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HomeMy WebLinkAbout1989-12-04 Council Packet - Work Session, EMTKenai City Council Work Session December 4, 1989 EMT Ambulance Program KE NA = C = TY COUNC = L WORK S E S S= ON — 1 2/ 4/ S S SUBJECT: EMT Ambulance Program Present: Mayor Williams, Measles, Monfor, Swarner Absent: O'Reilly, Smalley, Walker City Manager Brighton: Rather than discuss the mechanics of the program, I think we need to if Council wants to pursue this situation. The push is not coming from the voters. In my 9 years with the City there has not been a complaint from the public regarding the emergency medical services provided. However, we receive complaints every day about roads; plowing, grading, etc., plus water and sewer. If we are going to spend considerable money, we should try to alleviate those complaints. I think you can accomplish what you need in 5 years. You could hire 2 paramedics who are already trained and certified from outside instead of sending two men outside for training. My son who is a battalion chief and has been with the department for several years earns $21,000 per year. It is difficult to argue against police and fire. The government does not have money to provide for any contingency that may arise. Last year you had a memo from me that had all the information that described my recommendations against the training program. My opinion has not changed. We have two pumpers that are of 1971 vintage that will need to be replaced soon plus other places that money could be spent. Councilwoman Swarner: I see here that the police don't have to pay to go to the FBI school, why is that. Answer, the federal government pays for that training. Mayor Williams: I don't think it should be a question of replacing equipment and my opinion comes from a visit to Seattle where all of their equipment is 20 years old or better. Dr. Hansen: The push to upgrade to paramedic status has come from me. We have a group of fellows in the fire department who are enthusiastic and want to be better. Along with these people is my desire to be the best that we can be. I work on a contract basis with the fire department. Unless you say no, I won't be content with staying at the present level of service. We are the largest City on the peninsula and we should have the best level on the Peninsula. However, all the other areas are higher. I have statistics on the number of calls for the fish processors, the number of transports, the senior population and the potential for more seniors moving into this area. We need to be upgraded to provide for not only today but for the future. I agree with the survey of people who feel we are doing a good job, however, they don't know how we are doing. The people we affiliate with, the KENAI CITY COUNCIL Work Session December 4, 1989 Page 2 hospital, other departments, the Central Council of EMS, they all know. We are only fooling people in a way. We know we could be better. Dennis went outside to obtain paramedic status on his own, plus he has maintained that status by joining with Nikiski and other departments. In the last 5 to 6 years the federal and state regulations have changed such that it is no longer possible. No longer is in-house training allowable. In the past many of the men have obtained upgrading in their free time, that is no longer possible. However, if you decide you don't want to have a training program I can live with that. Mayor Williams: The question has been around for a long time. I feel it can be a self paying program. In changing the policy of the City we are going to have to have a broad input from other sectors. There are approximately 450 calls per year, of that between about 20% - 30% are from outside the City. In Atlanta I found that free ambulance service does not exist in any area outside of Alaska. Most do not exist as a municipal responsibility, they are contracted out to private firms. Our system began because the rural aspect made it unfeasible for a private contractor to come in. I think it is a good program. City Manager Brighton: I agree that we should be the best we can but there are limitations. That would hold true for the best senior housing, the best gym, etc. The $300 per ambulance call is high. I don't pay $300 taxes on my house per year. I would suggest that the department might be better served by hiring trained personnel. Mayor Williams asked for statistics on how many paramedics the other departments have: Nikiski will have a total of nine in the next two months, Soldotna has 6 to 8, Homer has 6 - all are approximate. City Manager Brighton pointed out that the budget was $1.3 million per year. Mayor Williams pointed out that the Borough, through service districts paid for the training. Dave Burnett: We used to be able to get an instructor to come here, that's how Soldotna and Nikiski got started, however, now they won't do that, they don't accept the in-house training and won't certify. Dr. Hansen: The field of medicine is one of the fastest changing fields there is. What was true a year ago, may not hold true today. Mayor Williams asked Dr. Hansen about various training facilities available in closer areas like Seattle. There are a number of accredited paramedic training programs and I and Dave Burnett, on our own, have been to several just to learn what they have to offer. The cost of all the facilities is about the same regardless of region. Mayor Williams: It appears that there are several departments around the community that took advantage of the earlier programs that we did not. I would suggest we institute a pay or fee program. None of the other larger cities on the Peninsula have one with the exception of such communities as Cooper Landing and Anchor Point. Dr. Hansen: The Mayor mentioned this method last April and we have been working on this since. KENAI CITY COUNCIL Work Session December 4, 1989 Page 3 Mayor Williams: We need to set up a collection program at the hospital, are they open to doing this. The majority of all ambulance fees are going to be paid by insurance anyway. This may be a viable alternative since the federal and state has taken away the funding for training programs. The group discussed the handouts presented by Finance Director Brown and are attached to the minutes. They are figures presented by the hospital on average charges, revenues gained, and cash experience. Mayor Williams: The bottom line looks like if we could expect $79,000 per year it would pay for itself. We will have to do a budget readjustment somewhere along the way. Finance Director Brown pointed out that the training issue and instituting the ambulance fee are not related. City Manager Brighton: If the people of Kenai heard that they are going to have to have to pay $300 per call for an ambulance they are not going to like it. Dr. Hansen: You might keep in mind that approximately 25% of the ambulance calls are for outside of the City. Mayor Williams asked the Council how they felt about instituting an ambulance fee. Councilwoman Monfor agreed. Councilwoman Swarner agreed, however, Fairbanks has an ambulance fee and it did not cut down on false calls. Dave Burnett explained a future billing procedure for ambulance calls stating that eventually, it will be charged very much like the hospital where every item used in a call will be billed individually. Councilwoman Monfor pointed out that the majority of the people really don't use an ambulance in even a 5 year time line. Mayor Williams: I would like to prepare an ordinance to adopt the ambulance use fee and have a public hearing to get public opinion about the issue. Then, with the results of the public hearing or the passage of the ordinance, we can look into the training issue. Dr. Hansen: Workman's Comp will pay for several calls. As an example, during the summer the cannery workers having injuries are a large part of the calls. We have been working with the hospital and they are ready to institute the billing as soon as you say go. They have the computers and the capability and are willing to do it. Dave Burnett has polled several places to obtain an average cost. The $300 seems in the ball park. Dave Burnett: The poll showed that a lot of places charge over $400 and in some places, the cost is so prohibitive you don't want to call an ambulance. Councilwoman Monfor: I don't think this kind of charge is overcharging, especially when you consider the alternative is raising the mil rate. Council agreed to draft an ordinance for instituting an ambulance user fee to be put to public hearing at the January 3, 198% meeting. The Ordinance will be introduced on that date. KENAI CITY COUNCIL Work Session - December 4, 1989 Page 4 The Council next discussed grants and funding with the conclusion that sources that had formerly been used have now become unavailable. Dave Burnett: Not too long ago, South Central Emergency Services offered some money for training, however, the stipulation was that you had to attend their meeting. We weren't able to attend so we didn't get any money. Dr. Hansen: Right now we do not have enough personnel to go to all these meetings. They are held all over the Peninsula as well as Anchorage. With three men on shift, if one goes that leaves two to cover an entire shift and causes some overtime. I have gone in place of these men on several occasions, however, I can't go to all of them. Dave Burnett: We've been assigning people so that there is coverage whenever one man has to be off shift. It has gotten to be we're sending someone to a meeting nearly every day some where. Dr. Hansen: To implement a good program we are going to have to bring in one person just to relieve shifts. In another three years we are going to need a paramendic to cover the department. This person could do the paper work required to keep the department current, cover shifts when one person is gone, and oversee any training that could be done locally. Mayor Williams: If we put in one temporary person, it will probably work into a permanent position from the sounds of it. Finance Director Brown: The Code says we can't hire temporary people more than 6 months. Mayor Williams asked the Finance Director if he had any information on the Borough tax base, answer it will not be going up significantly, however, it will not be enough to cover either. Dave Burnett: The department had a meeting and discussed the possibility of losing some personnel and that we would have to hire at the paramedic level. The thing to keep in mind is that paramedics are a dime a dozen. There are a lot of them out there. Mayor Williams noted that the Council could lay off some personnel and rehire at the paramedic level, or take the benevolent position and initiate a training program. Dave Burnett: Several of the personnel felt strongly enough about a higher level they wanted to get the training on their own, however, it is cost prohibitive now. It takes 60 hours per year to maintain a certification. The City paid for one man to get the training and he had been keeping up with the maintenance part by joining with other departments who had an accredited instructor come up here. Now that the regulations have stopped that practice, he cannot keep current without expense. Mayor Williams: How many men in this department are paramedics, answer one, Dennis Lovett. KENAI CITY COUNCIL Work Session - December 4, 1989 Page 5 The Council discussed attrition and concluded it is a moot point. They next discussed the possible revenues covering the cost of two additional men and the balance created with the elimination of overtime. Dr. Hansen: We discussed ambulance fees before. I must admit to frustration as I have been trying to get Council action on this for more than three years. We don't seem to be getting any closer. Mayor Williams: At this point, we are moving in that direction. What is your opinion of hiring 2 new persons instead of the training program. Dr. Hansen: I think you would create a morale problem. These are dedicated people. To hire 2 new paramedics, while it would raise the level of care, it would also lower morale. It is important in working as a team. Morale is the highest it has been in the last three years. I would hate to lose that. Education keeps us actively involved and interested. Dave Burnett: I don't think morale will go down that much. The men are a team and have been for a long time. I've been there 15 years, since early 1975 and we started with 13 men and today we still have 13 men. Those people won't turn anyone away who are in need. There is more training then in the field of medicine is required at the department, there is also the fire aspect. There are state and federal requirements there also. Meeting adjourned. 1791-1M1 CITY OF KENAI GoafWW 014 „ 210 FIQALO© KENAI, ALASKA 99511 TELEPHONE 2113 - 7555 FAX 90T-283.3014 NOTICE OF MEETING The Kenai City Council will be holding a work session on Monday, December 4, 1989 at 7:00 PM in the Council chambers. To be discussed: EMT Ambulance Program The public is invited to attend and participate. Janet Ruotsala, CMC City Clerk DATED: November 17, 1989 _� IFq a l vvll� G� To: William J. Brighton, City Manager From: Charles A. Brown, Finance Director 6 4 Date: December 4, 1989 �R Subject: Paramedic Training/Employment Agreements I have reviewed employment agreements for three employees of the Police Department. In two of these cases, employees attended a traffic institute for about 2.3 months. In the other case, the employee attended the FBI Academy for about 2.5 months. In all three cases, the City maintained the employee's salaries. However, the City incurred very little extra expense; most tuition, transportation, and living expenses were not paid by the City. All three of the Police Department employees signed employment agreements that would have required them to reimburse the City for wages and annual leave accruals if they voluntarily resigned within two years, as follows: If Resignation Occurs Within first 6 months Within second 6 months Within third 6 months Within fourth 6 months After 2 years % of Wages and Leave Accrued During School to be Reimbursed 100% 75% 50% 25% 0% You have asked me to project what such an employment agreement might look like for paramedic training to be discussed tonight. I am assuming that since the duration of the paramedic training is about twice that of the police training, the employment agreements should cover 4 years. Therefore, an employment agreement might look like: % of Wages and If Resignation Leave to be Approximate Occurs Reimbursed Wages/Leave Hrs.* Within first year 100% $19,500/184.8 hrs. Within second year 75% $14,625/138.6 hrs. Within third year 500 $ 9,750/ 92.4 hrs. Within fourth year 25% $ 4,875/ 46.2 hrs. After 4 years 0% $ -0- / -0- hrs. *Based upon annual salary of $39,000, and leave accrual of 30.8 hours per month. elple To: Kenai City Council From: Charles A. Brown, Finance DirectorC 4 Date: November 16, 1989 Subject: Paramedic Training and Ambulance Billing This information is being sent to you in preparation for the December 4, 1989 worksession on this subject. Here, I am reporting to you on financial issues relating to this training and the potential of billing for ambulance calls to recover costs. Dave Burnett, Assistant Fire Chief, has prepared a separate memo which describes the training program. That memo is attached. Dave and I have decided not to include the material that was sent to you several months ago. Some of that material is now quite dated, and is inconsistant with the newer calculations. COSTS: The plan, as I understand it, is to send five EMT's to Paramedic School, the duration of which is approximately six months. Each EMT would train at a different time. It is expected that a replacement employee would be needed for a 3-year period. Training costs are estimated at: Tuition and Books $ 2,300 Miscellaneous 225 Housing ($500 x 6 months) 3,000 Transportation and Parking 650 Living Expenses ($300 x 6 months) 1,800 Field Uniform and Fees 175 Air Travel ($750 x 3 trips) 2,250 Total for Each Trainee 10,400 Number of Employees x 5 Total Over 3-year Period 52,000 Note that living expenses are estimated at $300 per month. Normally, per diem rates are $30 per day. $30 x 30 is $900, which would be the usual living expenses while out of town for a month. The lower rate of $300 would have to be agreed upon in advance. Also, the Fire Department has recommended providing for three round-trip airfares. Paramedic Training page 2 Employee replacement costs are estimated at: Salary Certification Pay Health Insurance Holiday Pay Leave E.S.C. PERS Workers Compensations Supplemental Retirement Total (per year) Number of Years Total Over 3-year Period $ 33,570 1,500 4,500 2,130 2,000 500 1,500 2,600 1,500 49,800 x 3 $149.4_00_s Therefore, the total cost over the 3-year period is estimated to be: Training $ 52,000 Replacement Employee 149,400 Total Over 3-year Period 201,400 Number of Years 3 Average Annual Cost, Each of First 3 Years S 67,133 It should be emphasized that this average annual cost during the 3-year period is an incremental cost: the approximate amount that would need to be added to the annual budget. Council must understand that the plan includes maintaining the salaries and benefits of the employees while in school. This cost is about $137,500 ($55,000/2 x 5) over the 3-year training period, or about $45,800 per year. These salary maintenance costs are NOT taken into account here. REVENUES: Dave Burnett and I discussed billing for ambulance services with the Central Peninsula General Hospital. They have prepared a revenue summary (attached). The Fire Department and Peter Hansen, M.D. recommend charging a flat fee of $300 per ambulance run to each patient. Our cost analysis indicates that it costs the City about $150 in personnel costs each time the ambulance is called out. This is based upon three employees being called in to cover the station, paid at time and one-half for two hours, including benefits. Another $150 can be used to cover equipment repair and replacement, supplies, and fuel. According to the hospital's projections, annual revenues might be expected to be: Revenues, Less Allowance for Uncollectibles $ 84,610 Billing Expenses (hospital's 5% of gross) (5,535) Net Revenue Per Year 79,075 Paramedic Training page 3 I believe that the hospital's offer to bill and collect the charges, including medicare paperwork, is very attractive. I do not believe that the City could perform this function as well or at this cost. SUMKARY AND CONCLUSION: 3-Year Summary: Training and Replacement Costs $201,400 Revenues ($79,075 x 3) 237,225 Therefore, it appears that if the City Council desires to proceed with this training program for paramedics, the cost can be reasonably expected to be recovered within a 3-year period by initiating a $300 flat charge for ambulance services. Thereafter, the $79,075 of revenues collected through billings could be used to maintain and replace equipment. 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Hansen, is the most adaptable program that could be integrated within the Department. At present, the Kenai Fire Department is operating with one (1) Paramedic, five (5) EMT III's (ACLS certified), and three (3) EMT II's. I have personally spoken with the five EMT III's (Jason Elson, Scott Walden, Walter Williamson, Roger Anderson and Gene Backstrom) and all are ready and willing to accept the training and move ahead to the, Paramedic level of service. This would provide the department with six (6) Paramedics, allowing for two (2) Paramedics per shift. The Department is currently considering the prospects of sending the participant(s) to the Daniel Freeman Hospital which is located in Inglewood, California, for a period of six (6) months. Due to manning problems within the department, we will only be able to send one (1) man at a time, therefore the certification program will take an estimated two and one half (2-1/2) years to complete. In Order to alleviate the department's manpower reduction and to save overtime costs and personnel burnout, it is requested that the City provide a temporary hire for a period not to exceed three (3) years. The temporary hire will be required to be Paramedic certified and be willing to cross -train in fire, rescue and airport emergencies. This department has always felt that we should be providing the best services possible. With the continuous increase in medical calls, it is imperative this proposal be seriously considered, if not instituted. It is only through acceleration that we can obtain outimum performance. DCB/sb THE ITEMS/EQUIPMENT LISTED BELOW COULD BE CHARGED FOR IF USED DURING AN AMBULANCE RESPONSE. 1. ITEMS RELATED TO USE OF THE HEART MONITOR: a) Electrodes b) Leads c) Jell 2. Backboard 3. Mast Pants 4. Splints (arm, leg, etc.) 5. Extrication Equipment Use 6. BP Cuffs -and Stethoscopes 7. Printed Forms (cost each) 8. Oxygen 9. KED Sl ed 10. Cervical Collars 11. Bandages 12. Col d/Hot Packs 13. Medications TO DO L T S T WORK S E S S= O N — D E CEMBE R 4 1 9 8 9 KE NA I C I TY COU NC I L 1. Brown - Draft ordinance for initiating ambulance user fee for introduction at January 3, 1989 meeting.