STAFF REPORT
Meeting Date: August 19, 2025
To:
From:
Subject:
Honorable Mayor & City Council
Gregory W. Barton, Fire Chief
Recommendation of the Beverly Hills Fire Department’s
Emergency Medical Services Division to Establish a
Paramedic Subscription Program
Attachments: None
INTRODUCTION
The Beverly Hills Fire Department (BHFD) provides exceptional emergency medical services (EMS) to the community. However, the current system of billing for these services can create significant and unexpected financial burdens for residents. A bill for a single EMS response can range from $150 to $4,000. Depending on a resident's health insurance, their out-of-pocket share can eclipse several hundred dollars.
This financial uncertainty arises from several factors, including high insurance deductibles, coverage gaps, and specific payor rules, such as Medicare denying claims for patients who receive treatment but are not transported to a hospital. Residents without any medical insurance are responsible for the full charge. The concern over accruing these healthcare expenses may deter residents from calling 911 in a genuine emergency.
To address this challenge, staff proposes the creation of a voluntary Paramedic Subscription Program (PSP) to provide residents with financial security and peace of mind. This report outlines the proposed program and its fiscal implications for the Council's discussion and consideration.
DISCUSSION
A Solution for Resident Peace of Mind
The proposed PSP acts as a direct solution to the financial burden residents face. It is a voluntary program wherein a household pays a modest annual fee to have their out-ofpocket EMS costs waived for the year. This model is designed to alleviate financial hardship for residents and improve patient satisfaction.
Meeting Date: August 19, 2025
The core benefits of the program are:
• For Insured Participants: Any correlating shared insurance cost or expense for EMS charges will be waived. This includes subscribers covered by Medicare, where the program will accept the Medicare payment as payment in full. • For Uninsured Participants: A waiver of 10% of the Medicare allowed amount will be applied.
• A "Safety Net" Feature: A resident who is not enrolled at the time of an incident may enroll after receiving their EMS bill, providing crucial protection for those who did not anticipate needing emergency services.
A Proven Model in Southern California
Several surrounding communities have successfully enacted similar Paramedic Subscription Programs. This established history provides a strong precedent for Beverly Hills.
• The City of Huntington Beach established its "FireMed" program in 1990. The current annual fee is $60. They state a value proposition to residents: “FireMed accepts your insurance or Medicare payment as ‘payment in full’ – even if there is a deductible, a co-payment, or a denial”.
• The City of Newport Beach offers a "Fire Medics" program for an annual fee of $84. They state a value proposition to residents: members avoid bills • that can exceed $1,800 per incident and have no paperwork to file.
As seen in mature programs in cities like Huntington Beach and Newport Beach, residential participation often increases to 10-15% in subsequent years, which is a key factor in long-term financial sustainability.
Proposed Program Details for Beverly Hills
The Beverly Hills PSP would be administered by Wittman Enterprises LLC and structured as follows:
• Eligibility:
o Participation is based on a City residential unit, and one must be a resident within the City, registering their residential unit as their primary address.
▪ Membership is not transferable to another party should the residence be sold, leased, or rented.
▪ Should the registrant move during the membership period, the registrant will not receive prorated monies from the City. ▪ Should a registrant move from one registered household within the City to another residence within the City (not previously registered), membership may be transferred from the old City residence to the new City residence.
o The annual subscription covers the registrant and their immediate family members living at that primary residency.
▪ Immediate family is defined as persons who hold a family relation to the registrant and who are a permanent residence of the household covered under the PSP. A permanent resident is Meeting Date: August 19, 2025
▪ defined a person who resides at the registered household for more than 183 days per calendar year and who holds the same mailing address as the registered household.
• Enrollment:
o A registrant completes and submits enrollment forms along with the annual fee. The membership period is for one year and requires annual re-enrollment to continue benefits.
▪ Should a non-subscribed person receive emergency medical services, and subsequently receives a bill, the person will have the option to join the PSP. By submitting the $90 enrollment fee within 30 days of the bill date, all qualifying out-of-pocket costs for that incident will be waived, and they will be covered for the remainder of the 12-month membership period.
• Limitations:
o The PSP benefits only apply to EMS responses within the City limits of Beverly Hills.
o The Fire Department reserves the right to terminate a membership if a participant calls for EMS more than ten times within the membership period and the activity is deemed abusive.
▪ After a household's fifth (5th) non-emergent call in a membership year, the Fire Department will proactively contact the resident to offer a 'Coordination of Care' assessment with our Nurse Practitioner to identify alternative care resources.
▪ Membership will only be reviewed for suspension and or nonrenewal in cases of clear and persistent misuse of 911 for nonemergent situations after intervention has been offered. ▪ Should the member continue to deviate from the prescribed plan of care, suspension of benefits and or non-renewal may be considered by the Fire Department’s EMS Billing Committee, which consists of the Deputy Fire Chief, Risk Manager and EMS Division Chief.
o The program, as proposed, does not yet include services from the Nurse Practitioner Program, pending the creation of a state-approved billing process.
▪ Staff anticipates completing the CMS enrollment and billing validation process by the end of FY2026. At that time, Fire will return to Council with a supplemental report outlining a plan to integrate NP services into the PSP, ensuring residents receive the full benefit of our evolving EMS model.
FISCAL IMPACT
The fiscal impact of the PSP is contingent on resident participation and the annual membership fee. The following analysis is based on a conservative initial participation rate of 5% of the City's 16,200 residential units (810 households). Staff presents three fee options for the Council’s discussion:
Meeting Date: August 19, 2025
Participation % 5% @ $90.00 5% @ $135.00 5% @ $195.00
Revenue $72,900 $109,350 $157,950
Total write-downs $125,719.13 $125,719.13 $125,719.13
Expenses $31,580.00 $31,580.00 $31,580.00
Total Costs $157,299.13 $157,299.13 $157,299.13
Delta ($84,399.13) ($47,949.13) $650.87
Total Costs include estimated City and Wittman Enterprises LLC administrative costs of $31,580 and patient health insurance write-downs of approximately $125,719.
Path to Self-Sustainability
As seen in comparable programs, residential participation is expected to grow in subsequent years. As participation increases, the program becomes more financially sustainable, even at the recommended $90 fee.
Participation % 5% @ $90.00 10% @ $90.00 15% @ $90.00
Revenue $72,900 $145,800 $218,700
Expenses
Total write-downs $125,719.13 $125,719.13 $125,719.13
Expenses $31,580.00 $46,160 $60,740.00
Total $157,299.13 $171,879.13 $186,459.13
Delta ($84,399.13) ($26,079.13) $32,240.87
At a 10% participation rate, the program's net cost to the City is significantly reduced. At 15%, the program is projected to generate over $32,000 in annual revenue.
RECOMMENDATION
Staff seeks City Council concurrence to establish a Paramedic Subscription Program.
Following discussion and feedback from this study session, staff will present a formal resolution to adopt the program and amend the Comprehensive Schedule of Taxes, Fees & Charges for Council consideration at a future meeting.
Gregory W. Barton Jeff S. Muir
_____Fire Chief Director of Finance
Approved by Approved by