Jefferson County supervisors press hospital for share of ambulance transfer costs

Jefferson County supervisors spent the bulk of a regular meeting debating how to address repeated ambulance transfers the county says the local hospital expects it to perform without fairly sharing costs.

Supervisors and ambulance staff reviewed billing spreadsheets showing roughly 178–179 transfers over six months that generated an estimated $290,000 in billed charges, of which about $120,000–$124,000 was collected, leaving roughly $162,000 outstanding, according to staff summaries circulated to the board. Speaker 6 told colleagues the county recorded 48 transfers in the first six months that were completely unpaid.

Why it matters: Supervisors said the county operates two staffed ambulances around the clock to be available for both 911 calls and hospital transfers. They argued that a pattern of late‑night and reportedly low‑acuity transfers pushes staffing and overtime costs onto the county, and that Medicare and other payers sometimes later determine the trips were not “medically necessary.” Speaker 6 said CMS ambulance‑necessity rules do not always align with decisions made by hospital clinicians and that the county’s concern is keeping patients from receiving unexpectedly large bills.

The board aired concrete options to present to hospital leadership. Speaker 6 outlined four choices to include in a letter the board will send to the hospital’s leadership: (1) maintain current practice and accept only transfers the county chooses to accept; (2) hospital pays a per‑transfer fee (the staff discussion centered on $250 per transfer) with operational stipulations; (3) hospital pays a fixed annual fee (the staff discussion used $100,000 as an example) and county accepts transfers without question; or (4) the hospital establishes its own transport service. Speaker 6 noted that $250 per transfer would have equated to about $44,000 for the first six months in the data reviewed.

Board members and staff also discussed alternative approaches for nonurgent moves, such as wheelchair‑accessible vans or single‑driver transport, but noted regulatory and billing questions about whether such trips could be billed or would meet ambulance standards. Speaker 1 asked whether a nonambulance van option could be used for nonurgent transfers to avoid ambulance costs; staff said it might be feasible but would require billing review and possibly new equipment.

On who should deliver the message, supervisors agreed to circulate and mark up a draft letter prepared by a staff member identified as Josh. They discussed addressing the letter to Bridal, described in the meeting as the hospital CEO, and copying hospital directors. Speaker 2 said the supervisors should sign the letter jointly so it comes from the elected board rather than an individual staffer. The board asked staff to place a revised draft on the agenda for the next meeting for final approval.

What was not decided: The hospital’s response was unknown and no formal agreement or payment was secured at the meeting. Supervisors did not vote on a specific option; they agreed to revise the letter and pursue negotiations.

The records reviewed at the meeting: staff flagged per‑trip direct costs of roughly $200–$250 and noted recurring examples — eye pain, gallstones and a peri‑rectal abscess among them — that the county considered questionable ambulance uses. The meeting included repeated references to CMS rules on ambulance medical necessity as a controlling standard for reimbursement determinations.

Next steps: Supervisors will mark up the draft letter, circulate it among the board, and consider the item on the next agenda. No procedural motion beyond that scheduling step was recorded.