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4. Emergency Medical Services FundT l F� E E. E gph�p Kalispell Fire Department Randy Brodehl, Fire Chief Arvin Mower, Assistant Chief/Operations Jim Stewart, Assistant Chief/Fire Marshal (406) 758-7760 312 First Avenue East Kalispell Montana 59901 Workshop Date: 10/21/2002 REPORT TO: Honorable Mayor and City Council. FROM: Randy Brodehl, Fire Chief SUBJECT: EMS Fund PURPOSE: To provide information to the Council regarding the financial status of the EMS Enterprise ,Fund. BACKGROUND: The Kalispell Fire Department has operated the EMS ambulance service in the lower Flathead Valley since 1928. The ambulance service is operated as an enterprise fund. 15% of salaries and benefits for Operations personnel are paid out of the Fund. Forty percent of salaries and benefits of the Fire Chief and the Assistant Chief/Operations are paid out of the fund, as well as 1.5 FTEs for clerical staff personnel. In February of this year, the fund began to lose money at an alarming rate. At that time, Medicare/Medicaid was in six months in arrears for over $50,000.00. In addition, Medicare/Medicaid reduced the amount their patients could be charged by 5.4 %, and began requiring ambulance services to invoice Medicare/Medicaid directly, while also preventing ambulance services from invoicing the patient for the remainder of the costs associated with an ambulance response. Ambulance responses are billed an average of $600.00, and Medicare/Medicaid responses average $220.00. By June, the fund had been in the red four months. The fund was loaned $55,000.00 to prevent it from carrying a negative balance into the new fiscal year. Collateral for the loan was considered the four ambulances and the equipment carried in each. The Council approved a rate increase effective 7/1/2002. This increase was designed to be a stopgap measure that would allow the fire department to rebuild the invoicing system to the point the system is healthy again. While Medicare/Medicaid is now only 60-90 days in arrears, the fund has not fully recovered to date. However, you have a quarterly report before you. Please note the fve critical areas that are graphed out. The first is the line showing the charges for responses. Coupled with that, is the credits line. Basically, this shows what we have charged for responses versus what we are able to collect. You will also note that supplies and personnel costs have stayed nearly flat. As you compare the credits vs. charges, note that charges begin a significant rise in July that reflects the increase in billing. Since the credit cycle is 60-90 days behind the charge cycle, the `Asswing our eommuniA, in reducing, provnfing aryl miligalingemergencies. line showing credits reflects the increase in charges, but is delayed due to the cycle. The data is limited. However, the average increase in credits is $ 9,31.5.84 per month. The average monthly increase in charges is$79,979.70. In May, we projected that the July rate 'increase would reflect a credit increase of 9%. The actual increase, with the limited data we have to date is 11.6%. We anticipate this will be closer to the 9% as more data develops. Should this increase be typical; we could anticipate paying back the loan by July of 2003, and beginning to build an equipment replacement schedule again. The State of Montana allows up to 3 mils be collected that can be applied to EMS in the County. One mil is currently being taxed, and the hinds are applied to training costs of the volunteer departments in the Comity. The two additional mils are not being applied, and would have to be presented to the voters for approval. Annual ambulance responses are as follows: % Calls Total Overtime Cost per call City- 56% 1373 $24.26 County- 44% 1077 $55.35 Total 2451 RECOMMENDATION: Council considers pursuing additional funding measures to correct enterprise fund deficits, including waiting for this to correct itself, ballot measure to collect the additional 2 mils in our service district, and additional charges to the county for each response. ALTERNATIVES: As recommended by Council. Respectfully submitted, Fire Chief C r—is Kukulski, City Manager S;SOD IODUOSaad --X sailddnS pue S801AJOS --V-- "Paco Z0/40f SOBJeNO ZO/40� j