The City of Rocklin Fire Department is a full-service all-hazards response organization that serves approximately 70,000 residents, 2,500 businesses, and covers almost 20 square miles. In 2018, the Rocklin Fire Department responded to 5,568 incidents, and medical emergencies accounted for 67% of the total or 3,732 individual incidents.
Although the primary mission and responsibility of the Rocklin Fire Department is fire suppression and rescue, the Rocklin Fire resources are ideally positioned to provide additional essential services due to the geographical locations of the fire stations. When a medical emergency occurs, both a fire resource and transporting ambulance are dispatched to the incident. Dispatching both resources ensures that the patient receives the quickest and highest level of care possible. Fire-based medical response has a positive impact on patient care and outcomes on a daily basis. Emergency medical calls account for the largest percentage of response from the Fire Department. Rocklin Fire responds to all medical emergencies with at least one paramedic/firefighter on each apparatus. According to an American Heart Association study, early access to EMS, CPR, and defibrillation dramatically increase a person’s chance of survival. More specifically, a recent study showed an increase in patient survivability of 59 percent when they are treated immediately by a paramedic, as compared to just an EMT, and trauma patients specifically had an increase in survivability from 27% with just an EMT to 73% with a paramedic.
Historically, Fire Departments have provided fire suppression and first responder emergency medical services as a part of the normal services funded by property taxes rather than fees. However, as the cost of providing services rises, and local governments face difficulty funding basic services, fire agencies in California and across the nation have begun to examine and enact fees for a variety of services previously supported by taxes only. The principal rationale for fire service fees is that local government fire department services have expanded well beyond the traditional fire suppression generally supported by property taxes. The change in balance from fire suppression, medical response, and other services has shifted the rationale for financing fire department operations from primarily property-related taxes to a combination of property taxes and user fees. Property taxes are appropriate for providing funding for the basic response capacity of the department, while user fees are appropriate for non-traditional services that are provided to individuals rather than the entire community. Adopting this fee-for-service program won’t completely remedy the financial issues that lie ahead, but will help to create a more sustainable organization into the future by providing revenue sources aside from property tax.
The City of Rocklin has discussed “First Responder Fees” (FRF) in different venues for at least 10 years. At the beginning of this 2019 the City of Roseville and Rocklin Fire Chiefs began collecting information and developing the methodology for establishing FRF.
Imposition of First Responder Fees is within the constitutional powers granted to the City by Article XI, Section 7, of the California Constitution. The Fire Chiefs of both Rocklin and Roseville have collaborated on a this project and are both proposing the implementation of a First Responder Fee to their respective agencies to reimburse the cost for providing EMS response and the Advanced Life Support (Paramedic) Program. All surrounding Fire agencies that provide ALS services have some form of cost recovery or First Responder Fee, except the Cities of Rocklin and Roseville. This includes: South Placer, Folsom, Sac-Metro, Sacramento City, Elk Grove, Galt, and others. In fact, most municipalities in Placer and Sacramento County charge First Responder Fees nor additional non-ALS services.
The Centers for Medicare and Medicaid Services established the standard for medical service billing, and all other insurance providers follow this standard. This policy clearly identifies ALS provided by first responders as an approved billable event. It is in the insurance companies’ best interest to help sustain first responder emergency medical services due to the improved patient outcomes from early intervention. Essentially, it is more cost effective in the long run to have quality medical intervention early in incidents.
The proposed first responder fee would be charged on all EMS incidents where the patient is transported to the hospital. If a patient is treated and not transported, there will be no billing or cost recovery. The bill will be sent to the patient’s insurance company, including Medicare and Medicaid Services. If the patient does not have medical insurance the patient will be billed directly, but the proposed policy will provide guidelines and processes to waive all or a portion of the FRF due to financial hardship.
The Fire Chief is proposing a First Responder Fee of $292, plus billing cost. This fee is commensurate with fees charged by surrounding comparable agencies. See Attachments for the Fee Schedules for Cosumnes Fire District (Elk Grove/Galt), Folsom Fire, Sacramento City Fire, Sacramento Metropolitan Fire District, and South Placer Fire District. Their First Responder Fees range from $156-283, but all five of these agencies also charge additional EMS Fees. These can include additional equipment costs, mileage, and the fees can apply to patients who are treated at scene and not transported. The fee for the City of Rocklin would include all EMS costs, with no additional add-ons, and would not be applicable to patients who are treated but not transported.