Santa Barbara County’s new American Medical Response contract raises ambulance rates 35% compared with last year, reportedly making them some of the highest in the state.
The county Board of Supervisors adopted the rates on Tuesday when it reluctantly approved the four-year contract, which was a condition of a settlement agreement for a lawsuit filed by AMR.
The supervisors approve rates yearly for the maximum amounts that contractors can charge for ambulance rides, oxygen and related services. The amounts that patients actually pay will depend on insurance coverage and other factors.
The base rates increased 5% in 2023 and 2.7% in 2024, public records show, but the contract approved Tuesday comes with a substantial 35% increase.
“The revised rates account for enhancements to the system such as transitioning to priority dispatch and pre-arrival instructions, as well as increased oversight and monitoring,” county spokeswoman Kelsey Gerckens Buttitta said.
“The revised rates also account for inflation factors, as well as calculations for different payer mixes, which currently is typical for these types of contracts throughout California.”
She said the rates were not part of the settlement agreement terms, which stated that AMR would dismiss the lawsuit if the supervisors took specific actions, including approving the contract.
However, the rates were included in that contract.
The agreement also states that AMR will get annual rate increases, based partially on the Consumer Price Index, and can request additional increases if “significant changes occur” that substantially affect the company’s costs of providing services.
The rates also apply to areas where the county Fire Department provides ambulance services.
Several speakers at Tuesday’s Board of Supervisors meeting called attention to the rate increases and claimed that the new amounts are some of the highest in the state, if not the highest.
Supervisor Bob Nelson, who voted against the contract, said the rate increases over the past 20 years are “a pretty hefty number.”
The board-approved rates in 2005 were $566.10 for a basic life support (BLS) transport and $702.08 for an advanced life support (ALS) transport.
The transport base rates are about five times higher today.
“So, hopefully they have the money to hire the ambulances and paramedics and EMTs to actually hit those response times that they’ve committed to,” Nelson said. “If they do, we’ll be better as a community.
"But we haven’t in the past, and that’s the whole reason why we’ve seen fire come out in force, because we’ve gone down this road in the past and haven’t hit those numbers, and there’s a lot of trust that with the new contract we hit that.”
Highest Rates in the Region
A comparison to neighboring counties shows that Santa Barbara County has the highest rates in the region.
The base rate for an advanced life support transport in Santa Barbara County is about $1,700 higher than the rate in Ventura County, which also uses AMR as its ambulance services provider.
The local rate is about $1,300 higher than the ALS transport base rate in San Luis Obispo County, which is served by San Luis Ambulance.
ALS ambulances are staffed by paramedics, and BLS ambulances are staffed by EMTs (emergency medical technicians).
“Points of concern I have for my community when interpreting the contract include the proposed BLS responses and the patient charge increases for transport,” Santa Maria Fire Chief Brad Dandridge told the supervisors on Tuesday.
“Santa Maria, like Santa Barbara and Lompoc fire, provides medical-first response at the basic life support, BLS, level. We do not have paramedics on our apparatus responding to medical emergencies.
"The proposed contract allows the possibility not to receive paramedics for 911 calls for medical care.”
Dandridge also noted the rate increases, saying they would place the county in the top 5% in the state for transport costs.
The California Emergency Medical Services Authority does not have a statewide database of each county’s ambulance rates, according to Ashley Williams, deputy director of legislative and external affairs.
“We cannot confirm which county has the highest base rates in the state,” Williams said.
Contract Details
The county’s new AMR contract looks a lot like the company’s 2022 proposal. One major difference is that the county Fire Department has the option to take over ambulance services in Lompoc, Montecito, Summerland and Carpinteria.
Santa Barbara County originally pursued a request-for-proposals process to set higher standards than the current contract. AMR has been the main provider since 1981, and the county had never done an RFP process for those services.
At the time, Emergency Medical Services officials said they were less concerned with who was providing the service than how well they were doing it.
The process offered the current, 2022 rates to bidders.
The county asked for innovations in the interfacility transport system, “a significant opportunity for improvement,” and required contractors to implement the First Watch third-party compliance monitoring tool.
AMR’s new contract includes those and other system improvements that the company put in its proposal that the Board of Supervisors rejected in 2023.
All of the sitting supervisors except Roy Lee (who wasn’t on the board yet) voted to reject that bid and move to a multi-provider system.
Later that year, they voted to award contracts to the county Fire Department and deny them to AMR. Supervisor Steve Lavagnino dissented in the vote to deny AMR’s permit application, citing legal concerns.
The permit denial — over which AMR sued — stated that the county was concerned about AMR’s ability to serve remote areas such as the Cuyama Valley while meeting response time requirements. The new contract keeps the county Fire Department as the ambulance provider there.
While most of the contract debate has centered on 911 emergency medical services, hospital leaders have been concerned about delays for interfacility transfers — such as ambulances transporting patients between hospitals, or to and from psychiatric facilities or skilled-nursing facilities.
The settlement agreement and new contract seem to address that as well.
AMR will create a critical care transport paramedic program to supplement its CCT registered nurse program and implement the system described in its bid proposal, according to the contract.
The new contract includes a critical care transport base rate of $6,213, which is a 10.8% increase from the 2024 rate.
AMR also will use a fleet of four secured safety vehicles to transport patients with behavioral health issues between facilities.
That will reduce wait times, free up hospital beds and make ambulances available for “true emergencies,” the company wrote in its big proposal in 2022.
