Seattle-area fire service loses $37 million levy for Medic One
By Gary Ludwig, MS, EMT-P
Quick quiz: How many fire service EMS management conferences are there 
esigne
specifically for chief officers?  How many that combine top fire-based EMS
speakers and topics that fire service EMS managers crave for one low price?
Answer: Just one "the IAFC EMS Section's new "Critical Issues Conference on
Fire-Based EMS."
The conference will be held in conjunction with Responder magazine from May
26-28, 1998, at the Orleans Hotel in Las Vegas. The conference will address
how managed care and Medicare/Medicaid issues will affect fire-based EMS;
provide details on generating revenue through EMS billing and cost allocation
techniques; and offer case studies of important fire service EMS topics.
Here's a sample case study title: "How the fire service lost a $37 million
levy without trying: a true tale of woe and worry."  Watch your mail in
early February for more details and a registration form.
That's right. Seattle and King County voters dealt a blow to the fire service
with their November rejection of a 29 cent per $1,000 valuation levy to pay
for the notable Medic One program. The measure received 57 percent approval
from the voters, but it needed 60 percent to pass. The six-year tax levy
passed in 1985 and 1991; it expired on January 1,1998.
The Medic One program started in Seattle in the 1970s and expanded 
ountywide.
The system evolved into a regional network that includes 21 city-run fire
departments, 33 other fire districts and six paramedic units. Officials are
scrounging for its estimated $37 million annual cost. For now, the Seattle
City Council agreed to shift $12.7 million from its budget to finance the
city's program for one year. The county executive wants to identify a
permanent funding source to prevent such financial crises in the future.
The federal government continues its march to eliminate waste and fraud in
federal spending. Leading the charge is the Inspector General's Office of the
Department of Health & Human Services. Inspector General June Gibbs Brown 
ays
in a new draft report that ambulance services frequently billed Medicare for
medically unnecessary transportation. The report documents how some ambulance
companies falsified destination information and charged the government for
unneeded, unprovided supplies and services.
Brown indicated that more than 100 ambulance service providers were cited for
civil or criminal violations of Medicare laws in the past five years. Brown
said some ambulance companies billed Medicare for supplies, even though their
vehicles were restocked free-of-charge by local hospitals.
Such findings may have led to the October 8,1997, warning from the Inspector
General's Office that a hospital restocking of an ambulance's supplies and
medications constitutes "illegal remuneration" under federal anti-kickback
statues. The Inspector General contends that helpless patients in need of an
ambulance cannot reasonably make a decision about destination, therefore the
choice is probably influenced by EMS personnel. Subsequently, a hospital's
remuneration, including free supplies or medication, might be considered a
kickback.
Some warn that the Inspector General's Office interprets federal regulations
to cover "any arrangement where one purpose of the remuneration was to obtain
money for the referral of services or to induce further referrals."
To avoid anti-kickback allegations, ambulance services are advised to have
written agreements with those hospitals replenishing supplies or providing
services. It should document the agreement's justification, the value of the
service provided, and include an agreement that the ambulance service will
pay fair market value for supplies or services.
Is the Foresight Document dead? Not according to the minutes of the Oregon
State Ambulance Association's  quarterly meeting in October; the minutes
quote the AAA president: "It was felt the document should have died but
didn't and is still alive."
Gary Ludwig is the chief paramedic for the St. Louis Fire Department and is
on the Executive Board of the IAFC EMS Section; contact him at 314-645-9160
or via e-mail at GaryLudwig@aol.com.
       
                                        Gary Ludwig
                                        Chief Paramedic/EMS Bureau Chief
                                        St. Louis Fire Department
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