Commissioners press AMR and staff for more data after request for multiyear ambulance rate increases

Board members and county staff discussed a three-year rate increase proposal for 9-1-1 emergency medical transports presented by American Medical Response (AMR) and Washington County Health & Human Services staff. AMR requested an “outside the formulary” increase that would raise rates by 13% beginning in July and then 30% in each of the following two years. County staff and AMR said the increase would be required to reach a sustainable, profitable operation for the local AMR unit under the company’s current forecast.

Adrienne Donner, supervisor for the county EMS program, and Rob McDonald, AMR regional director, described the local EMS system as fee-for-service and said Medicare and Medicaid account for roughly 73% of transports. McDonald and Donner said that because Medicare and Medicaid payments are fixed, most of any rate increase shows up only in private-insurer reimbursement; AMR estimated the pass-through of a rate increase results in approximately $6–$8 of additional revenue per $100 of increased charges.

AMR provided a three-year profitability forecast that, according to the presentation, would produce net losses in the first two years and a modest profit in year three: a projected before-tax loss of about $1.79 million in 2026, a $906,000 loss in the second year and a forecasted $457,000 profit in year three if the proposed schedule were implemented. Commissioners asked for Washington County–specific financial statements and a clearer breakdown of how much of the proposed rates would be allocated to corporate or regional overhead versus local operations.

Commissioners raised operational and policy questions. Several noted Oregon’s paramedic workforce constraints — including the state’s academic requirements for paramedics — and the national shortage of paramedics, which drive wages. Commissioners discussed alternatives to the requested rate path, such as a one-year increase with annual review, exploring other local revenue options (for example, a dispatch fee), expanding charitable/compassionate-care programs, and continuing to evaluate the nurse-navigator program in the 9-1-1 center to reduce unnecessary transports.

Rob McDonald summarized the reimbursement challenge succinctly during the discussion: “Medicare has not kept up.” Several commissioners expressed concern about the proposed magnitude of increases and the effect on insured residents and uninsured patients. One commissioner said, “I can't get to where you want us to go. It'd be really hard pill to swallow to approve that much of an increase.”

After discussion, commissioners directed staff to return to the board at the May 27 meeting with a narrower option: a one-year rate adjustment for July 1 and additional Washington County–specific financial information, while continuing work on longer-term options that aim for profitability in year three. Staff said a July 1 effective date would be preferable but that the board could choose a single-year increase now and continue to pursue other revenue and efficiency options before committing to later years.

No formal roll-call vote on the multiyear schedule was recorded in the work session transcript; the item was left as staff direction to prepare alternate proposals and follow-up data for a future board meeting.