Scott County Fiscal Court discussed proposed adjustments to emergency medical services fees on a motion to consider raising the ALS-2 blood-administration rate and specialty-care transport charge, but the court did not approve a permanent change and asked staff to return with more data.

The proposal presented by Chris Runyon sought to raise the ALS-2 line item — the code the county uses when whole blood is given — from $1,200 to $1,800 to better reflect blood-administration costs. Runyon said the county’s billing partner identified an average market figure of about $4,500 for blood administration and recommended raising local fees. He also presented a suggested increase for “specialty care” interfacility transport rates, which apply when patients require multiple infusions or ventilator-level monitoring during transfer.

The court’s discussion focused on how fee increases could affect patients and county finances. Several magistrates questioned whether the national averages cited by the billing company were an appropriate comparison for a small county. Concerns included the potential for higher insurance costs for residents, the county’s responsibility for unpaid balances, and the small number of runs that have so far required whole blood. Court members noted that, to date, the county had administered whole blood only twice and that blood inventory is rotated to avoid waste.

Assistant Chief Natalie, addressing operational safeguards, said county personnel “make sure that we rotate it a week before the expiration date so that we can provide [it]…so we make sure that it's not at the cost of any of us.” She also described staffing and credentialing needs: only credentialed critical-care paramedics may administer blood under the medical director’s protocol, and maintaining those credentials carries additional expense.

Rather than adopt the recommended fee increases immediately, the court asked staff to gather more detail on how the billing partner derived its $4,500 comparison, to provide counts and revenue impact estimates for blood and specialty-care runs, and to report back at a later date (members suggested September or a six-month review). Court members emphasized the need for additional data on payer mixes, collection practices, and the potential effect on uninsured or underinsured residents before approving any rate increases.

Background: The county recently began carrying whole-blood units in its ambulances and pays replacement cost if a unit is administered or negligently allowed to expire. Billing for ambulance service includes a base ALS charge and separate mileage and other itemized fees; the court heard that the county does not currently itemize blood separately to a patient but bills under the ALS-2 run code.

Staff direction: The court asked EMS and finance staff to provide sourcing for the billing-company comparison, historical and projected run counts that would use the blood or specialty-care codes, revenue and write-off estimates, and a recommended timeline for reconsideration. No formal ordinance or fee schedule amendment was adopted at the meeting.

What’s next: County staff will return with the requested data and, if the court wishes, prepare a proposed ordinance or fee-schedule revision for formal consideration.