# The true costs of PHEMS: anyone have articles or info?



## mycrofft (Jan 5, 2012)

Ambulances are not cheap, equipment is not cheap, staff are not cheap, but where is all the rest of the money going? Or is it failing to come in and the ones that do pay are taking up the slack? Insurance? Executive pay? Employee turnover?


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## dmc2007 (Jan 5, 2012)

Insurance is a big chunk of it.  Other than that, the only place I can see it going is into my boss's pocket (assuming our patients are paying).


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## AlphaButch (Jan 6, 2012)

PM Sent.

As in most business, payroll/benefits is your big revenue eater. A decent chunk is lost due to bad debt (more so if on the public side). 

Insurance actually isn't that bad in comparison to those two numbers.

Where it goes is actually pretty agency dependant. The ones that spend the money on trucks/equipment/training vs. lining pockets are pretty easy to spot.


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## mycrofft (Jan 6, 2012)

I know that one locally prominent hospital with a lot of emergency department business has at times been receiving as low as $0.16 on the dollar (I presume more most of the time or they couldn't afford to be buying up all the local real estate as they have been recently). I imagine ambulances get shorted a lot also, especially Medicare/Medicaid reimbursement.


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## AlphaButch (Jan 6, 2012)

The medicare/medicaid funding for hospitals is very low (especially considering the cost for service). It's normally highly subsidized by what they bill private insurance/private pay. Having an ER is often a loss depending on the demographics of the area (% of insured folks).

For an ambulance service, it's not too bad though since it's pretty set in stone for the year and can be planned/budgeted (just a pain to figure out due to the adjustments/coinsurance rules - what you bill vs. what they allow vs. what they actually pay). The medicare reimbursement rates are public information. For many services however, there is a different rate for facilities which have a contract, if you're in a competitive environment, it's going to be close to the medicare amount - if the service is acting legally. Every service ends up subsidizing a little bit with revenue generated by private insurance patients as medicare reimbursement tends to be right at the cusp of covering costs for all but the bigger agencies.


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## mycrofft (Jan 6, 2012)

One service I worked for (again, Bedrock EMS) had a fixed-amount annual contract for all emergency transport and all indigent IFT with the County (not in California). This helped, especially in the short period they repealed the law agains public intoxication.


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## AlphaButch (Jan 6, 2012)

mycrofft said:


> This helped, especially in the short period they repealed the law agains public intoxication.



Now that can be job security


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## mycrofft (Jan 6, 2012)

Only one ambulance company in town. We drove Cadillacs in 1981!


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