2. Ambulance RatesKALISPELL FIRE DEPARTMENT
Randy Bra hl - Fire Chief =bpr
1 First su e East
-� .
Daniel Diehl ssi t .t ie eratio Kalispell, Mona 5 901
Brent Christopherson - Assistant Chief/Prevention� 06) 758-770,0
. 758-7952
2 2 o
TO:
Mayor Pamela B. Kennedy
and Kalispell City Council
FROM: Randy o), Fire Chief
James H, Patrick, City Manager
SUBJECT. Ambulance transportation rate increases
WORKSHOP DATE: January 3, 2004
BACKGROUND * The Kalispell Fire Department provides ambulance service to the City of
Kalispell and the surrounding areas in the Flathead valley. This is an e .ter r'se 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. Additio.all , the department is requesting a change in billing
methods to comply with new requirements by Medicare and Medicaid. A breakdown of this
ifornatlo.n follows:
1. Ambulance transport rates were last adjusted in July of Zoo . 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 2001 and 2003, the ambulance fund borrowed $ 1. 5 , oo from the
general .mod, to keep the ambulance fund solvent. During that time, several charges 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 clerks by a. 5 FTE, caging to a software billing process, allowing
discounts for early pay, allowing payment by credit card, and aggressive collection
assignment. In fiscal year Zoo , the department der t rovid ed anbulance service to the United
States Forest Service at a complex of fires in and rear Glacier Park, generating enough
income to sustain the fund for apen* od of time. In 2005, a county -wide EMS levy was
implemented that allowed the ftmd to generate approximately $62,000 annually for
reimbursement of equipment and supplies costs. Several purchases, including the
replacement of an ambulance and replacement of defibrillators, were postponed to help
protect the balance of the mod. With these changes, the fund has been able to pay back all of
the 11.5,00 'borrowed from. the General Fund, plus the interest owed. To date, the fimd 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. trough cost containment and EMS levy revenue, the department continues to
operate in the black.
Table
KALISPELL FIRE DEPARTMENT
Fiscal ye a .
2
2/3
3
5
05106
......... ...
jestimate
Revenue
$698,982.00
$642 367,
$747,647.00
$7863 6
$ ,041,023.00
Expenses
$7� 9
$6445642.00
$719,263-00
$6459959-00
$968,232. '
Nos ru J
2538
2466
2918
3 53
75
Average
cosh per run
$288,33
$261,41
$246,49.
$$237.60*
Average
cost
ff
f run
$275-41
$260.49
$256.22
$227.83
$255-47
Average
difference
per run
_$2.92
"$O,,93_._L
$9,73
$40,76
—$17,86*
For equal comparison, this does not include the capital improvement purchases of one ambulance and
three defibrillators ,, which would show the average difference per run to be -17.72.
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 `ailing, ill increase the expenses .faced by the department by approximately
1 ,,o. In addition, the department has added e firefighter FTEs in order to open the
new fire sub -station. Fifteen percent of firefighter's wages are assigned to the Ambulance
ftmd. This amounts to approximately 1,0o. These two increases toW approximately
$20 ,000 per year, and will significantly reduce the "average difference per run"'. ale we
anticipate an annual response increase of about %, It will not be enough to offset the
difference into the future.
2. 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 d-tan
transport agencies typically charge, but agencies are not allowed to collect costs above their
fee schedule from Medicare and Medicaid patients. Until now, transport agencies 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 taken such as sing
are IV line, l t ba ions defibrillation, and cardiac monitoring. Medicare and Medicaid are
now strear llm'g how they accept billing, by making the following change, effective January
, 2006. This edge requires that supplies and actions be included into the base rate, and
that no additional charges be included, except mileage. Medicare and Medicaid billing is
required to match what is billed to private pay patients, even though they do not pay the
complete invoice. So, making this change how we invoice, means that we will do this
with all patients. Since private insurance companies are quick to follow the federal 6nges,
we should also see this as a requirement by all billing systems within the next few months.
Kalispell Fire Department responds to five categories of patients. The current average per
call charges for supplies in these categories are as follows;
Basle Life Sort -non emergency ..
Basic Life Support- emergency $ -.
Advanced Life Support -non -emergency - -
Ad anced Life Support I- $73-97
Advanced Life Support - ' 8, o
Additionally fuel costs have risen significantly, Medicare and Medicaid have recognized this
and are allowing an increase of $ .00 per loaded mile to compensate for this sc.
RECOMMENDATIONS: Rates for ambulance services are set by City Ordinance so must he
approved by the City Council} -fhe department is requesting that Council approve the rate changes
to the fee schedule as shown in Table #2 (attached).
Respectfully submitted,
R� TriordehJ, i Fire Chief
i-/
es H. Patrick, pity Manager
Fable - Proposed Fate changes
Current ram
6% coat increaw
Supplies
inclusion:
Recommended rate
Basic We Sub oTr end
use Rate
35.00
-
-
.60
Loaded mile Fate
8-50
$
9.50
Basic* Life S r
Base Rate
iiy .00
.
�
-20
Loaded mile rate
iF3
YAF
Advanced Lft SUPPOO4 Non-ernergency
Base Rate
.00
48.80
Loaded mile rate
.a
dva n d Life Support I
Bass' Rate
680.00
10
7 .
4 ;
Loaded mile rat9.50
Advanced Life sueeei2
Base Fade
680.00
$
92.80
$
278.401
.
Loaded mile rate
8.60
9.601