Douglas County previews higher ambulance fees; staff project $3.5 million–$4.0 million in 2026 revenue

At a June meeting of the Board of County Commissioners of Douglas County, staff and Lawrence‑Douglas County Fire Medical (LDCFM) officials previewed changes to ambulance service and standby fees and presented revenue projections for 2026 that range from about $3.5 million to $4.0 million depending on collection rates.

The presentation, given by John Darling, LDCFM chief of emergency medical services, and summarized by County Administrator Sarah Plenske, described three main changes: raising emergency transport fees (basic life support and advanced life support) roughly 28%; increasing mileage to the market average; and adding or formalizing charges for specialty care transports and certain “treatment no‑transport” responses. Standby fees for events will also be raised to better reflect the full cost of staffing and equipment, officials said.

The county has updated its ambulance code to allow the county administrator and city manager jointly to set the fee schedule. Darling said the fee changes, combined with higher standby charges and the planned transition of nonemergency interfacility transfers to third‑party providers, lead to the headline projection: “the headline number is that at a 67% collection rate … we’re projecting 3,500,000.0. And at a 76% collection rate, we’re projecting 4,000,000 in 2026,” he told commissioners.

Why it matters: ambulance revenue is an input to the county’s 2026 general fund budget. Commissioners said they want conservative revenue assumptions because prior years showed volatility in collections and timing of payments. County staff told the board that collection rates reflect recoveries after Medicare and Medicaid allowable adjustments and that collection percentages are measured against net claims (after program write‑offs), not gross charges.

Key details

- Payment mix: officials said roughly 54% of transports are billed to Medicare, 11% to Medicaid, about 25% to commercial insurance and about 10% private pay/uninsured. Medicare and Medicaid set allowable caps that limit recoverable amounts for many transports. - Proposed fee changes: a roughly 28% increase on emergency transport (BLS/ALS/ALS‑2) to account for inflation since 2018; mileage raised to approximately market average (county’s current loaded‑mile charge was cited at about $9.92; Medicaid allows $13.20); new specialty care transport codes and a lower “treatment‑no‑transport” fee (example cited: a $100 charge) for limited nontransport treatments. - Standby fees: staff said previous standby billing covered overtime but not wear/tear or full equipment costs; new standby rates are intended to recover full FEMA‑based cost estimates for vehicles and personnel when agencies request ambulances at events (KU games, high‑school events, races). Staff said some charitable events have continued to receive donated/discounted standby staffing in the past and that flexibility can remain for certain nonprofit events. - Revenue math and timing: staff presented 2024 as the most recent full year. They reported gross charges of about $7.6 million (projected call volume basis), adjusted to $5.4 million in net allowable claims after Medicare/Medicaid adjustments. At a 76% collection rate that yields about $4.1 million; at 67% it yields about $3.6 million. After removing anticipated nonemergency transfer revenue and adding higher standby revenue, staff arrived at the $3.5M–$4.0M 2026 projection. - Collection practices and protections: officials said the county offers flexible repayment for patients, no interest or late fees, does not report medical debt to credit agencies (policy applies even for debts above the current $500 reporting threshold), and forwards unpaid balances to the Kansas Setoff Program for recovery against future state payments.

Discussion and next steps

Commissioners questioned whether collections are driven primarily by private pay patients or by the post‑allowable recoveries from commercial insurance and government payers; staff explained that the collection percentage aggregates recoveries across payer types after Medicare/Medicaid write‑offs. Commissioners asked about peer benchmarks; staff said the market comparison used KCK Fire Department, Sedgwick County and Johnson County MedEx rates.

Sarah Plenske told the board the fee schedule authority granted by the updated code will allow annual adjustments by the administrator and city manager, which staff said should reduce the multi‑year “catch‑up” increases and minimize sticker shock. No formal action was required or taken during the meeting; staff will include the revenue options in the proposed 2026 budget package and asked commissioners for direction on which collection assumption to use.

Ending

The presentation was informational only. Commissioners and staff said they will continue monitoring collection performance, peer benchmarks and any impacts to 911 utilization as the commission and city manager consider a final fee schedule for the 2026 budget.