Abusing the system?

Posted at: 03/22/2013 5:22 PM
Updated at: 03/22/2013 5:58 PM
By: Ray Levato

An ambulance ride can cost big bucks. A big part of that cost comes when people call for an ambulance in non-emergency situations. It's something that has become a real problem in our area.

Felix Osso just got an ambulance ride to the hospital this week for a swollen ankle. He is one of thousands of poor people in the Rochester area who depend on a free ride to the emergency room in an ambulance, many times for less serious injuries or ailments.

Maggie Brooks, Monroe County Executive, said, “In 2011, 50,000 Medicaid patients were seen in the emergency room that didn't need to be there. These were people who were treated for sprained ankles, sunburn, cuts and bruises, flu, miner things, what they categorize medically as minor issues.

News10NBC's Ray Levato said, “If they can't pay for that, who picks up the cost?”

Brooks said, “The Medicaid program picks up the cost.

Levato said, “Taxpayers?”

Brooks said, “The taxpayers, absolutely.”

Of those 50,000 Medicaid patient ER visits for minor ailments, 14,000 were by ambulance. The average emergency room cost for ambulance patient was $1,743 versus $180 average cost for an urgent care visit.

Brooks said, “In 2011, if we could have switched the Medicaid patients who didn't need to be seen in the emergency room to another facility in Monroe County, we would have saved $68 million.

Levato said, “Wait, $68 million?”

Brooks said, “$68 million. We are one community in one county in one state across this nation.”

Of that $68 million figure, Brooks talked about, the local share picked up by Monroe County taxpayers was $17 million.

Eugenio Cotto is former director of the neighborhood group 14621 and an advocate for the poor.

Eugenio Cotto said,  “They have an emergency need as far as they are concerned and they have to find a way to see a doctor. They know a ride to the hospital, they're going to get doctor care. Yes, the majority of people who get that ride they know they're going to get doctor care and they're probably also going to get some aftercare with that.”

Cotto also said, "We are trying to get a lot of people not to go to the hospital just with a common cold and all of that stuff to avoid this extra cost. But unfortunately, many people don't have the financial means to do this, they don't have access to a doctor, so they will use the ambulance and they will use the emergency room."
A spokeswoman for Rural-Metro Ambulance, which has a contract to serve the City of Rochester, says their rates are as follows:
       Ambulance $652.73
       Advanced Life Support Ambulance $1085.27

Rural-Metro says it has negotiated rates with the commercial insurers as an in-network provider (MVP, Excellus BC/BS). Medicaid and Medicare are set by the government.

Right now, Medicaid doesn't allow an ambulance to transport a patient to anyplace other than a hospital. County Executive Brooks is trying to get the rules changed to be able to transport Medicaid patients to an urgent care facility when that's all they need.