Memorandum
City of Lawrence
Fire Medical
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TO: |
David Corliss, City Manager Diane Stoddard, Assistant City Manager Cynthia Boecker, Assistant City Manager Jonathan Douglass, Assistant to the City Manager
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FROM: |
Mark Bradford, Fire Chief
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Date: |
April 9, 2008
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RE: |
Ambulance Fees and Stand-bys
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An analysis of a 2007 survey conducted by MARCER of ambulance rates revealed that Lawrence-Douglas County Fire Medical is significantly lower than its surrounding community ambulance service providers.
This analysis focused on five of the 41 categories surveyed by MARCER: Mileage, Basic Life Support (BLS), Advanced Life Support 1 (ALS-1) rates, Advanced Life Support 2 (ALS-2) rates and Specialty Care Transport (SCT) rates. The categories which were not analyzed are charges related to individual drug treatments and procedures.
Ambulance service providers surveyed by MARCER included AMR, Belton, Blue Springs, Excelsior Springs, Fort Osage, Liberty, MAST, Med-Act, North Kansas City, Overland Park Fire Department, Ray County, Gladstone, Grandview, Kansas City, Kansas and LDCFM.
When evaluating ambulance service provider rates, it is important to remember that the rates charged may be different from the rates allowable by insurance companies and Medicare. In some circumstances, providers agree to waive the portion of the fees not covered or outside of the allowable charges, and as a result, the amount collected will differ from the amount charged.
MILEAGE
Mileage for the ambulance service providers surveyed ranged from $5.00 per mile to $16.25 per mile (see chart on page 4). The adjusted average (discounting the outlier of $16.25) is $7.38 per mile. LDCFM currently charges $5.50 per mile, which is 74.5% of the average. In 2006, we transported for 38,884 miles at a charge of $213,862. In 2007, we transported for 38,233 at a charge of $210,281.50. Raising the mileage rates to the average would result in a $71,878 increase.
BASIC LIFE SUPPORT (BLS)
BLS rates for the ambulance service providers surveyed ranged from $250 to $675 (see chart on page 4). The average rate is $475.80. LDCFM breaks its BLS into emergency and non-emergency. Emergency BLS is charged at $375 (78.8% of average) while non-emergency BLS is charged at $250 (52.5% of average). There were 1,310 emergency BLS charges (76% of the total BLS charges) resulting in $491,250 and 417 non-emergency BLS resulting in $104,250 in 2006. In 2007, there were 1,354 emergency BLS charges resulting in $507,750 and 405 non-emergency BLS charges resulting in $101,250. Increasing both rates to the average would result in a $227,932 increase.
ADVANCED LIFE SUPPORT 1 (ALS-1)
ALS-1 rates for the ambulance service providers surveyed ranged from $338 to $732.53 (see chart on page 5). The average is $559.41. LDCFM breaks its ALS-1 into emergency and non-emergency. Emergency ALS-1 is charged at $450 (80.4% of average) while non-emergency ALS-1 is charged at $275 (49.2% of average). There were 2,702 emergency ALS-1 charges (96.5% of the total ALS-1 charges) resulting in $1,215,900 and 98 non-emergency ALS-1 charges resulting in $26,950 in 2006. In 2007, there were 2,803 emergency ALS-a charges resulting in $1,261,350 and 37 non-emergency ALS-1 charges resulting in $10,175. Increasing both rates to the average would result in a $317,199 increase.
ADVANCED LIFE SUPPORT 2 (ALS-2)
ALS-2 rates for the ambulance service providers surveyed ranged from $425 to $938.00 (see chart on page 5). The average is $618.58. LDCFM currently charges $500, which is 80.8% of the average. In 2006, LDCFM had 40 ALS-2 transports resulting in a charge of $20,000. In 2007, LDCFM had 50 ALS-2 transports resulting in a charge of $25,000. Raising the rate to the average would result in a $5,929 increase.
SCT
MARCER defines SCT as transport using specialty personnel, such as a nurse, doctor or advanced paramedic. SCT rates for the ambulance service providers surveyed ranged from $550 to $1,108 (see chart on page 6). The average is $774.83. LDCFM does not charge separately for this category.
CONCLUSION AND RECOMMENDATIONS
The MARCER survey indicates that, in each of the five categories analyzed, LDCFM falls significantly below the area average. As a result, I recommend that the City and County consider raising the rates charged by LDCFM for ambulance services. Increasing rates to the area averages as outlined above would result in a $622,939 increase.
Additionally, I recommend that Article 4, Section 8-401 I-5 of the City code be reviewed and clarified. The code now states that “when a patient is treated and not transported, the patient will be charged the applicable base rate”. This would seem to indicate that any time LDCFM responds to a scene and treatment of any level of service is provided, we charge for it (BLS rate for BLS care, ALS-1 rate for ALS-1 care, etc.). However, this may not necessarily be the intent of the code. LDCFM currently only charges when we do not transport but were dispatched emergency or when ALS services were performed. For example, if a medic unit is dispatched to an incident as emergency, but arrives on scene and discovers that the patient has a non-life-threatening cut and is treated on-scene but does not require transport, we would charge for an ALS-level response since that is how the call was dispatched. Conversely, if we were dispatched to the same scene as non-emergency and treated the patient (non-ALS) on-scene but did not transport, under our current policy, there would be no charge for the cost of services provided. However, the City code seems to contradict that by indicating that there should be a charge. In 2007, LDCFM responded to 6,858 medical calls. Thirty-three percent of those were non-transport calls, which can range from anything to a diabetic needing care to a bed-confined patient needing a lift-assist.
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CURRENT |
PROPOSED |
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MILEAGE |
$5.00/mile |
$7.38/mile |
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BLS (EMERGENCY) |
$375 |
$476 |
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BLS (NON-EMERGENCY) |
$250 |
$476 |
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ALS-1 (EMERGENCY) |
$450 |
$559 |
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ALS-1 (NON-EMERGENCY) |
$275 |
$559 |
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ALS-2 |
$500 |
$619 |
Lastly, I recommend that the City and County consider raising the stand-by charge to at least $137 per hour and charging an administrative fee to ensure that, at a minimum, we do not lose money by providing stand-bys. In 2007, the department staffed 95 stand-bys lasting an average of four hours. This resulted in a loss of $14,060 due to not including benefits in the amount charged for stand-bys. Adding an administrative fee of $25 would have generated an extra $2,375 in 2007. Increasing the hourly rate above the $137 per hour fee and/or increasing the administrative fee beyond $25 will result in additional revenue being generated.
DOUGLAS COUNTY BOARD OF COUNTY COMMISSION
On July 2, 2008 the Douglas County Board of County Commissioners approved County Resolution 08-28 establishing their part of a joint resolution/ordinance concerning charges for ambulance services.
RECOMMENDATION
Authorize Mayor to sign City Ordinance No. 7774 establishing the City’s part of a joint resolution/ordinance concerning charges for ambulance services.
Special Events Rates
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Lowest MICT |
Highest MICT (Lieutenant) |
Captain MICT |
Average |
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Hourly Rate |
$15.95 |
$24.75 |
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OT Rate or Add Pay Rate* |
$23.93 |
$37.13 |
$50.00 |
$37.02 |
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KP&F (0.1286) |
$3.08 |
$4.77 |
$6.43 |
$4.76 |
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Medicare (0.0145) |
$0.35 |
$0.54 |
$0.73 |
$0.54 |
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FICA (0.0156) |
$0.37 |
$0.58 |
$0.78 |
$0.58 |
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Unemployment (0.0024) |
$0.06 |
$0.09 |
$0.12 |
$0.09 |
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Total Compensation Per Hour Per Person |
$27.79 |
$43.11 |
$58.06 |
$42.99 |
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Total Compensation Per Hour for 2 People |
$55.58 |
$86.22 |
$116.12 |
$85.98 |
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Average cost per hour of Vehicle Operations |
$11.50 |
$11.50 |
$11.50 |
$11.50 |
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Average per hour medical supplies |
$8.93 |
$8.93 |
$8.93 |
$8.93 |
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TOTAL |
$76.01 |
$106.65 |
$136.55 |
$106.41 |
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Total Charged Per Person Per Hour (based on 2 people) |
$100.00 |
$100.00 |
$100.00 |
$100.00 |
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Difference per hour |
$23.99 |
($6.65) |
($36.55) |
($6.41) |