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Home My WebLink About1993-11-09; City Council; 12467; AMBULANCE FEE INCREASE0 0 3 9 if z 0 F 0 a J a z 3 0 0 c;(.Y UF CARLSBAD - AGWA BILL 2‘ AB # ldiqIF”7 TITLE: DEP’ MTG. ii/~/m AMBULANCE FEE INCREASE CITY DEPT. FIN~RE CITY RECOMMENDED ACTION: Adopt Resolution No. 9 3 * g ‘revising the ambulance fee schedule and establishing a tw tiered system for assessing the base rate. ITEM EXPLANATION: City staff has reviewed its charges for paramedic services, and has found that the Gener Fund is subsidizing these services. An increase in charges for paramedic services w provide a greater offset to the General Fund costs totaling approximately $1 million. Wh the City can benefit from increased revenues, the financial impact on the individual us should be minimal, as insurance providers allow for higher fees for emergency medic service than Carlsbad presently charges. In addition, staff recommends that the City implement a program with two tiers where nonresidents are charged a fee higher than that of residents. The nonresident fee wou approximate the actual cost of providing the service. The Carlsbad resident then benef through a lower rate which is partially subsidized by the General Fund. Prior to recommending the increased rates and tiered charges, a survey of nine agencies w completed in February7 1993. The results show that the average transport fee (exclud;: medical supplies) is $344, while the average bill for a Carlsbad transport is $22 Additionally, six of the agencies surveyed utilize a two-tiered charge system, where residents are assessed a lower rate that nonresidents. Survey results reinforce the fact th Carlsbad‘s current rates are not only below the market, but also do not recover the cost providing the service. In addition to establishing higher fees for basic transport and mileage services, staff proposing implementing a nonresident base rate and charges for night calls and oxygc All of the proposed charges are components that are recognized and approved by t medical insurance industry7 including Medicare. When documented, these charges will paid for in whole, or in part, by an insurance carrier. The proposed charges are outlin below: . . . b Adding $25 night charge . Adding $25 oxygen charge Increasing resident base rate from $200 to $250 Implementing nonresident base rate of $500 Increasing mileage charge from $5 per mile to $7 per mile Increasing supplies charge from cost + 40% to cost + 60% c FISCAL IMPACT: Estimated annual revenue collections utilizing the proposed fee will total $323,000, increase of $186,000 over the current revenue projection. The direct cost of providi paramedic service is $1 million as presented in the 1993-94 operating budget. Even WI the new rates and charges, the General Fund will continue to subsidize paramedic servicc Revenues will increase by approximately $90,000 for the remainder of 1993-94. I 0 0 PAGE TWO OF AGENDA BILL NO. I 2: ‘1 (93 EXHIBITS: 1. Memo from Fire Chief to City Manager dated 11/2/93 regarding ambulance 1 increase proposal. 2. Resolution No. 4’3 -3’* revising the ambulance fee schedule and establishing a tM tiered system for assessing the base rate. 0 aBIi 1. November 2,1993 TO: CITY MANAGER FROM: Fire Chief VIA: Fire Administration & Operations Battalion Chiefs AMBULANCE FEE INCREASE PROPOSAL ISSUE; Should the City of Carlsbad implement a tiered ambulance fee program to recover additional fmc to maximize recovery to the General Fund? RECOMMENDATION: Increase the City’s ambulance fees for residents to the average for public agencies in San Diel County. In addition, create a tiered fee program that would charge m-residents a fee higher th that of residents. The non-resident fee would be based on the approximate actual cost of providir the service. If the city holds the fees down, the General Fund is in effect subsidizing priva insurance companies, Medicare and Medical. IMPACTS; Fiscal: This fiscal year we expect to collect $220,000 in ambulance revenue at the old rate The cost to the General Fund to provide paramedic service is at least $1,020,165 in dire costs, not including overhead or other costs as paramedics are also part of fire/resci services. This proposal would produce an average resident ambulance bill of $323 and , average non-resident ambulance bill of $573. Based upon the 1992 billing figures, , additional $186,000 of revenue would be collected per fiscal year. Policy: The difficult issue will be to educate the community that the fees are principal collected from insurance carriers. Those unable to pay will be supported by the Gener Fund financing the balance of the paramedic program. We know that 30% of our billin are for Medicare and Medical patients where, by policy, we not only collect what tho systems pay, but we also bill the patient for the remaining difference. The other 70% of a billings have private insurance or are uninsured. Regionally, it is estimated 70% of tl population has some form of insurance. While we do not know how many uninsurc billings we have, it would be reasonable to expect given Carlsbad’s demographics that ma people have insurance. ALTERNATIVES; A. Do nothing. While the current fee structure does not maximize our recovery of progra costs from insurance carriers, it does help. The General Fund is one appropriate way fund paramedic services. B. Raise all fees above the public agency county average to the private sector average. T€ 0 0 Paramedic Fees November 2, 1993 Page 2 fee level would reflect a truer cost of providing the service on a per call basis as shown the non-resident fee proposal. The downside is that uninsured, but tax paying reside] would not get credit for already contributing to the General Fund. BACKGROUND; Carlsbad’s current pveraae paramedic ambulance transport fee is among the lowest for pub agencies in San Diego County based upon a survey conducted in February 1993. The surv average (excluding medical supply charges), is $344.17. Carlsbad’s current average bill, excludi a medical supply charge, is $230 or $144.1 7 below the county average. The City currently colle approximately 62% of the total billings. An average paramedic transport fee is comprised of a number of components. These componei are derived from services and items recognized and approved by the medical insurance indust including MediCare.The standard components are: When properly documented, these charges will be paid for in whole, or in part, by an insura carrier. The percentage of the bill covered by insurance varies widely with the type of insurar carried, such as: All private, Medicare with supplemental, Medicare without supplemen1 which includes all the separate charges, rather than to have one fee which has an artificially hig base rate to compensate for not including the separate charges. The attached charts show the fee structures of the agencies included in the survey. The bottom th bars show the average of the agencies (excluding Carlsbad), Carlsbad’s current average, and w our average wouZd be if our proposed adjustments are accepted. These adjustments are: Medicare with Medical. From the patient’s financial perspective, it is better to have a fee struct We have included non-resident fees in the survey because cities that use them calculate that reve into their overall cost of operation while setting the resident rate. Also, Santee and Lakeside are 0 0 Paramedic Fees November 2, 1993 page 3 County Service Areas and only charge residents a small annual fee on their property tax bfils. The non-resident fee, however, reflects a fair per transport cost of the service. p1scuss ION Historically, Carlsbad has not developed a permanent policy on setting ambulance fees. Fees ha. been raised at irregular intervals usually to some definition of average without attention to t reimbursement structure of insurance companies. The whole issue of billing policies for Emergency Medical Services (EMS) is not clew define Since the inception of paramedics in the early seventies, public agencies have been vacillating as whether EMS is a “privilege” or a “right”, so we tend to treat it as both, co-mingling tax suppc with user fees. Further complicating the issue is one of control. If EMS is a “privilege”, th public health services are traditionally administered and paid for by state or county region governments through contracting hospitals. If EMS is a “right”, it is a public safety issue and t€ the province of local government. If EMS were a “privilege”, as is the rest of the current health care system, user fees and insurar coverage would completely pay for it. In the health care system, those paying insurance premiui subsidize those who do not. If EMS were considered a “right”, the public tax base would who support the cost of the service as in police and fire protection. Taxpayers would subsidize those 1 paying taxes. It is no wonder the system is in a state of chaos - most areas can not agree on how pay for (or control) EMS, so they take a little bit from everywhere - user fees, insurance paymei and tax subsidies. One policy issue question is, to what degree and where do we want to shift the cost of the servic subsidized by the General Fund. We have in effect a split policy for financing the service by 1 support and third party insurance reimbursement. Because we do not totally support the sew through taxes, we in theory, lose revenue when non-residents are served, or insurance programs l under billed Our recommendation is to continue the common public agency practice of co-financing our E1 system from tax and user revenues - but do it more efficiently. If any user has insurance, that sou will be billed; If the user is a resident, the service fee will be lower reflecting their contribution to community tax base; If the user is a non-resident, they will pay a user fee more reflective of 1 actual cost of the service. In either case, billing will be “humane” - that is, we would unnecessarily hound those without the means to pay. For these losses, a General Fund tax subs for the public safety aspect of the service seems appropriate. As can be seen from viewing the information contained in the charts, the recommended incre will place an average Carlsbad resident bill very near to that of the other agencies surveyed. We j this is a prudent approach and strikes a fair balance between taxation and insurance carrier financ for Carlsbad’s paramedic system. Additionally, non-residents will be charged a fair fee represent and not harm those without insurance, or the ability to pay. Carlsbad has operated paramedics since 1977 as a “right” - a public safety service heav cost of service without General Fund subsidy, The billing policies for both groups will be hum 0 0 Paramedic Fees November 2, 1993 Page 4 Therefore, our recommendation is to increase the City's ambulance fees for residents to the avera for public agencies in San Diego County. Also, the City should institute a tiered fee program tk would charge non-residents a fee higher than that of residents. The non-resident fee wou approximate the actual cost of providing the service. Additionally, the fee should be reviewed annually against the public agency average in San Diego County and what the insurance cornpati allow for reimbursement. LdC S VAN D R MAATEN Attachment: County Fee Study e 0 0 0 b 0 0 co 0 0 m 0 0 d. 2 n a 0 - - 0 0 m 0 0 cu 0 0 l- 0 h h n n 'El 'El 'El 'El m W m W P In P v) v) 0 v) 0 Q Q L Q 0 v) W - - L 2 0 Q i z P m m 2 Y U W - - 0 x W 0 x Q) U W Y 'El pci m v) 'El W m U P v) m L > m - v) rn L m - 2 0 4 0 0 0 0 0 a 0 0 7 0 .. n. x. @@z@2@$&0&E@an, 03 C x x 0 z 0 z (Jl z 3 z 3 z 2 z z a, a,'a 5 g." a : ss Ycn - (JIKqijTJOiao a,o e52a 28 5 z z .- a $2 5 $02 020 z d z 0 2 Ayunurwo3 0 0 UJ oo$?$?$J$!gg$-g$?$?$?$!$?$? i;9g 0 + +;- 8 8>> + + + + + 8 S 555;gg 55555% m ooss- o0000f&? 0 00 b 000000 a, Q a v) .- - - 7-0m-tff.~ % ol ol m m m w to ++ 9,- 00 00000~ 8 oomm*moooooommm0 bUlrn,m -99YY9q999qqqkkF9 79TcY ~ooaaamolololbaaaa*8 *(*)me3 .5!mmaam*abmbaabolmm *ma+ -mmmm*m*bolmol*ol*olm mcs*Lha . - ge3e3e3e3e3e3e3e3e3e3e3e3e3e3e3%e e3we3e 23 om 0 x a t-L v oooooaoooooooooo 7-ooc.3 m 9999Pc?9999999999 Tesc?Cs a, oommmboooooooomo bmmm 'c) e3e3ololmae3e369e369e3mm-* 7-N-N 0 e3e3e3ee e3-e e3f3tp)eegh) 0 ooooolooooooooooo mom8 = 9999rP999999qq99 99qq a, oooommoooommaamo omam 2 6eeeolol*mmm*a--olol-?Y3 mmolw g e3e3e3e3e3e3e3e3e3e3e3e3ee e3we3- ooooolooooooooooo modo I3) eeeeololbmmmmbe3e3olol-m CUnaolN e3eeeee3e3e3ffe3 -69- ee(Spe3a z 99997P9999999999 T9ke E oooommooomoo~am0 av)*v) .- 0000~00000000000 oloola a00007-aol~olmolololola8 mmonB a,=fBeemm~bbb*a****~m *%Few e3e3e3e3e3e3e3e3#3e3e3e3€e* e3we3e Z9999Ta?99999999Tf? r-r9kF TE - aa @ .- E? v a, 0000000000000000 ma00 - 9999999999999999 TSLOC! a ooooaaoomNoooo~o cDQol8 E mm-m-aambammommo am00 g eee3eee3eee3e3e3e3e3e3e3e3e3e3%e e3ee3@3 m mmmmmmma7olol*nlmolw olmmV, m > c, c ,I u n ikZ i c s s s.e.o,o 0 >=.+:a z 6 2n Ecr: cD2 k rj gam rd'iij'iij mu s 2g.p s 3 2 go zsu, -=a-=a ppm K.Zf 33gG oI,"rnL 0 a, >=>a J~>>~TCCOQ~~ZZ&~U~ <0QO o*a aaaOO@rj g3 yr~S€E~mOOoooomm rj rn.2.92 rj r6 0 0 'i 1 2 3 4 5 6 7 a 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 a 0 RESOLUTION NO. 9 3 - 3 10 A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARLSBAD, CALIFORNIA ESTABLISHING FEES FOR PARAMEDIC SERVICES WHEREAS, the City Council of the City of Carlsbad has the authority to establish fees for the City; and WHEREA!j, from time to time said fees are reviewed and evaluated to maintain an adequate fee structure recovering costs for City services; and WHEREAS, the City Council has determined the cost of providing general City services; and WHEREAS, the City Council has determined that the fees shown in Exhibit A attached hereto are fair and reasonable in relation to the services received. NOW, THEREFORE, BE IT RESOLVED by the City Council of the City of Carlsbad, California that the fee schedule shown in Exhibit A attached hereto is hereby adopted and shall become the official fee schedule for the City of Carlsbad. All fees shall become effective on December 13, 1993. PASSED, APPROVED AND ADOPTED at a regular meeting of the City Council held on the 9th day of NOVEMBER , 1993, by the following vote, to wit: AYES: Council Members Lewis, Stanton, Kulchin, Nygaard, Finn NOES: None ABSENT: None ATI'EST: ~ 4 /- ALETHA L. RAuTElrJKRANZ, City Clerk (SEAL) Fee Description General City Fees Resident Base Fkte Nonresident Base Rate Mileage Charge (per mile) Supplies Charge Night Charge Oxygen Charge Code 3 Charge Total 1993-94P~opod FW Note Cost Fee Fee Amount 2w.00 250.00 50.00 0.00 500.00 500.00 5.00 7.00 2.00 A New 0.00 25.00 25.00 New 0.00 25.00 25.00 New 0.00 25.00 25.00