6. Resolution 5086 - Rate Increase - Kalispell Ambulance ServiceKALISPELL FIR.E DEPARTMENT
Randy Broc i - Fire Chief 312 Fire Avenue Easy.
Daniel Diehl — Assistant Chief/Operations w.#:w Kalispell, Montana 59901
Brent Christopherson Assistant Chief/Prevention (0 758-7760
•:��. ems'
-7952
1/512006
T:
Mayor Pamela B* Kennedy
and Kalispell City Council
FROM: Randy Brodehl, Fire Chief
James H. Patrick, City Manager
SUBJECT: Ambulance transportation rate increases
COUNCIL MEETING DATE. January 17, 2006
BACKGROUND: The Kalispell Fire Department provides arnb lance service to the City of
Kalispell and the surrounding areas in the Flathead valley. This is are enterprise fund so operates
without support of the tax base. Due to increases in costs over the past four years, and changes in
invoicing required by Medicare and Medicaid, the fire department is requesting an increase in rates
charged for ambulance transportation. Additionally, the department is requesting a change in billing
methods to comply with new requirements by Medicare and Medicaid. A breakdown of this
nfornation follows:
1. Ambulance transport rates were last adjusted In fiscal year Zoo l 00 . Since then, there have
been dramatic cost increases in fuel, utilities, paramedic training, salary adjustments, and
there has been reduction in what is covered by Medicare/Medicaid and several private
insurance companies. Between Zoo l and 2003, the ambulance fund borrowed $ l 1 ,000 from
the general fund, to .deep the ambulance fund solvent. During that time, several changes
were made to the billing process, collections, and cost containment that assisted the
department in generating sustainable revenue versus expense ratio. These changes focused
on reducing the number of ambulance clerk by a .5 FTE, changing to a software billing
process, allowing discounts for early pay, allowing payment by credit card, and aggressive
collection assignment. In fiscal year oo 2oo , the department provided ambulance service
to the U'Mted States Forest Service at a complex of fires in and near Glacier Park, generating
enough income to sustain the f nd for a period of time. In 2005, a county -wide EMS levy
was implemented that alloixed the fund to generate approximately $62,000 annually for
reimbursement of equipment and supplies costs. Several purchases, including the
replacement of an ambulanee and replacement of defibrillators, were postponed to help
protect the balance of the fund. With these charges, the fund has been able to pay back all of
the $1 l ,o o borrowed from. the General Fund, plus the interest owed. To date,; the find is
solvent, and the postponed ambulance and defibrillators have been purchased, without
borrowing additional funds.
2. As can be seen in the following table, cost recovery has been a key focus of the Kalispell Fire
Department. Through cost containment and EMS levy revenue, the department eont n es to
operate in the black.
Table
FIRE DEPARTMENT
.-........K-ALISPELL
Fiscal ear
23
03104
04/056
(estimated)__
:Revenue$698,982.00
$642�357.00:
$747�647.00
$786,706
$1,041 , 23,
Expenses
3 ,7 -
$644,642-00
$7195253-00
$645,959,00
$968,232.00
N. of runs
2638
2
29180
---------------
3 53
5
Ave r
cosh per run
$288.33
$261.41
$2 .
$187.07
$23 `* *
Average
cost
recovery
jpq�r rug
$275,41
$260.49
$266.22
$227,83
$265,47*
Average
difference
per run
'$ 2,.2
'$0.93
$9.73
$40.76
$ . 6*
* For equal comparison., this does not include the capital 'improvement purchases of one ambulance and
three dr'll rs , , which would l show the average difference per run to be $ -1 . 2.
This year, the department has moved ahead with purchasing and replacing the postponed
ambulance and defibrillators. These Purchases, while very necessary to replace equipment
that was failing, will increase the expenses faced by the department by approximately
$145,,000. In addition, the department has added nine firefighter FEs in order to open the
new fire sub -station. Fifteen percent of firefighter's wages are assigned to the Ambulance
mod, This amounts to approximately$6 1, 000. Tee two increases total approximately
$2061,000 per year, and will significantly reduce the "average difference per nm"w While we
anticipate an Dual response increase of about 1 %, it will not be enough to offset the
difference into the future.
Medicare and Medicaid patients account for approximately seventy percent of our responses.
Medicare and Medicaid pay according to their own fee schedule. This schedule is less than
transport agencies typically charge, but agencies are not allowed to collect costs above their
fee schedule from Medicare and Medicaid patients. (See Table 2)
Table 2
MEDICARE
Billets
Medicare
Payment
T
Insurance -
�
What is allowed to be
collected
I
Non Billable
LS Base Charge
-
$ 30T84
$7&96
$384.80$
196.20
Mileage
$8.50
$ .
$ .66
$8.30
$ 0.20
BLS Base Chaff a
$ 20-00
$260-54
$65.13
$325.67
$194.33
Mileaca
$8.50
$ . 44
$1.66
$ &30
MEDICAID
Billed
Medicaid
PaymentNon
Insurance co-
What is allowed to be;
Billable
LS Base Charge
$
$ 234_5
N/A
$234.57
$345.43
Mileage
$8.50
0.11
N
.
$8.39
BLS Base
$2_
$1_
NIA
$197. q4
$322.46
Milea........................
$8.50
$0.11
NIA
$0.11
$ s 39
4. Until now,, transport a e eles have been required to list separate charges for supplies used,,
including oxygen, medications, splints, etc. They .have also been required to list separate
charges for actions men such as starting an IV line, intubations, defibrillation, and ardi .e
monitoring. Medicare and Medicaid are .now streamlining how they accept billing, by
requiring that supplies and actions be included into the base rate, and that no additional
charges es e included, except mileage. Medicare and Medicaid billing is required to match
what is billed t a e pay patients, even though they do not pay the complete invoice. So,
making this edge .in how we invoice, means that we will do this with. all patients. Since
private insurance companies are quick to follow the federal changes, we should also see this
as a requirement by all billing, systems within the next few mots.
5. Kalispell Fire Department responds to five Bate r-es of patients* The current average per
call charges for supplies in these categories are as follows:
Basle Life Support -non emergency $ � _
Basle Life Support- rt- emergency $ - s
.d anced Life Support -non -emergency $ - -
Ad anted Life Support - $ 73.97
Advanced Life Support 2- $278.40
. Additionally fuel costs have risen significantly. Medicare and Medicaid have recognized this
and are allowing an increase of $ LOO per loaded mile to compensate for this rise. Table 3,
shows the changes needed to continue to provide ambulance transport service at the current
level.
Fable 3
Proposed rate
clan ea
Current rate
% cost increase
S.Upplies inclusion
Recommended rate
Basic Life Support,
Non -emergency
Base Rate
$235.00
$ 3 .
-
;
Loaded mile rate
$ 8.50
$ . fi
Basic Life Support,
Emergenicy
Base Rate
$520.00
83.20-
$603.20
mile rate
$8.50
$ 9.
-Loaded
dvan ed Life
Support, Non -
Base Rate
3 -
48_
-
3 3= 0
Loaded mile rate
$8.50
$9.50
Advanced Life
Support
Base fate
$580.00
$92.80
$73.97
$746.77
Loaded mile rate
$8.50
$9.50
Advanced Life
Base Fate
$580-00
$92.80
$278.40
$951.20
Loaded mile rate
$8.60
$9.50
RECOMMENDATIONS: Rates for abidance services are set by C qr Ordinance so must be
approved by the City Council. The department is requesting that Council approve the rate changes
to the fee schedule as shown in Table 43.
Respeeffully submitted,
dy rl# Fire Chief
x
Jtimes H. Patrick, City Manager
RESOLUTION No. 5086
A RESOLUTION AMENDING RESOLUTION NO. 46941 BY REVISING AMBULANCE
RATES FOR THE USE of THE KALISPEL .AMB LANCE SERVICE AND DECLARING
AN EFFECTIVE DATE.
WHEREAS, the City of Kalispell maintains an ambulance service through its fire department;
ent;
WHEREAS, on May 6, 2002, the City Council passed resolution No. 4694, wh.i.ch increased. the rates
for the Kafispell Ambulance Service set by Resolution 46 3; an
WHEREAS, due to increases in Costs and ebanges in rel.m.burser .eats, it is necessary to revise the
rates that are charged for the ambulance service use.
STOW, THEREFORE, BE IT RESOLVEDBY THE CITY COUNCIL of THE CITY OF KALISP L
AS FOLLOWS:
SECTION I. That Resolutlon No. 4694 is hereby amended by revising the rates of the
Kalispell Ambulance Se +I e asfollows:
Pro used Rate ha
Current Rate
16% Cost Increase
SU22fies Inclusion
1 . corn rre ded Rate
BLS, Non-Emerg9.cv
Base Rate
5.0
S37.60
S _
7..60
Loaded Mile Rate
I S 8,50
.50
BLS, Emerge e',
f
Base Rate
S520.00
S83.20
$603.20
Loaded Mile Rate
S 8.50
S .5
AL , Non-Emeruenfly
ffBasc R�atc
S305.00
S48.80
S353.80
Loaded Mile Rate
8.509.50
f ALS Level 1
�
t Base .ate
0. V 1
� '
F. f
$746.77
Loaded Mile Rate
.50
$ 9.50
1 ALS Level 2
5$
r6L l ate
5 0. 0 1
$ 2.8
1 $278,40
S951.201
a Loaded File . . ........Rate I
S .o f
f
s .5
Return Transfer Rate 150.00 plus m.fleage
Stand-by Ambulance.- $ :.l o.00 for the first hour and $8 5.00 per hour thereafter. TN.s rate will be figure
on a quarter hour basis. Anyone transported during stand-by w.1.11 be billed per any normal rug..
B.I .S. �:= Basic Life Support A.L.S. = Advanced Life Support
SECTIO N 11. Th.1s Resolution shalI become effective irnme iatel y upon its passage by the City
Council.
PASSED AND APPROVED BY THE CITY COUNCIL AND SIGNED BY THE MAYOR THE
CITY OF KALISP LL, THIS 1 T T DAY OF J N UAR , Zoo .
Pamela B. Kennedy
Mayor
ATTEST:
Theresa White
City Clerk