Washington County panel to consider AMR ambulance rate increase after efficiency work and caution from commissioners

Washington County officials on Oct. 7 heard a presentation from county health staff and American Medical Response (AMR) on a proposed increase to 9-1-1 emergency medical transportation rates and on steps being taken to improve system efficiency.

The presentation described two timing options for a single rate increase and emphasized that efficiency gains are necessary for long-term financial sustainability. AMR asked the county to approve either a 27% increase effective Jan. 1, 2026, or a 30% increase effective July 1, 2026; presenters said the earlier, smaller increase would reduce the immediate percentage requested. County staff and AMR also outlined ongoing projects intended to reduce operating waste and offload delays at hospital emergency departments.

Why it matters: Ambulance rates affect county residents’ access to emergency medical transport, the finances of the contracted provider and the county’s EMS system resilience. Commissioners expressed support for placing the proposal on the Oct. 21 board agenda while stressing they expect measurable improvements from efficiency projects before considering further increases.

County health staff described Washington County’s EMS model as a fee-for-service system in which AMR receives revenue only from transports, and the county collects a franchise fee rather than directly subsidizing EMS operations. Adrienne Donner, the county program supervisor who oversees EMS work, told the board the county is pursuing several efficiency efforts that take time to yield savings, including improving dispatch notifications for crews on the road, reducing ambulance patient offload time (APOT), and reducing instances in which multiple ambulance resources are assigned to the same scene when not medically necessary. Donner said the county’s goal for hospital offload is no more than 20 minutes from ambulance arrival to transfer of care; she reported that 18% of offloads were longer than 20 minutes (data through January–August) and that delay translated to roughly 1,022 hours and about $200,000 in ambulance time at an assumed $200 per hour.

Rob McDonald, AMR’s regional director, described AMR’s operations in Washington County and repeated the company’s modified rate request: a single increase (27% if implemented in January or 30% if implemented in July). “If a heart stops beating in Washington County, you have the greatest chance of survival anywhere in Oregon,” McDonald said, noting local CPR training and AED access. McDonald and AMR staff said national payment rates from Medicare and Medicaid do not cover the full cost of emergency transport and that only a portion of any rate increase is likely to “pass through” to AMR revenues once payer behavior is accounted for; they estimated a rough pass-through of 6%–8% of a rate increase into AMR’s receipts, and cautioned that the company would still operate at a loss through 2026 if system inefficiencies are not mitigated.

AMR described a county-funded Compassionate Care Program — funded from response-time fines and franchise payments rather than general tax revenue — that expands eligibility for assistance up to 400% of the federal poverty level so uninsured households can have transport costs covered. AMR also described use of traffic-signal preemption (Opticom-style) on ambulances as a modest contributor to response-time reduction and provider safety, while acknowledging the technology’s benefit will vary by intersection and municipality.

Commissioners pressed for numbers and monitoring. One commissioner asked how much annual revenue a 27% increase would generate; presenters said estimating actual revenue is difficult because payer behavior and pass-through vary and must be observed over months. Commissioners repeatedly requested that county staff and AMR track the effect of efficiency work (double-dispatch reductions, APOT improvements, and signal preemption) and report results on an annualized basis; several said they would support placing the Jan. 1/27% option on the Oct. 21 agenda only if the county holds AMR and system partners to continued progress and reporting.

Board direction and next steps: Commissioners signaled support for bringing a single-rate proposal to the Oct. 21 board meeting (several commissioners explicitly backed the January/27% option), subject to close tracking of efficiency metrics and explicit expectations about return visits for additional increases. The board asked staff to provide the Oct. 21 action item with a shortened presentation focused on key data, and to continue working with hospital and fire partners on offload and dispatch issues.

Separately, the board voted 5–0 to adjourn into executive session under Oregon statute ORS 192.660(2)(d) for labor negotiations later in the meeting.

The county’s decision on the requested ambulance rate increase is scheduled for the Oct. 21 board meeting; presenters said AMR plans to meet annually with county staff to review how efficiencies affect the system’s cost of doing business.