County raises fees for ambulance service

ALL TOGETHER NOW: Graduates from the WNC Diversity Engagement Coalitions' eight-week professional development series talk about their experiences in the program during the Buncombe County Board of Commissioners meeting on Feb. 6. The coalition is a network of organizations dedicated to promoting diversity, equity and multicultural inclusion. Photo by David Floyd

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.

BREAKING IT DOWN: The county Board of Commissioners discussed limited obligation bonds to help finance a plethora of school projects. Image courtesy of Buncombe County
BREAKING IT DOWN: The county Board of Commissioners discussed limited obligation bonds to help finance a plethora of school projects. Image courtesy of Buncombe County

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.

All aboard

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.

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About David Floyd
David Floyd is the Buncombe County reporter for the Mountain Xpress. He previously worked as a general-assignment reporter for the Johnson City Press. Email him at dfloyd@mountainx.com.

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6 thoughts on “County raises fees for ambulance service

  1. cecil bothwell

    Gotta say I think ambulance charges are a rip-off. A few years ago I stopped in to Sisters of Mercy on Patton with a mild chest ache. My brother had lately died of a heart attack, making me a bit over-cautious. EKG at Sisters was clear but they said I ought to go to Mission for a deeper check-up. I said I’d drive, they pressed me … no, you shouldn’t. Brief argument, I acceded. Five minute ride to Mission. AFTER insurance, I was billed over $400. Should have taken ART.

    • BMacAVL

      Fear is the greatest motivator for sales because consumers are emotionally driven which completely over-rides logic in 99.9% of health related situations. This paired with a convenient solution is a hard to turn down, especially when a ” experienced industry professional” says so. Growing up, my brother had a chronic illness, so I spent lots of time at doctors appointments and hanging around the hospital…they, like all business, explore all possible methods to capitalize profitability for each and every opportunity. I’m sure we have all gone to the doctor for something, told they found something else and claimed they would recommend “running a test” but a follow up appointment would be necessary. That test creates an additional insurance claim along with at minimum an additional co-pay but may also include the doctor writing an additional prescription which then helps big pharma sell more pills/drugs along with getting some kind of kickback for the doctor or practice from the pharma rep. and ultimately more insurance transactions at the pharmacy when the script ends up getting filled or “necessary procedure” to correct “said” issue that equates to additional lined items on a bill which is eventually paid out by insurance and/or the consumer. The United States has the highest prices for healthcare worldwide but also raked 25th for life expectancy within the developed world…that correlation to me proves we are being ripped off as much as possible by big pharma and its cohorts within the insurance and medical industries. We also have the largest black market(100% perpetuated by the war on drugs & privatized prison system) for illicit substances worldwide which has only grown since the introduction of oxycodone/oxycontin(laboratory synthesized opiate aka same thing as heroin) in the mid-90’s which was marketed/advertised by manufacture Purdue Pharma as a safe, non-addicted form of chronic pain relief which is one of the major contributing factors as to why we are experiencing the massive epidemic financially & emotionally crippling our community and so many others throughout our nation. Long and short is we live in a system that is ruled by GREED and corporate america is and has always been a dog eat dog struggle for power/control!

  2. Catori Swann

    These are serious topics that affect the very core of our communities.

    Raising rates on emergency services may seem opportunistic in the extreme, and can hardly be defensible. However, you must examine the rates of these services in context to state averages and other local county rates. The fact that the Board of Commissioners has not raised rates since 2011 speaks volumes to their dedication to the people of Buncombe County.

    For instance, in Wake County, a basic ambulance service starts at $517, with Level 2 Life Support topping $890 with a $10.94 per mile charge, according to wakegov.org patient cost breakdown. Considering popluation density and transportation complications inherent to both counties, I’d say the Board has been very successful in keeping costs down up to this point. Coupled with the consistent losses on Medicare Reimbursement, I feel the Board was absolutely justified in their decision to recuperate some expenses at this time.

    The issues facing school facilities upgrades and investments are ones that have been a long time coming. I have worked in many of our county schools, and am well aware of the inefficiency of their lighting and HVAC systems. I applaud the Board for facing these challenges and seeing that immediate action is required.

    By upgrading lighting systems to LED (something my company specializes in) schools will see an immediate and remarkable decrease in overhead costs, energy consumption, and level of comfort in the classroom. Not only is this better for the environment, it will have a direct impact on student productivity.

    The Board of Commissioners might consider raising the Occupancy Tax on hotels by a point or two. It is currently 6%. An additional one or two percent would hardly deter any tourism traffic to our great county, and would spur hundreds of thousands in additional income.

    These are my thoughts.

    Catori Swann

    • Lulz

      LOL, the county should lower taxes considering that graft and corruption has become the hallmark of democrat control lulz.

  3. Enlightened Enigma

    hmm, yeah and maybe we should heavily tax LED lighting systems too …this was my thought.

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