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Lake Country fire department treating more patients on Medicare than private insurance

July 15, 2013

City of Delafield — A dramatic increase in the number of Medicare patients over the last 2 1/2 years may pose new challenges in raising revenues to help pay for Lake Country Fire and Rescue (LCFR).

For the first time since its inception in 2010, LCFR is providing emergency medical services to a larger number of Medicare patients than individuals who rely on private insurance to pay for medical services.

It cost an average of about $1,400 to $1,500 for each emergency medical response, according to LCFR officials.

Nearly $1,000 of the cost is recovered when the patient relies on private insurance.

The remaining $400 to $500 is paid for through revenues generated by various LCFR medical service contracts with hospitals and other municipalities, in addition to tax dollars paid by the department's municipal "owners," the City of Delafield and the villages of Chenequa and Nashotah.

However, Medicare paid an average of only $440 for its patients' ambulance and emergency medical bills in 2012. In 2013, the amount has been been reduced to $397, according to LCFR officials.

The more-than $1,000 gap between the cost of providing emergency medical services per call and the amount paid by Medicare has to be made up either through additional service contract revenues or more tax revenues from the three municipalities, according to Rod Stotts, president of the LCFR Board.

Filling the gap

Stotts and Fire Chief Jack Edwards have acknowledged gaining new contract revenues will be a challenge. When the City of Delafield Fire Department began its paramedic service in 2000, it was the only one in the region.

The city generated contract revenues from other municipalities and local hospitals who occasionally needed paramedic services. Those revenues, about $200,000 a year, were turned over to LCFR when the City of Delafield consolidated its department into the Lake Country Fire Department which, at the time, served the villages of Chenequa and Nashotah.

Since the consolidation, three communities — Lisbon, Sussex and Pewaukee — have created their own paramedic services and no longer need to contract with LCFR. In addition, there has been a decrease in some hospital revenues.

During last week's board meeting, Stotts explained that LCFR officials became suspicious in 2012 that the number of Medicare patients was increasing. Before the 2010 consolidation, Delafield officials did not attempt to keep track of the percentage of private pay v. Medicare patients that were served by city paramedics.

LCFR officials asked a service contractor who helps the department with billings and collections to do some research.

Changing payers

In 2011, after its first year of operation, nearly 56 percent of LCFR patients paid medical bills through private insurance coverage.

In 2012, that percentage dropped to 49.5 and, so far, in 2013, about 44 percent are private pay patients, a decline of 12 percent in a 2 1/2-year period.

At the same time,the number of emergency medical service calls to Medicare patients has increased. In 2011, there were 209 calls paid for by Medicare, about one-third of the total number of medical emergencies.

In 2012, the number of Medicare calls increase to 355, nearly 40 percent of emergency medical care calls.

So far, this year, the number of Medicare calls is 183, which represents abut 42 percent of the calls. At the current rate, there will be about 396 medicare calls by the end of the year.

LCFR officials are not sure what caused the increase in Medicare patients.

Stotts speculated that the aging and affluent Lake Country population may have become more dependent on Medicare because of lost jobs or early retirements, losses in retirement accounts and reductions in company health benefits and availability of private insurance as a result of the recession.

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