All Bastrop residents will henceforth receive free medical helicopter transport services under a new agreement with air ambulance company PHI Air Medical.
Under the agreement, which went into effect Feb. 1, the city of Bastrop will pay the helicopter company $18,126 annually so that its 9,420 residents become part of its PHI Cares membership program, which relieves all charges related to an emergency air evacuation for any of its members. With around 3,021 households in the city, this equates to an annual fee of about $6 per household, which is paid through property taxes.
Bastrop Mayor Connie Schroeder, whose father received a $40,000 bill for a medical helicopter ride in 2014, explained in an interview last year how the deal came together.
"(City officials) were in an emergency management meeting and it came up as an available service that PHI had," Schroeder said. "(Former City Manager Lynda Humble) talked to council and asked, 'Are y'all able to support this?' And we all said, 'Hell to the yes.'"
According to the contract, the air ambulance service will transport a city resident from anywhere within Bastrop County. And for an extra $35, any resident is eligible to upgrade their household's membership for coverage anywhere within PHI's nine-state service area, which includes Texas, New Mexico, Arizona and California.
But there are caveats to this agreement. PHI Air Medical is not the only air ambulance provider that serves Bastrop County, and the membership does not cover costs if another provider—like Travis County's STAR Flight air rescue helicopter—is called to the scene.
"A PHI aircraft may not be available at the time a flight request is made due to inclement weather, the PHI aircraft being in service at the time of the request, the PHI aircraft undergoing maintenance or repairs, weight limitations of the PHI aircraft, or other reasons that make the PHI aircraft unavailable to respond to a request," the contract reads. "Further, medical or dispatch personnel may call another air ambulance provider in which event your PHI Cares membership will not cover the medical transport."
PHI Air Medical also says it has the right to consult with other healthcare providers or dispatch agencies to determine whether air transport is medically necessary and appropriate. The contract also excludes recipients of Medicaid benefits from membership.
The contract is in response to what the city describes as poor ground ambulance service from Acadian Ambulance Service, which has a contract with Bastrop County to provide services to all incorporated and unincorporated areas.
In the city's proposed FY 2020 budget released last summer, the city said it's turning to air medical services due to Acadian's "ongoing challenges" to meet contractually required response times, "including occasions when there are zero ambulances in the county."
"Having to wait on an ambulance and deal with traffic congestion can create significant life-safety challenges," the city's budget states. "When life-safety is in question and an air medic is requested, a cost for one transport can be $10,000+. This financial cost, which can save lives, can also create a financial challenge for patients with limited or no health insurance coverage."
Bastrop County Commissioners approved a two-year contract extension with Acadian from June 2019 through May 2021.
Under the terms of the county's contract, Acadian's ambulances are required to arrive at emergencies in Bastrop, Elgin and Smithville within 10 minutes, in the western exurban area of the county within 15 minutes, and in all other unincorporated parts of the county within 20 minutes. For non-life threatening emergencies, medics are expected to arrive within 15 minutes for 911 calls in the three cities, within 20 minutes in western Bastrop County and within 25 minutes in other parts of the county.
The company reports these numbers monthly to the county and is required to meet these goals at least 90% of the time, as per the contract. However, the contract gives the company the ability to ask the Bastrop County judge to waive individual violations due to extenuating circumstances. If the percentage of calls that meet the contract's requirements falls below the 90% threshold on a monthly basis after waivers are factored in, the county can levy up to $4,000 in penalties per month.
Acadian ambulances responded to 3,951 calls between June and December in 2019, but arrived late on scene 470 times, or 88% of all 911 calls, according to compliance reports. The company requested 216 exemptions, and Bastrop County Judge Paul Pape granted 194 of those requests. After factoring in those exemptions, Acadian's contact compliance rate was 93%.
Within that same seven-month period, ambulances responded to 880 emergency calls in Bastrop and arrived late 85 times—a compliance rate of 90%. Pape granted 72 exemptions of Acadian's requested 43, bringing the company's compliance rate up to 94%.