close the projected funding deficit, but it is a substantial step in the short term. TCLS is working diligently to identify options that will preserve local ambulance coverage for the long term.
Grants and Community Outreach
In a typical year, grants and community outreach are 10% of revenue.
Medical equipment and ambulances are obtained almost entirely through grant projects. Needed facility upgrades are also achieved through grant funding.
TCLS offers public safety training, including American Heart Association First Aid and CPR. Course fees charged to the public help to offset the cost of providing training to the volunteer fire departments at or below the cost of providing their training.
When you take a course to increase your knowledge and skills to deal with an emergency, the fee helps support training for your local volunteer fire department.
Donations and Other Funding Sources
Donations to TCLS are welcome. Donations can be applied to the general fund for operations or they can be designated for special programs, such as the provision of EMS training to our volunteer fire departments.
There are times (when our community is on fire!) TCLS can generate income by contracting an ambulance to fire camp. This does not reduce 24/7 first-out staffing in Hayfork and Weaverville.
Fire camp has been our avenue for developing adequate reserves for stability of operations, and for grant matches to obtain equipment, training, special programs, and ambulances.
How the Dollars are Spent
Employee related expense including payroll, health care, training, uniforms, and physicals — 75%
Expense for facilities, utilities, insurance, fees, and non-ambulance supplies — 8%
Ambulance related expense including fuel, vehicle maintenance, medical supplies and equipment — 17%
TCLS employs about 20 people, which includes 8 full–time positions and the remainder working a supplemental, seasonal, or call–when–needed basis. All but two positions are emergency response personnel.
Challenges Ahead
TCLS has been providing quality patient care and transport since 1993. In that time, the cost of operating has risen dramatically, especially in recent years.
One of the greatest challenges is the makeup of our rural area with respect to unemployment and poverty levels. As stated above, TCLS patients are approximately 50% Medicare and 20% Medi–Cal.
Medicare reimbursement has been studied by the U.S. Government Accounting Office, in report #GAO–07–383 (available on the web), and found to be 17% less than the cost of maintaining readiness in a ‘super-rural’ area such as ours.
Medi–Cal reimbursement is less than one–quarter the amount of Medicare. Combined, Medicare and Medi-Cal comprise 70% of Trinity County Life Support patients.
Thus, 70% of patient care reimbursement can accurately be described as falling below the expense required to facilitate 24/7 advanced life support crews medically trained, equipped and in safe vehicles, ready to respond.
Insured patients are 17% of the total and the remaining 13% are uninsured and private pay. In Trinity County there is a high number of uninsured and medically underserved persons living in poverty conditions. The emergency services are frequently the first or primary access to health care for this population.
In 2010, TCLS wrote off $49,540 to indigent care. Hospitals and physicians receive some reimbursement for indigent care through Maddy (AB12/612). Unfortunately there is no program in place for ambulance services to recover the cost of providing service.
TCLS continues to adapt its structure in order to keep ambulance staffing at effective levels in tough financial times. Since 2005, the company has operated without a CEO position. In 2012, we are planning to outsource billing, cutting a full-time staff position at the end of 2011.
TCLS EMTs and paramedics are performing an essential service in caring for the sick and injured. The staff works for wages not competitive with like positions in Trinity County and surrounding ambulance services. Recruitment is not difficult, as inexperienced paramedics need a place to gain experience. Retention is a challenge.
Efficiencies are continuous, as call volume and health care coverage do not support the cost of operating.
The challenge is great and the Staff and Board of Directors are focused on preserving emergency ambulance response and patient care for the immediate and long–term benefit of the public we care for.
If you are interested in reading more material, you may download the TCLS 2010 Annual Report.