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19 <br /> Slide #20 <br /> Fee Study Review — Emergency Medical Services <br /> Fee Recovery% Net Cost . County <br /> 28% $11,498,601 <br /> Fee Services Provided: <br /> The Emergency Medical Services Division provides 24/7 ambulance transport and life services support. County provides <br /> services for the whole county. EMS cost recovery is limited by Federal and state reimbursement schedules, commercial <br /> insurance contracts,and limited collection rates for self-pay. <br /> Considerations for Fee Recovery <br /> Peer Comparison: County is at low end of peer comparisons. County uses 175%of Medicaid reimbursement rates as a <br /> standard for its ALSIBLS billing, which updates automatically each year. <br /> Community Benefit: County provides an essential service to ensure resident well-being at life-critical events. <br /> User Impact:Despite current cost recovery, current ALS/BLS fees are very significant, especially for uninsured <br /> residents. <br /> Strategic Alignment: Healthy Community Obj.7—Provide sustainable, equitable, and high-quality community safety and <br /> emergency services to meet the community's evolving needs. <br /> Opportunity Cost of Subsidy: Funding that is used to subsidize EMS services could instead invest in increased staffing, <br /> improving response times and health outcomes. _ <br /> Targeted Subsidy: County provides hardship assistance through a waiver administered throu1 <br /> bWANGE COUNTY <br /> 20 Federal law prohibits an automatic discount for self pay patients. WOR-rx CAROLIWA <br /> Kirk Vaughn said the county only spends $40,000 a year on the hardship waiver. <br /> Commissioner McKee asked if it is income-based. <br /> Kirk Vaughn said it is. He said it is only for full-time residents of the county, meaning not <br /> university students. <br /> Chair Hamilton asked what the fee recovery rate is in other counties. <br /> Kirk Vaughn said they haven't looked at that. He said the ability to do cost recovery <br /> depends on your payer mix. He said if they have a higher level of insured patients, they they get <br /> a higher cost recovery regardless of the fee. He said in 2026 a lower percentage of their payer <br /> mix is self-pay, and Medicaid expansion may have had an impact. <br /> Vice-Chair Fowler said Alamance and Durham seem to have higher fees, and she <br /> suggested keeping Orange in line with neighboring counties. <br /> Chair Hamilton said this is a service where there is inelasticity of demand. <br /> Commissioner McKee said the main worry for the patient is how many minutes away the <br /> ambulance is. <br />