For the first time since 2011, the Buncombe County Board of Commissioners approved a fee increase for ambulance services.
Given the green light at the commission’s Feb. 6 meeting, fees will increase by $100 across the board for life support. Basic life support will climb from $410 to $510, advanced life support from $510 to $610 and advanced life support level 2 from $710 to $810. Mileage charges will increase from $8.75 to $10 per mile, and the cost of treating a medical condition without transport will jump from $200 to $375. The cost associated with oxygen use will stay the same, at $10.
The county is increasing these rates to take advantage of a recent 2 percent increase in Medicare funding. “Medicare, which is the primary provider of reimbursements, hadn’t approved any more funding than what they did in 2011,” said Buncombe County Emergency Services Director Jerry VeHaun, explaining why the county hasn’t increased rates since 2011.
This increase would allow the county to recoup some of the cost associated with providing these services. VeHaun said that in fiscal year 2017, the county billed about $10 million but only collected about $5 million.
“We collected on almost 70 percent of the calls that we made, but we only got about half the money, and that’s due to the tremendous amount of write-off for various reasons,” VeHaun said.
This fee hike would give the county an approximately $160,000 increase in revenue per year, decreasing the total subsidy that the county would need to provide for the service.
“So Medicare has raised the rate, and if Buncombe doesn’t raise the rate, it prevents us from asking Medicare to reimburse at the rate for that service that every other ambulance in the country now has the opportunity to do,” clarified County Manager Mandy Stone.
VeHaun said the extra revenue would be used to offset the cost of providing the service. “Personnel costs, medicine costs or supplies, you know everything’s gone up a pretty good amount since 2011,” VeHaun said.
This fee increase would put Buncombe County in line with what other counties in Western North Carolina charge for these services, VeHaun said.
“These are pretty big increases,” said board Chair Brownie Newman. “But on the other hand, we haven’t done any since 2011, so my hope maybe going forward is that we do kind of more frequent but maybe smaller [increases].”
Commissioners approved the increase unanimously. During the meeting, VeHaun said the fee increase could go into effect as early as Monday, Feb. 12.
Financing school projects
The board held a public hearing on issuing limited obligation bonds to help finance about $60 million in projects that commissioners have approved over the last few years.
These include about $46.7 million in major renovations to Asheville High School, Community High School and Montford North Star Academy as well as LED retrofits for schools in both the Buncombe County and Asheville City Schools systems and roofing and HVAC replacements at Ira B. Jones Elementary School. The county will also be financing about $13.7 million in miscellaneous projects.
Up to this point, county Finance Director Tim Flora said the county has been able to finance these projects using sales tax revenues, but the county now needs to start looking for other means to preserve that money.
“It’s always been the plan since the beginning of this process that, in order to stretch those dollars to meet all the capital needs of the local schools, that we were going to have to finance these projects,” Flora said.
Ty Wellford, a senior vice president for Davenport and Co., the county’s financial adviser, said that under this plan, the county would be issuing limited obligation bonds under the county’s 2015 deed of trust, which was used to sell the county’s limited obligation bonds in 2015.
Asheville High School and Montford North Star Academy would be used as collateral, which would be added to the collateral created in 2015, and the county would issue the bond through public sale as opposed to a bank loan. Wellford said a public sale would be a better fit for the size and duration of the bond. The term of issuance would be 20 years.
Commissioners will consider a resolution authorizing the proposed financing process on Tuesday, Feb. 20. The financing plan is undergoing a concurrent approval process through the Local Government Commission, which Wellford said has to approve any debt financing of this magnitude. It will consider this plan on Tuesday, March 6.
Commissioners also considered how they will fill a bevy of board openings on Tuesday. This includes one vacancy on the Asheville Board of Adjustment, which has two applicants, as well as two vacancies on the Buncombe County Board of Adjustment, which has eight applicants. The board decided it would conduct interviews to fill the vacancies on both of these boards.
Commissioners also discussed how they would select prospects for the newly created Library Board, which has five vacancies but a total of 26 applicants.
“We have a big pool of applicants here, a lot of interest in the new Library Board,” Newman said. “So there’s been a suggestion that [county staff] work to identify the geographic diversity of the applicants and bring back a smaller pool of candidates, which the board would then interview and make selections on which would be geographically representative of the library system in the county.”
Commissioners ultimately decided to limit the pool of applicants to eight to 10 for interviews, with two or three applicants coming from each district. The library board must consist of one board member from each district with an additional two board members chosen at large.
The board also filled vacancies for the Historic Resources Commission, the Metropolitan Sewerage District and the Adult Care Home Community Advisory Committee.
The next regular meeting of the Buncombe County Board of Commissioners is scheduled for Tuesday Feb. 20, at 5 p.m. at 200 College St., room 326 in downtown Asheville.