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Home My WebLink About1995-02-08 Council Packet - Special Meeting, AmbulanceKenai City Council Special Meeting February 8, 1995 Proposed Ambulance Fee AGENDA RENAI CITY COUNCIL - SPECIAL MEETING FEBRUARY S, 1995 7:00 P.M. RENAI CITY COUNCIL CHAMBERS A. CALL TO ORDER 1. Pledge of Allegiance 2. Roll Call 3. Agenda Approval B. PUBLIC HEARING 1. Proposed Ambulance Fee Schedule a. Presentations b. Public Comment C. Council Discussion C. 4,�4, 4�ez 1 M S v MEASLES BANNOCK SMALLEY WILLIAMS BOOKEY SWARNER MONFOR M S V MEASLES BANNOCK SMALLEY WILLIAMS BOOKEY SWARNER MONFOR ,;C� '.IL MEETING OF a2 IF S V MEASLES BANNOCK SMALLEY WILLIAMS BOOKEY SWARNER MONFOR M S V MEASLES BANNOCK SMALLEY WILLIAMS BOOKEY SWARNER MONFOR M S V MEASLES BANNOCK SMALLEY WILLIAMS BOOKEY SWARNER MONFOR M S v MEASLES BANNOCK SMALLEY WILLIAMS BOOKEY SWARNER MONFOR PACKET INFORMATION FOR AMBULANCE FEE SCHEDULE DISCUSSION 1. Cover letter accompanying information packets sent to citizens of the community and memorandum attached to packets made available at City Hall for the public. 2. List of citizens sent a copy of the information packet. 3. Items included in packet mailed and made available to citizens: Enclosure No. 1: 1/18/95 TM memorandum to Mayor and Council -- RE: Kenai Ambulance Billing Fees, Effective 4/1/95; Public Hearing 2/8/95. Enclosure No. 2: 8/18/94 CAB memorandum to TM -- Subject: Ambulance Billing. Enclosure No. 3: 9/1/94 DB memorandum to TM -- RE: Competitive Ambulance Fee Survey. Enclosure No. 4: Emergency Medical Service - User Fee Proposal; Questions and Answers & Information. 4. Questionnaire Responses MAYOR'S REPORT FEBRUARY 8, 1995 SPECIAL COUNCIL MEETING CHANGES TO THE AGENDA ADD: ADDITIONAL INFORMATION - 2/5/95 Peter O. Hansen, M.D. letter. ADDITIONAL INFORMATION - 2/7/95 D. Burnett memorandum regarding Estimated Revenues for Billing. ADDITION/CHANGE REQUESTED BY• Clerk Burnett CITY OF KENAI Od Cap" 4 4144,4a 11 210 FIDALGO AVE., SUITE 200 KENAI, ALASKA 99611-7794 TELEPHONE 907-283-7535 FAX 907-283-3014 byllwyl rF�..ban 'III�1 January 19, 1995 The Peninsula Clarion P.O. Box 3009 Kenai, AK 99611 RE: AMBULANCE FEE PROPOSAL City of Kenai The Kenai City Council is investigating the possible institution of ambulance fees for the use of City of Kenai ambulance and emergency medical services. The Council will hold a special city council meeting on February 8, 1995 in order to hear public comments. The meeting will begin at 7:00 p.m. and will be held in the Kenai City Council Chambers. Enclosed is the following information for your review: 1. 1/18/95 T. Manninen memorandum regarding, Kenai Ambulance Billing Fees. 2. 8/18/94 C. Brown memorandum regarding Ambulance Billing. 3. 9/1/94 D. Burnett memorandum regarding Competitive Ambulance Fee Survey. 4. 11/94 Kenai Fire Department Emergency Medical Service, User Fee Proposal -- Questions, Answers and Information. We hope you will review the enclosed information and attend the special council meeting on February 8, 1995. We look forward to hearing your questions and comments. CITY OF KENAI hn J. illiams Mayor JJW/clf Enclosures CITY OF KENAI It G4t 210 FIDALGO AVE., SUITE 200 KENAI, ALASKA 99611-7794 TELEPHONE 907-283-7535 FAX 907-283-3014 P�� - — �nnah MRK0RAMDUM 1992 TO: TO WHOM IT MAY CONCERN FROM: Mayor John J. Williams City of Kenai DATE: January 23, 1995 RE: AMBULANCE FEE PROPOSAL City of Kenai The Kenai City Council is investigating the possible institution of ambulance fees for the use of City of Kenai ambulance and emergency medical services. The Council will hold a special city council meeting on February 8, 1995 in order to hear public comments. The meeting will begin at 7:00 p.m. and will be held in the Kenai City Council Chambers. Enclosed is the following information for your review: 1. 1/18/95 T. Manninen memorandum regarding, Kenai Ambulance Billing Fees. 2. 8/18/94 C. Brown memorandum regarding Ambulance Billing. 3. 9/1/94 D. Burnett memorandum regarding Competitive Ambulance Fee Survey. 4. 11/94 Kenai Fire Department Emergency Medical Service, User Fee Proposal -- Questions, Answers and Information. We hope you will review the enclosed information and attend the special council meeting on February 8, 1995. We look forward to hearing your questions and comments. JJW/clf Enclosures CITIZENS TO WHOM INFORMATION PACKETS WERE MAILED George and Mary Ford Leon and Mary Quesnel Lloyd Johnson, Manager, 1st National Bank Bill Kluge, President, Kenai Chamber of Commerce Tom Wagoner Vince O'Reilly Ronald Malston Jim Elson Leo Oberts Barbara Waters Charlie Pierce Kevin Walker Teresa Werner-Quade Wm. Toppa Dr. Peter O. Hansen Dr. Charles Essex Barry Campbell, PA-C Kathy Scott Bill Thompson, Area Manager, PTI Assemblywoman Betty Glick Clint Hall Loretta Breeden Mark Necessary Blaine Gilman C. R. Baldwin, Atty. Dave and Glenda Feeken John Steinbeck Dwain Gibson Gloria Canning, Last Frontier Insurance Jim Doyle Joanna Hollier Roger and Frances Meeks The Peninsula Clarion CITY OF KENAI Od eapo" 4 4&44a 11 210 FIDALGO AVE., SUITE 200 KENAI, ALASKA 99611-7794 TELEPHONE 907-283-7535 FAX 907-283-3014 rE�..bar 1"a MEMORANDUM TO: The Honorable Mayor John J. Williams & Kenai City Council FROM: Thomas J. Manninen, City Manager DATE: January 18, 1995 RE: KENAI AMBULANCE BILLING FEES, EFFECTIVE 4/1/95; PUBLIC HEARING 2/8/95 Following the Mayor and City Council's directions at the FY95 budget sessions, Administration has prepared, and I have approved, a tentative ambulance billing rate schedule EFFECTIVE APRIL 1, 1995. It is attached for your review and consideration, along with the Finance Director's August 18, 1994 memorandum. I have initialed/approved the ambulance billing rates dated April 1, 1995 per KMC 7.15.100. Since setting these fees are subject to ratification/change by the Council, I am requesting Council's consideration and ratification after the scheduled February 8, 1995 public hearing. The procedures look workable, practical and streamlined with a mix of "contracting out" some minor, specialized Medicare/Medicaid billings. They address problems to be faced in the future; the City cannot continue to offer free ambulance services. It is also a competitive, fair and equitable user fee. This user fee may be used to contribute towards ambulance equipment replacement through the equipment reserve as determined by the City Council during the annual budget process. I am looking forward to discussing this issue with you at the 2/8/95 meeting and moving forward with this ambulance billing system effective April 1, 1995. If you have any questions or comments, please feel free to contact me directly. I wish to thank Fire Chief David Burnett and Finance Director Charles Brown for their research and simplification of this complex system. I am sure it will be a workable one in the best long-term interests of continuing to provide the highest quality services to system users. cc: Charles Brown David Burnett C:\WP51\TJM\AM8ULANC.MEM fWJ*ff& *I/ CITY OF KENAI It Gil eC4f2,i" q ,41&,i, 210 FIDALGO AVE., SUITE 200 KENAI. ALASKA 99611-7794 TELEPHONE 907-283-7535 FAX 907-283-3014 krANI �Z 14EMORANDUM TO: Thomas J. Manninen, City Manager FROM: Charles A. Brown, Finance Director � DATE: August 18, 1994 cR SUBJECT: Ambulance Billing Attached are two documents: (1) Billing Rates for Kenai Fire Department - E.M.S. Services, and (2) the E.M.S. Billing Source Document. This memo provides additional information. As you read this memo, please keep the following concept in mind: SIMPLICITY. If this isn't simple, it won't work. We are trying to do this with existing personnel. The rates, content of the source document, and billing procedures have been agreed to by the Fire Chief and me. We request that you: 1) Sign the Billing Rate document. 2) Submit this entire package to Council in the September 7, 1994 Council packet. I. The City has enrolled with Medicare and Medicaid. I enrolled with Medicare as a participating supplier, accepting assignment. This means that we accept the Medicare determined charge as the full charge. We can only bill Medicare patients for the deductible and co-insurance. We must write-off any excess. II. I will write a complete set of programs to bill, record receipts, and maintain the accounts receivable of the E.M.S. billings. The Finance Department will bill all accounts. Non -Medicare and non -Medicaid bills will be mailed by us to the patients. Medicare and Medicaid accounts will be forwarded to a subcontractor who has experience and contracts with those agencies to process the filings electronically. They will do this for $7 per filing. This will save us time and supply costs. This is just 2% of a BLS billing and just 1% of an ALS billing. We simply don't have the personnel or Oidoctippe 0 .? Memorandum Thomas J. Manninen August 18, 1994 Page Two equipment to bill Medicare and Medicaid less expensively. All payments will be made directly to the City. Therefore, I'll need about $750 in professional services to pay the subcontractor for the balance of this fiscal year. I assume that you will approve a transfer from contingency. III. The Finance Department will input data from the E.M.S. Billing Source Document, completed by the Fire Department, to begin the receivable process. The Fire Department must ensure completeness and accuracy of the source document. IV. Understanding that there will be difficulties in collections, we need broad authority to enter into payment plans, adjust accounts for Medicare or Medicaid ineligible charges, and determine uncollectible accounts. Penalty and interest will only serve to complicate (remember the simplicity concept) these efforts. Medicare and Medicaid won't pay penalty or interest. Other people may have to wait for private insurance to pay them before they can pay us. I'd like the ability to accommodate a wide variety of payment schemes. We don't want this to be a P.R. problem. Penalty (10%) would be charged only in extreme cases, such as refusal to acknowledge the debt or refusal to cooperate in any payment method at all. V. You may have noticed that we dropped the idea of medication and supply charges originally proposed by the Fire Department. This was too complex. There were about 50 individual charges, each of which could change periodically. Instead, we opted for simplicity and increased the BLS base rate by $25 and the ALS base rate by $50. This will work better for the Fire Department and the Finance Department (and, Medicare prefers it). VI. Also note that the non-resident rate is still double that of the resident rate. I'm a tad skeptical of this; it will probably cause collection problems (I know Medicare won't pay it). The rationale is that, even after the $150,000 or so that we might collect in fees each year, most of the Fire Department/E.M.S. is financed with tax dollars. VII. The Fire Chief wants 20% of collections to be designated for E.M.S. equipment replacement, up to $250,000. Memorandum Thomas J. Manninen August 18, 1994 Page Three This doesn't need to be approved by an ordinance. Designations of fund balance are tentative management plans for financial resource utilization in a future period (codification of Governmental Accounting and Financial Reporting Standards, 1800.125). Council consent will be given by their review of the billing rates; I included the dedication provision there. My personal view is that I'm not enthused about another designation of fund balance for a single department's use. But, I admit, there is no reasonable accounting or financial reason to object to it. I guess I'm neutral. That wraps up our proposal. Now, for some advice. This billing plan just might be more controversial than we think. Technically, according to KMC 7.15.100, the rates are set by you; Council is simply advised and given the opportunity to object. Given the scope of this, that se suggest you consider placing this on the hearing. A little advertising might not Department should do this). Some people ambulance service as free transportation. stop. Surprises won't be welcome. cc: Cary Graves Dave Burnett ems extreme. I agenda as a public hurt (if so, the Fire have been using the That's going to Billing Rates for Kenai Fire Department - E.M.S. Services E.M.S. Rates: Level I 100 Transport Level II 325 Basic Life Support Level III S 550 Advanced Life Support Level IV S 750 Advanced Cardiac Life Support Level V S1,500 Technical Rescue with ACLS or ALS Mileage S 4.50 / mile Rates include supplies and medications. Level I through V rates are 200% of the above rates for non-residents of the City of Kenai. Billing procedures and dedication of revenues: 1) Medicare and Medicaid billings are expected to be filed electronically by a subcontractor. 2) other billings will be made by the Finance Department. 3) The Fire Department completes the source document for billings. 4) Interest will not be charged. 5) Penalty of 10% may be charged on accounts not paid within 45 days of billing. 6) The Finance Director has authorization to write off accounts deemed uncollectible, including amounts in excess of allowable charges under Medicare and Medicaid. Effective April 1, 1995. Approved by the City Manager: Signature Approved by City Council on Date CITY OF KENAI, ALASKA Incident # _ _ _ _ _ _ Suffix # _ EMS SERVICE Date of Service (MMDDYY) BILLING SOURCE DOCUMENT 1) Patient Name (First, Middle Initial, Last) 2) Medicare _ Medicaid _ Neither _ (check one) 3) Medicare or Medicaid Patient # 4) Social Security Number 5) Date of Birth (MMDDYY) _ _ _ _ _ _ 6) Sex M F (circle one) 7) Patient's Physical Address 8) Is patient a resident of the City of Kenai? (circle) Y N 9) Patient's Telephone Number (Home) 10) Billing Information: (Work) a) Name b) Mailing Address c) Relationship d) Telephone Number (Home) (Work) 11) Was Illness or Injury: Y N a) Connected with employment? b) Result of an auto accident? c) Result of other type of accident? 12) For Medicare or Medicaid patients only, if any medical expenses will or could be paid by another insurance organization or government agency, show: a) Name and address of organization or agency: b) Policy or ID # c) Is other insurance primary to Medicare or Medicaid? (circle) Y N d) Is the other insurance Medigap coverage? (circle) Y N 13) TO THE BEST OF MY KNOWLEDGE THE ABOVE INFORMATION IS TRUE, ACCURATE AND COMPLETE AND THE REQUESTED SERVICES ARE MEDICALLY INDICATED AND NECESSARY. I authorize the release of any medical or other information necessary to process this claim. I also request payment of government benefits to the party who accepts assignment below. I accept responsibility for charges not eligible for Medicare or Medicaid. SIGNED DATE (By patient or other authorized person) NOTE: The City of Kenai accepts assignment of all Medicare and Medicaid billings. Other billings are the responsibility of the patient or other responsible person. 14) Describe nature of illness or injury and symptoms 15) 16) 17) 1s) 19) 20) 21) 22) 23) 24) Check one: Emergency Admission Discharge Outpatient Visit _ If Medicaid non -emergency, enter prior authorization Ordered by Name of treating doctor Address of treating doctor Transported from Transported to Number of miles with patient Level of service to be billed (I through V) Describe services performed (include BLS, ALS, ACLS, etc.) Signature of officer in charge Date signed Reviewed by Date Finance Section: Codes Rates Resident? Y N Notes CITY OF KENAI FIRE DEPARTMENT 105 SOUTH WILLOW STREET KENAI, ALASKA 99611-7745 (907) 283-7666 • FAX (907) 283-2267 MEMORANDUM To: Thomas J. Manninen, City Manager From:-0 David Burnett, Fire Chief Date: September 1, 1994 RE: COMPETITIVE AMBULANCE FEE SURVEY Uo RE KENAI Attached are the results of the competitive ambulance fee survey you requested for the 9/7/94 Council agenda packet. All results were obtained from individual services around the State during the past week and may vary slightly from a similar survey conducted by this department last year. I would be happy to meet with you to discuss the results before they are made part of the Council agenda packet, if you so choose. cc: CAB n. E'v,dP64M 0.4 CITY OF KENAI FIRE DEPARTMENT )� 105 SOUTH WILLOW STREET KENAI, ALASKA 99611-7745 (907) 283-7666 9 FAX (907) 283-2267 KENAI AMBULANCE FEE SURVEY DATA Updated August 30, 1994 Attached are the results of an ambulance fee survey conducted by the Kenai Fire Department. They are attached alphabetically, not in priority of service or billing structure. Services which provided information are: Anchorage/Girdwood Central Emergency Services Fairbanks Fire Department Homer Volunteer Fire Department Juneau (Capitol City) Fire Department Ketchikan Fire Department Kodiak Fire Department Matanuska-Susitna Borough Abbreviations listed in the survey are defined as follows: BLS: Basic Life Support or non life threatening medical problems or injuries (sprained ankle or broken leg). ALS: Advanced Life Support or medical problems or injuries which make the patients vital signs unstable, may be life threatening (amputations or other severe trauma). ACLS: Advanced Cardiac Life Support or medical problems or injuries which are life threatening (cardiac arrest or severe trauma requiring life support measures such as CPR). No Transport: Patient refuses treatment or transport, or a good intent call (auto accident with damage to cars only, no injuries). Routine Transport: Provide ride for patient and nurses to airport for medivac flight, little or no medical service necessary from department personnel. Some of the services responding to this survey attached samples of billing forms and itemized statement forms. Those have also been included in this packet. AMBULANCE SERVICE FEE SURVEY - SUMMARY Completed September 1, 1994 City/Service BLS ALS/ACLS PER MILE STANDY FEE SPECIAL RESCUE FEE BILLING METHOD Anchorage/Girdwood $350 $400 $6.00 $50/hour n/a self Central Emergency Services $250 $500 $4.50 $50/hour n/a contracted Fairbanks Fire Dept $250 $350 n/a n/a n/a self Homer Volunteer Fire Dept. $250 $500 $5.00 $25/half hour n/a self * Juneau Fire Dept. $300 $550 $6.00 $65/1st hour $700/air vac/4 hrs. self (hospital) $30/ea. add. then $60/hour ** Ketchikan Fire Dept. $275 $500 $5.25 $2.25/min over $1000 self 20 minutes Kodiak Fire Dept $300 $300 n/a n/a $50/hour (x number Hospital of personnel used) Matanuska-Susitna Borough $100 $200 $4.50 $65/1st hour n/a C.P.A. $30/ea. add. plus round trip mile fee. *** Sitka Fire Dept. $200 $300 n/a n/a n/a self $450 Explanation of Non Resident and Routine Transport Fees: * Juneau Fire Dept: Credits residents $50 for BLS and $100 for ALS/ACLS for all charges. Charge for routine transport: $450 ** Ketchikan Fire Dept: NON RESIDENT: BLS: $ 300 ALS/ACLS: $ 525 SPECIAL RESCUE: $1025 ROUTINE TRANSPORT: $ 200 and $250 (depends on Level of treatment) RESIDENT ROUTINE TRANSPORT: $ 175 and $225 (depends on Level of treatment) *** Sitka Fire Dept: NON RESIDENT: BLS: $ 250 ALS/ACLS: $ 375 and $ 525 (depends on level of care needed) ROUTINE TRANSPORT: $ 175 (RESIDENT IS $150) AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: City of Anchorage (includes Girdwood) CONTACT NAME/TITLE: Sidney Jenkins, EMS Asst. DATE: 8/29/94 PHONE #: 267-4944 FAX #: POPULATION: 240,000 SERVICE PROVIDED BY: Paid ( Anchorage) LEVEL PROVIDED: ALS Volunteer (Girdwood) SUPPORTED BY: TAXES/SELF IS THERE A FEE? YES Is there a non-resident charge variation? NO CHARGE FOR MILEAGE? $6.00 per mile. BLS: $350 ACLS: $400 ROUTINE TRANSPORT: Fee same as BLS or refer to private service. ITEMIZED CHARGES? NO STANDBY CHARGES? NO SPECIAL RESCUE CHARGES? NO COLLECTION RATE? 72 % RUN VOLUME: 12,698 (1993) # NO TRANSPORTS: Not listed BILLING PROCEDURE? SELF REMARKS: City bills on behalf of fire department. NOTE: 1993 Breakdown of calls: 2,911 ALS Calls (38%) 4,764 BLS Calls (62%) Remainder of calls were No Transports OR referred to a private service (includes routine transports). AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: Central Emergency Services CONTACT NAME/TITLE: Steve O' Connor, Asst. Ch. DATE: 8/29/94 PHONE #: 262-4792 FAX #: POPULATION: 20,000 SERVICE PROVIDED BY: Paid & Volunteer LEVEL PROVIDED: ACLS SUPPORTED BY: Taxes & Self IS THERE A FEE? Yes Is there a non-resident charge variation? NO CHARGE FOR MILEAGE? Yes, $4.50 per mile from scene to hospital. BLS: $250 plus mileage. ACLS: $500 plus mileage. ROUTINE TRANSPORT: Not listed. ITEMIZED CHARGES? None STANDBY CHARGES? $50 per hour or actual cost ( calls over 2 hours) . SPECIAL RESCUE CHARGES? None COLLECTION RATE? Averaged 84.4% during past five months. RUN VOLUME: 961 (1993) # NO TRANSPORTS: 207 (1993 ) BILLING PROCEDURE? Contracted IF CONTRACTED, TO WHOM? Lynn Mitchell, Palmer, Alaska. REMARKS: Total of 824 patients transported (1993) . AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: Fairbanks Fire Department CONTACT NAME/TITLE: David Rockney, Batt. Chief DATE: 8/25/94 PHONE #: 459-6500 FAx #: 452-1588 POPULATION: 28,000 SERVICE PROVIDED BY: Paid LEVEL PROVIDED: Paramedic SUPPORTED BY: Taxes IS THERE A FEE? Yes Is there a non-resident charge variation? NO CHARGE FOR MILEAGE? None BLS: $250 ACLS: $350 ROUTINE TRANSPORT: $250 ITEMIZED CHARGES? No, cost included in fees. STANDBY CHARGES? None SPECIAL RESCUE CHARGES? None COLLECTION RATE? 77% RUN VOLUME: 2,000 per year # NO TRANSPORTS: 7 0 % BILLING PROCEDURE? SELF REMARKS: Contact Karen Shaver (459-6714) Finance Dept. AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: Homer Volunteer Fire Department CONTACT NAME/TITLE: Ms. Elaine Grabowski DATE: 8/29/94 PHONE #: 235-3155 FAx #: 235-3157 POPULATION: 9,000 + SERVICE PROVIDED BY: VOLUNTEERS/PAID LEVEL PROVIDED: Paramedic SUPPORTED BY: TAXES/SELF IS THERE A FEE? Yes Is there a non-resident charge variation? NO CHARGE FOR MILEAGE? $ 5.0 0 per mile, scene to hospital. BLS: $250 plus mileage ACLS: $500 plus mileage ROUTINE TRANSPORT: NO charge. ITEMIZED CHARGES? NO STANDBY CHARGES? $25.00 per half hour when standby is requested. SPECIAL RESCUE CHARGES? Standby charge only. COLLECTION RATE? 90% RUN VOLUME: 470 per year # NO TRANSPORTS: 5 % ( estimate ) BILLING PROCEDURE? SELF REMARKS: $300 charge for non emergency transport (DOA's to Morgue). AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: Juneau (Capitol City) Fire Department CONTACT NAME/TITLE: Curtis Jones, Fire Marshal DATE: 8/29/94 PHONE #: 789-7554 FAx #: 789-9769 POPULATION: 30,000 SERVICE PROVIDED BY: Volunteers/Paid LEVEL PROVIDED: ACLS SUPPORTED BY: Taxes/Self IS THERE A FEE? YES Is there a non-resident charge variation? YES CHARGE FOR MILEAGE? $ 6.0 0 per patient mile. BLS: $300 ACLS: $550 (includes one I.V. ) ROUTINE TRANSPORT: $450 (base on round trip transfer) ITEMIZED CHARGES? Yes, per supply, medication, and injury or illness severity. STANDBY CHARGES? Yes, $65 for the first hour, $30 for each additional hour (or fraction thereof) SPECIAL RESCUE CHARGES? Yes, two times actual cost for service. Air medivac service is $700 (four hours) for personnel only, plus $60 per hour over four hours. Does not include cost of flight. COLLECTION RATE? 8 0% RUN VOLUME: 2,000 per year # NO TRANSPORTS: 25% - 33% BILLING PROCEDURE? SELF REMARKS: Hospital is part of the City and bills on behalf of the fire department. There is a $50 credit for BLS and $100 credit for ALS/ACLS for residents, toward all base fees. AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: City of Ketchikan Fire Department CONTACT NAME/TITLE: Bill Kriegsman, Captain DATE: 8/29/94 PHONE #: 225-9616 FAx #: 225-9613 POPULATION: 15,000 SERVICE PROVIDED BY: VOLUNTEERS/PAID LEVEL PROVIDED: ACLS SUPPORTED BY: TAXES/SELF IS THERE A FEE? YES Is there a non-resident charge variation? YES CHARGE FOR MILEAGE? $5.25 per mile (plus ferry crossing fee of $21) BLS: Billed as Level III: (Resident) $275 (Non Resident) $300 Acts: Billed as Level IV: (Resident) $500 (Non Resident) $525 ROUTINE TRANSPORT: Billed as Level I: ( Resident) $175 (Non Resident) $200 Billed as Level II: (Resident) $225 (Non Resident) $250 ITEMIZED CHARGES? Yes STANDBY CHARGES? Yes - after 20 minutes fee is $2.25 per minute. SPECIAL RESCUE CHARGES? Billed as Level V: (Resident) $1000 (Non Resident) $1025 COLLECTION RATE? 75 % RUN VOLUME: 1,162 (1993 ) BILLING PROCEDURE? SELF # NO TRANSPORTS: Not listed REMARKS: City Finance Department bills for service. Transported total of 951 patients. AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: Kodiak Fire Department CONTACT NAME/TITLE: Andy Nault, Asst. Chief DATE: 8/29/94 PHONE #: 486-8050 FAX #: 486-8600 POPULATION: 15,000 + SERVICE PROVIDED BY: VOLUNTEERS/PAID LEVEL PROVIDED: ACLS SUPPORTED BY: TAXES/SELF IS THERE A FEE? YES Is there a non-resident charge variation? NO BASE RATE: $300 flat fee for all calls. CHARGE FOR MILEAGE? No BLS: Flat fee (above). ACLS: Flat fee (above). ROUTINE TRANSPORT: Flat fee ( above) . ITEMIZED CHARGES? Yes - supplies STANDBY CHARGES? No - do not offer standby service. SPECIAL RESCUE CHARGES? Yes - $50 per hour (x number of personnel on scene). COLLECTION RATE? 60% (estimate) RUN VOLUME: 800 - 1,000 per year # NO TRANSPORTS: 10% (estimate) BILLING PROCEDURE? CONTRACTED IF CONTRACTED, TO WHOM? Hospital REMARKS: Hospital bills for all supplies and fees. Hospital retains 25% of all fees and supply costs collected. Hospital provides all supplies to the service. AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: Matanuska Susitna Borough CONTACT NAME/TITLE : Ms. Kathie Cunningham DATE: 8 / 3 0 / 9 4 PHONE #: 746-1553 FAx #: 746-2696 POPULATION: 40,000 SERVICE PROVIDED BY: Volunteers LEVEL PROVIDED: ACLS SUPPORTED BY: TAXES/SELF IS THERE A FEE? YES Is there a non-resident charge variation? YES CHARGE FOR MILEAGE? $4.50 per patient mile. BLS: ( Resident) $100 (Non Resident) $250 ACLS : ( Resident) $200 (Non Resident) $350 ROUTINE TRANSPORT: Transport - Round trip ( all types) $450 ITEMIZED CHARGES? Yes STANDBY CHARGES? Yes - $65 plus round trip miles and $30 per hour after first hour. SPECIAL RESCUE CHARGES? None noted. COLLECTION RATE? 76% average RUN VOLUME: 2,824 (7/1/93 - 6/30/94) # NO TRANSPORTS: 15% BILLING PROCEDURE? CONTRACTED IF CONTRACTED, TO WHOM? Lynn Mitchell CPA REMARKS: Aircraft services are billed as follows: Direct cost billing to patient for any flight time costs incurred to borough. AMBULANCE SERVICES SURVEY NAME OF CITY/DEPARTMENT: Sitka Fire Department CONTACT NAME/TITLE: MS. Susan Coffland DATE: 8/29/94 PHONE #: 747-3233 FAX #: 747-7450 POPULATION: 8,500 SERVICE PROVIDED BY: VOLUNTEERS/PAID LEVEL PROVIDED: ALS SUPPORTED BY: TAXES/SELF IS THERE A FEE? YES Is there a non-resident charge variation? YES CHARGE FOR MILEAGE? None BLS: (Resident) $200 (Non Resident) $250 ALS: (Unstable Patient - Resident) $300 (Unstable Patient - Non Resident) $375 (Questionable Survivability - Resident) $450 (Questionable Survivability - Non Resident) $525 ROUTINE TRANSPORT: ( Resident) $15 0 (Non Resident) $175 ITEMIZED CHARGES? Yes STANDBY CHARGES? None noted SPECIAL RESCUE CHARGES? None noted COLLECTION RATE? Average 6 0 % - 7 0 % ( Billing within 5 days = 9 0 % ) RUN VOLUME: 700 -750 per year # NO TRANSPORTS: Unknown BILLING PROCEDURE? SELF REMARKS: City bills on behalf of the fire department. Changed to a tiered system recently - collections have improved. City of Kenai Kenai Fire Department Emergency Medical Service (ENS) - User Fee Proposal Questions and Answers & Information November 1994 F.roc1a5ure 4*// Introduction For years, the City of Kenai has provided Emergency Medical Services to residents and non-residents, without charging a fee. It is becoming more difficult to provide these services without initiating a user fee. In order to provide the Emergency Medical Services, we must provide continued training for our personnel and rescue vehicles must be maintained or replaced, when necessary. Emergency Medical Service providers are required to meet stringent State and Federal Regulations, or the service cannot exist. With this in mind, we hope this booklet of questions and answers can provide you with a complete outlook, of the what's and why's of the Emergency Medical Service user fee proposal. This proposal was not created to "get more money from the tax payer", but to keep our services running at peak performance through a user fee, rather than a tax increase or a cut in services. As you read further in the booklet, we hope you will understand the need for this proposed user fee and know that if the need ever arose, we would be there for you. At the end of this booklet is a short questionnaire. We hope you will take the time to fill it out and give us your input about this proposal. These comments will be given careful consideration by the City Council. Thank you for taking the time to become involved and we look forward to your support of the Kenai Fire Department. Respectfully, David C. Burnett Fire Chief QUESTION AND ANSWER SECTION Q: Why do we need an ambulance service? A: To provide emergency and non -emergency care and transport to the community on an "as needed" basis. This has proven to be a great asset to the community in time of injury or illness. Q: From where do you usually receive funds? A: The City's tax base provides most of the funding for day to day operations. However, most costs for vehicle replacement, maintenance, housing and personnel training are funded through matching grants. Many providers have been dependent on State and Federal grants. These funding sources are dwindling and will continue to decrease. For example, Federal Revenue Sharing to the City of Kenai has been cut from $750,000 to $0. Also, in the last seven years, State Municipal Assistance and Revenue Sharing has been cut from $1,500,000 to approximately $500,000. Therefore, it has become necessary to explore an alternative means of support for this service. Q: What is the logical solution? A: A user fee is perhaps the most logical and appropriate means of supplemental funding for local emergency medical services. Only those who use the service would pay this fee. City taxes would not be increased. This same principle also applies to water and sewer services, City Dock facilities, and senior housing services. All are funded by the user and NOT by the tax base of the City. Q: How can this help our ambulance service? A: While many rural services do not have adequate call volumes to financially support themselves exclusively through fees for services, user fees can offset costs to the City for required training and equipment. User fees can also provide a means to match those State and Federal grants which do remain available. Q: Will this decrease patient care? A: It will not impact access to, nor quality of, care. All patients will be provided emergency care and transportation without regard to race, creed, color, sex, national origin, or ability to pay. The consumer's ability to pay or economic status does not interfere with the delivery of -1- services in a time of need, nor does it affect the quality of emergency medical services provided. We anticipate we will write-off as uncollectible approximately 20% of all fees. This loss is in line with what the hospital now writes off. Q: How will the user fee revenues be used? A: They will be deposited to the General Fund, with a minimum of 20% of revenues to be put in a vehicle/equipment replacement fund, as proposed. This fund will also offset some personnel costs, such as overtime and training required to provide emergency medical services. The additional funds may also be used to offset costs of equipment replacement such as life support packs and cardiac equipment. Q: Will every patient pay a user fee? A: Every person that is treated or transported will pay a user fee. It is important to note that during the past five years (1989-1993), over 30% of patients transported reside outside the City of Kenai. Interestingly enough, of those who live elsewhere in the Kenai Peninsula Borough who require the services of the ambulance, would be required to pay a fee unless that services begins in the City of Kenai. Nikiski is paid by a special tax for the service. Q: How much does it cost the city to provide this service to us? A: Based on a five year average (1989-1993) of call -outs and transports, the average annual cost was $119,970. When you add in required training and personnel, equipment replacement, vehicle housing and maintenance, the average annual cost to provide emergency medical services is over $250,000. This does not include salaries. Q: Will there be a charge for supplies used? A: The proposal does include an itemized fee per supplies used. However, this fee is considerably lower than what a patient would pay for the same supplies at the hospital. Presently, supplies are traded out at the hospital. The patient is then billed by the hospital, not only for the supplies, but for the service to administer the supplies as well. This proposal would lower the patient cost for both the supplies and the service to administer them. Q: How will the user fee be structured? A: The proposal is designed to maintain a lower user fee for the resident of the City. Non-residents will have a higher -2- user fee. The following page explains each level of service, and gives examples of user fees for each level (resident versus non-resident). Q: Will you bill insurance companies? A: The majority of the people using the service do have insurance which covers emergency care for illness and injury, and expect to pay for this service. The proposal is flexible in its method of billing, but the most likely method would be to bill the patient, who would then pass the bill on to their insurance carrier. There are a variety of insurances available including auto, homeowners, health, Worker's Compensation and private insurance. Q: Who will be doing the actual billing to patients? A: The proposal includes two options: The City could manage this through the City Finance Department, or it could be contracted out. It should be noted that based on a five- year period (1989-1993), the average annual revenue possible was estimated at $157,928. Based on an 80% collection rate, the average annual collected revenue possible was estimated at $126,342. -3- QUESTIONNAIRE What is your opinion on the information you just read? Do you approve or disapprove and why? If you feel a User Fee is not the answer, what do you think the answer is? Do you have any other concerns or questions which should be addressed? Thank you for taking the time to give us your views. We will include all questionnaires in our proposal review. Please return to: Kenai Fire Department Attn: Susan Binkley 105 S. Willow Street Kenai, Alaska 99611 Phone: (907) 283-7666 KNICl. Y jyi To: John Williams, Mayor City Of Kenai 210 Fidalgo Avenue Suite 200 Kenai, Alaska 99611 From: Peter 0. Hansen, M.D. EMS Physician RE: Proposed Ambulance Fee For City Of Kenai Dear Mayor Williams, 11355 KENAI SPUR HWY. February 5, 1995 KENAI, A ASKA 99611 This letter is being sent with a request that it be read into the discussion and hearing on the above issue Wednesday evening May 8, 1995; it is unfortu- nate I will be out of town and thus unable to be present in person. It has been my belief for sometime the City Of Kenai should be charging a fee to users of the ambulance service the City provides. My reasoning is based on several factors outlined in the paragraphs below. The cost of keeping a high quality emergency medical service available for the public has gone up significantly during recent years. This includes the cost of continuing education necessary for paramedics and EMT's to keep current in a field with a rapid growth of technology, the cost of sophisti- cated new equipment that is necessary to provide life sustaining measures, the cost of keeping one or more well trained paramedics on duty at all times who are able to utilize this equipment. Kenai has the major airport on the Peninsula. The area hospital is located in Soldotna. Since Central Peninsula General Hospital has grown into a second level hospital, I predict the City is going to see more patients flown into our area hospital (via the Kenai Airport with ambulance transport) and at the same time we are going to see an increasing number of patients flown out of this hospital (via the Kenai Ambulance and the Kenai Airport) to tertiary level hospitals in Anchorage. Since many of these patients do not live in the City of Kenai, I believe it is appropriate they should help pay for our ambulance services through user fees. The City Of Kenai has a transient population a good part of the year and this includes fish processing plant workers and tourists who make use of ambulance services. It is appropriate for these individuals to help pay for ambulance service the City provides. Finally, it is my belief, services of all sorts should be paid for by users to the degree that the users use the services; in other words a routine transport requiring advanced cardiac life support would be charged more than a user requiring basic life support, etc. Sincerely, ' Peter 0. Hansen, M.D. POH:rs CC: Kenai Fire Department Attn: Susan Binkley 105 South Willow Street Kenai, Alaska 99611 MEMORANDUM Date: February 7, 1995 From: /David C. Burnett, Fire Chief To: Thomas J. Manninen. City Manager Subject: Estimated Revenues for Billing Estimated gross billings for a 12 month period were made by averaging the total number and types of responses for 1989-1993, then averaging those numbers. It was noted that non-residents accounted for an average of 30% of all patients transported. PROPOSED PROPOSED POSSIBLE BILLING LEVEL AVG PATIENTS/YR FEE REVENUES I 430 $ 325 $139,750.00 II 65 550 35,750.00 III 8 750 6,000.00 IV 8 1,500 12,000.00 Totals: 511 $193,500.00 Patient Miles: 5,621 % $4.50 per mile $ 25,294.50 Estimated Gross Billings: $218,794.50 Levels of Service LEVEL I: BASIC LIFE SUPPORT. Treatment and/or transport of a stable patient who may have an altered level of consciousness. Two to three personnel are needed, overtime may be necessary for recall, and generally 2 hours are adequate. LEVEL II: ADVANCED LIFE SUPPORT. Treatment and transport of a patient with unstable vital signs and altered level of consciousness. Pre -hospital treatment will not adequately stabilize these patients. Minimum of 3 personnel ar needed, overtime is necessary for recall, and minimum of 2 hours is necessary. LEVEL III: ADVANCED CARDIAC LIFE SUPPORT. Treatment and transport of a patient with deteriorating, life threatening condition. Survival is generally questionable, and pre -hospital care is needed immediately. Minimum of 3 to.4 personnel are needed, overtime is required for recall, and generally more than 2 hours are necessary. LEVEL IV: TECHNICAL RESCUES which tax the resources of the department. Entrapment of a victim requiring extensive extrication and Level II or III treatment would be examples of this level. Minimum of 5-6 personnel are needed, overtime is required for QUESTIONNAIRE RESPONSES Below are responses to the Questionnaire included in the packet of information mailed and made available to the public. The questionnaire answers have been compiled and retyped for easier reading. QUESTION 1: WHAT IS YOUR OPINION ON THE INFORMATION YOU JUST READ? At first, I did not have a problem with the idea of a user fee -- in fact I would support some type. Very informative. Looks like administration has done their homework. I can't help but wonder why the sudden need to charge for something that is already being paid for by tax dollars, and in the past has been provided to needy people without charge. No objection to ambulance user fees -- if it is used for just that alone. Will fees allow ambulance service to pay its own way? I believe the fee schedule should reflect the "middle of the road," i.e. BS $250, ALS/ACLS $450, Routine Transport $200, No Transport - No Charge. Although I have been a vocal opponent on ambulance fees -- I see the time coming when they are necessary -- users must pay. Seemed to be a sensible solution. Acceptable. QUESTION 2: DO YOU APPROVE OR DISAPPROVE AND WHY? (Disapprove circled.) Non-residents fees and definitions are not clear. Is a resident someone who works in Kenai? Is a resident someone who owns property in Kenai but lives elsewhere? Is a resident someone who lives and works in Kenai? I approve. I feel the fact that we are providing services outside the City is a big factor. I think that it is time but I feel the user fee should be used within the Fire Department. Granted, there will be administrative costs and a contingency for those that cannot afford to pay, but the Fire Department should receive their share as I am sure they will ultimately have to bear the brunt of the complaints from those that disagree with the fee system. I don't think this is a good idea. I know that my insurance would only pay 60% of the charge and I believe there are others who would not call for help because they have no money and no insurance. What about when someone else calls an ambulance for you -- who pays then? Basically, the numbers in the report concerning expenses is not a true representation of the expense involved -- there is a lot of double talk going on! (1) I str� object to these user fees going into the general fund. Obviously if you do that -- you don't need user fees for the ambulance service. I view this as a fee for users so property owners aren't the only ones paying for these services -- we most certainly don't need to put these collected fees into other departments. (2) I don't think patients should be billed by hospital. (3) Object to contracting out -billing services with exception of perhaps Medicare/Medicaid. But am sure a Finance Department clerk could handle this. (4) I think user fee funds should eat the costs of uncollectibles and believe it's more like 25%. (5) What will be your collection process for unpaid accounts? (6) How do you determine where/who/what account is deemed uncollectible? Will you go after their assets? (7) Who and when -- signs on for ambulance charge as responsible for debt and/or who/when signs on as responsible for billing costs? User fees are the most appropriate form of taxation. Those persons utilizing a specific service should help fund that service. Also, user fees may cut down on non -essential calls. I am not sure that non-resident fees should be double those of resident fees. What is thinking here? Especially since Medicare/Aid will not pay on a different schedule, what about a 25% discount for resident fees if paid within certain time period. Mr. Carey is right -- this is a controversial item -- be prepared for the onslaught. Approve. No free lunch. Yes! Because the Us should pay for the service, but not the homeowner on their tax billing. QUESTION 3: IF YOU FEEL A USER FEE IS NOT THE ANSWER, WHAT DO YOU THINK THE ANSWER IS? I think a fee could be the answer for additional dollars to help offset expenses if the funds saved or replaced are verifiably saved. (1) To continue to budget this program with money that the city already collects or has in its reserves. (2) Stop spending money foolishly in this department, i.e. new fire chiefs car, delivering flowers using a fire unit, holding weddings at the firehouse, etc. QUESTION 4: DO YOU HAVE ANY OTHER CONCERNS OR QUESTIONS WHICH SHOULD BE ADDRESSED? Not at this time. I feel we should be very liberal in our charge back system. There are those in the community who may not be able to pay, but they should be referred to agencies that may be able to assist them. Just that Kenai has money in reserve to run this program and need not increase its budget by increasing its revenues. The government is like a big green monster, the more you feed it, the more it grows. The bigger it gets, the more $ it takes to feed it -- STOP! I turn this in having doubts about it being included because it is not favorable to your cause. This department is known for its impropriety in following rules and regulations and misuse of public property. So be it! (8) In letter from Manninen -- 2nd paragraph -- states user fee MAY BE USED etc. -- Why not shall be if funds available -- while pg. 2 of questionnaire says 20% of revenues into a vehicle eqipment replacement fund. (9) Will Medicare/Medicaid cover all levels of rate/service? (10) Is air transport with personnel to Anchorage covered in fee schedule? Would medical fees (usually billed by hospital) now (by this proposal), include in fees for service -- still be billed by hospital also -- therefore double billed?? Will my taxes go down in response to this? i.e. with user fees paying the bills -- can I expect to see the $ demand on taxpayers decrease?? Although I've been assured by Mr. Brown that homes would not be taken to satisfy debts -- my husband wants his objection to be noted -- HOMES and means to get to work in order to pay said debt -- i.e. CARS should NOT be taken -- or only as a very last resort -- after all else has been tried. Do we have to hire additional personnel? How do you judge who needs the ambulance? Do you consider who called for the ambulance? There are times when the ambulance is called but wasn't needed. Who pays? And why do patients get shots, etc. when not needed (when they were awake and not asked)? 1791 - 1991 I CITY OF KENAI . rL T C�odal o f 7lhZkd _��j TO 210 Fidalgo, Suite 200 K�eaai,Alaska 99611-7794 Phone 907-283-7535 Fax 907-293-3014 r Date / / / Number of Pages 4_7 _�/?/ / _ �/_5 / V- -21F PUBLIC MEETING NOTICE The Kenai City Council will meet in a SPECIAL MEETING, FEBRUARY 81 1995 in the City Hall Council Chambers, beginning at 7:00 p.m.. The topic to be discussed is: PROPOSED AMBULANCE FEE Information packets regarding the proposed ambulance fee are available to the public at Kenai City Hall. The public is invited to attend and participate. Carol L. Freas City Clerk