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Fire department flags rising ambulance call volume and staffing pressure; billing rates proposed to climb
Summary
Department leaders reported record ambulance and engine calls, warned of firefighter gaps when crews are on medical calls, and proposed higher EMS billing rates to push ambulance revenue toward $1 million; committee discussed potential interfacility transports and union constraints.
Fire and EMS staffing, call volume and ambulance revenue were a central focus during the finance committee’s budget review, with department leaders reporting record monthly ambulance counts and warning that concurrent ambulance and fire responses are creating potential coverage gaps.
The fire chief told the committee that ambulance calls rose sharply, citing roughly 3,450 ambulance calls in February 2024 and an engine‑call count near 2,300 in the same month. Committee members and the chief said increased ambulance activity has, at times, left a single firefighter available to respond to some fire incidents when other crews were committed to medical calls.
To shore up revenue, staff proposed raising base billing rates for ambulance transport. The billing consultant recommended moving basic life support (BLS) from $950 to $1,250, ALS‑1 from $1,250 to $1,500 and ALS‑2 from $1,600 to $1,800, with smaller increases in mileage and paramedic intercept fees. The chief and the billing contact said insurers pay below billed rates; the department’s average reimbursement has been about $386 per call, and only a small fraction of calls (66 in the prior year) paid billed amounts in full.
Using conservative assumptions, staff projected ambulance revenue of roughly $1,000,000 for the coming year if the new rates are adopted and recovery efforts continue. The committee discussed potential new revenue streams — notably interfacility transports — but members cautioned that the firefighters’ collective bargaining agreement grants the union exclusive rights related to ambulance service and that any operational changes would require negotiation.
The committee also reviewed staffing tradeoffs: the fire department plans to leave three vacancies unfilled going into the upcoming year to meet budget targets. Staff warned that vacancies would raise overtime and reduce the number of responders available for concurrent incidents. Committee members asked for more detailed projections of fiscal‑year overtime and for a plan to refill vacancies when possible.
The committee directed staff to refine the ambulance revenue and overtime projections and return with more detailed assumptions on insurer reimbursement, student‑class reimbursements and any contractual barriers to expanding EMS‑only services.
