HomeMy WebLinkAboutAgenda Report - September 18, 2002 I-02114 1 0004
CITY OF LODI COUNCIL COMMUNICATION
AGENDA TITLE: Approve City of Lodi Fire Department Paramedic Business Plan
MEETING DATE: September 18, 2002
PREPARED BY: Michael Pretz
RECOMMENDED ACTION: That the City Council approve the Lodi Fire Department Paramedic
Business Plan as presented.
BACKGROUND INFORMATION: Council is being asked to approve the Ambulance Transportation
Proposal allowing the City of Lodi to provide paramedic services to
the community and implement an emergency transportation program.
As Council will recall, the paramedic issue has been a subject of Council discussion since 1995. Council
has had many opportunities to discuss response times, number of ambulances in the City of Lodi, quality of
care, and the fire department's role in this program. In August of 2000, Council requested the fire
department evaluate the costs associated with establishing paramedic services within the fire department. In
January 2002, fire department staff presented four (4) options for Council to consideration. Staff was
directed to return with refined cost and revenue estimates and to evaluate partnerships with private
providers. In July 2002, fire department staff presented Council with the refined options and was directed
to return to Council with a "Business Plan" incorporating emergency medical transportation as an element
of the paramedic program.
During the July meeting, fire department staff provided Council with a description of the current state of
Emergency Medical Services in the City of Lodi. Since 1995, the City of Lodi has experienced an 11.9%
increase in population, a 35% increase in ambulance response time, a 72% increase in call volume, and a
varying number of ambulances in the City.
Council also reviewed information provided by the Reason Public Policy Institute, addressing "high
performance" EMS systems. Eighty percent of the cities illustrated in high performance systems utilized
fire department paramedics to do the bulk of the work. Moreover, 50% of the largest 200 cities in the nation
utilize fire based EMS systems, 22% utilize a combination fire-based/private partnership, and the remaining
280/. use private commercial providers.
The City of Lodi Fire Department Paramedic Business Plan (Ambulance Transportation Program) is a
comprehensive look at establishing a paramedic program within the fire department with an emergency
medical transportation component. The business plan covers projected fire department costs over a three
year build -out. In addition, a 5 -year revenue projection from two separate companies is included. The
APPROVED:
H. bixon Flynn -- City Manager
CITY OF LODI COUNCIL COMMUNICATION
revenue projections assume the City will provide 30% - 100% of the service. However, there are revenue
projections for lesser call volume included in this report.
In addition, the report includes an additional revenue source known as a subscription plan. The subscription
plan is modeled after a highly successful program in Huntington Beach, California and Eugene/Springfield,
Oregon. The essential elements of this program demonstrate that for a nominal voluntary fee, a subscriber
would not incur any out of pocket expenses for utilizing City of Lodi ambulances. With the exception of
Medicare patients, most insurance programs only cover 80% of the cost of ambulance services. That
remaining 20% is the responsibility of the patient. This program would cover those expenses even for
patients with no insurance. Subscribers could pay for the program with their utility bills. Details of this
program were forwarded to Council in a memo, dated August 29, 2002.
The key elements of this program call for an incremental approach to providing paramedic services. One
(1) ambulance and six (6) paramedics will be hired the first year of the program. A second ambulance and
six (6) paramedics will be hired the second year of the program with a third ambulance purchased in the
third year and the last three (3) paramedics hired. Billing for emergency medical transportation will be
handled by a third party.
Revenue generated by the transportation program and from the subscriber program is sufficient to cover all
the costs associated with the program. Revenue and cost projections are detailed in the proposal.
FUNDING: Funding will be developed for the 2003-2005 budget cycle.
Q-41zt��p
Michael E. Pretz
Fire Chief
Vicky McAthie
Finance Director
APPROVED:
H. Dixon Flynn -- City Manager
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I
Emergency Medical Services
Ambulance Transportation Proposal
LODI FIRE
DEPARTMENT
Emergency Medical Services
Mission Statement
- The mission of the Lodi Fire Department Emergency Medical Services (EMS)
Division is to provide the citizens of Lodi a complete pre -hospital emergency
medical care program, which includes ambulance transportation. The program
will provide a rapid response, on -scene patient treatment, and transportation to
the nearest medical facility. The proposed EMS program will ensure continuity,
consistent EMS resource deployment, and all the while ensuring quality patient
care. A fully integrated fire -based EMS program delivers an enhanced level of
EMS response and patient care. Under the guidance and policies of the City of
Lodi, our citizens will benefit from the teamwork provided by a unified command
structure.
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The Lodi Fire Department (LFD) currently provides fire suppression, basic life
support (BLS), and first response services to the citizens of Lodi.
With City Council support and approval the fire department will purchase the
appropriate equipment, and hire qualified personnel provide an enhanced level of
Emergency Medical Services (EMS), which includes transportation services to
the City of Lodi and the surrounding fire districts. The City of Lodi is in San
Joaquin County Ambulance Zone 4, which is detailed in Appendix A. Our
proposed EMS transportation program will provide a much higher level of service
than is currently provided to the residents of the greater Lodi area. The proposed
EMS transportation program will meet, and or exceed, the required standards
established by the San Joaquin County EMS Agency.
Our proposed EMS transportation program
enterprise fund, and would not be an ongoing
The operating cost associated with providing t
the community will be supported by service
service. Considering the
current emergency ambulance
transportation needs of the
community, it is estimated that
the program will generate
approximately $1,054,255 in O
gross charges. Based upon
current billing industry KYR
methodology the program will
collect approximately $701,790
in annual revenue. In our
proposal, we will demonstrate
how the proposed revenues will
clearly offset the anticipated
expenditures, while providing
the citizens of Lodi with
enhanced EMS services.
will be fiscally operated as an
burden to the City General Fund.
he EMS transportation program to
charges to those who utilize the
The Lodi Fire Department currently provides basic emergency medical service
first response to the citizens of Lodi. For many months the fire department
management staff has shown continuing concern regarding extended ambulance
response times, and low ambulance staffing resources for the citizens of Lodi. At
Council's direction, fire department management staff began to investigate
various options for ensuring efficient and quality EMS service delivery to the
community. After careful consideration and Council direction, the fire department
management staff was asked to develop a business plan with LFD providing
emergency ambulance transportation to the citizens of Lodi. The proposed EMS
program, which will include a transportation component, is designed to ensure
the patient receives quality care and the continuity afforded by a single service
provider.
By incorporating an emergency medical transportation program into the existing
fire department services, the citizens of Lodi will realize a higher level of
efficiency through a reduction in ambulance response times, consistent on -scene
patient care, and transportation to the closest medical facility. The citizens of
Lodi will also realize an enhanced level of effectiveness through a cross -trained
multi -tasked fire department. In addition, the fire department will be in a position
to eliminate duplicated services by incorporating administrative duties for both
Fire and EMS services under one command. Therefore, it is recommended the
City of Lodi implement emergency medical transportation into the Lodi Fire
Department operations at the earliest possible opportunity.
Under our current San Joaquin County EMS system in Zone 4, there is one (1)
commercial ambulance provider who is solely responsible for emergency 9-1-1
transportation services. The current provider operates a maximum of three (3)
Advanced Life Support (ALS) ambulances during most times of the day.
Although there are three ambulances assigned, they are not solely dedicated to
the 9-1-1 emergency system. Unfortunately, there are many times when the one
or more of the so-called dedicated ambulances have been utilized to perform
non -emergency functions. It is during these times, when the community has
reduced ALS ambulance resources that our citizens are at risk of extended
response times. This means the fire department is faced with continuing to
provide BLS treatment, while waiting for an ambulance to be dispatched from
another county EMS zone. If the Lodi Fire Department was equipped to provide
ALS intervention, and immediate transport, it could be the deciding factor on
saving the life of one of our citizens. Just imagine how you would feel if it was
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one of your family members we were trying to save? What kind of EMS system
would you prefer, one that is managed and supported within the community, or
- outside the community? I believe this whole issue begs the question of why the
City of Lodi has its own police and fire, rather than depending on San Joaquin
County to provide the service? I believe it is an issue of local control, and an
— expectation of immediate response and accountability. With these fundamental
concepts in mind, we feel the community of Lodi deserves an EMS system that is
efficient, professional, and subject to the needs and desires of the Citizens. If
this community were receiving the above-described level of service, I would not
feel it necessary to present this program.
- Our current commercial ambulance provider does not, and has not, been
meeting the expected service levels required for public safety for various
reasons. The commercial ambulance provider has:
Eliminated dedicated 9-1-1 ambulances for financial reasons.
• Continued to allow our EMS zone drop to a low ambulance status
without adding immediate resources.
Have placed ambulances out of service due to employees that
have become sick or injured on duty.
• Pulled 9-1-1 ambulances out of the system to support non-
emergency activities.
The American Heart Association (AHA) and the American Red Cross have
established specific guidelines for the amount of time the brain can survive
without oxygen, as is the case in sudden cardiac arrest. The established
guidelines require that Basic Life Support (BLS) measures begin in four (4)
minutes and Advanced Life Support (ALS) care is initiated within eight (8)
minutes. The chances of survival diminish drastically after eight (8) minutes.
San Joaquin County has adopted the eight (8) minute standard response time for
arrival of an ambulance.
The Lodi Fire Department has conducted a response time study based on years
1995 to 2001 using data reported to the San Joaquin County EMS Agency by
- American Medical Response (AMR) and the Stockton Fire Department's
Computer Aided Dispatch (CAD) system. The data shows the current
commercial ambulance provider has experienced an increase in response times
and at the same time has reduced the number of ambulances serving the Lodi
area.
- For these very important and significant reasons, the LFD has developed a
"complete" pre -hospital Emergency Medical Services (EMS) program that
includes the transportation of patients. Our proposed program will meet and/or
exceed the needs of a 9-1-1 emergency response for our community. The LFD
feels strongly that we can and will provide a dedicated 9-1-1 emergency
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ambulance transportation service greater than that of our current commercial
provider including timelier response periods.
Fire -based 9-1-1 emergency ambulance
advantages. The resource level is based
public safety needs are not compromised
established response time guidelines, an
ambulances must be strategically located
— concept forms the basis of our design.
transportation systems have many
on patient care while ensuring that
by "for-profit" motives. To meet the
efficient number of dedicated 9-1-1
in the community at all times. This
A Fire -based 9-1-1 ambulance transportation systems has the ability to
immediately staff additional reserve ambulances in emergency situations, such
as, Multi Casualty Incident's (MCI's) and Weapons of Mass Destruction (WMD)
occurrences. Current commercial ambulance providers are historically unable to
place additional ambulances in service during times of low status. Based on a
fire departments daily staffing levels for suppression companies, additional
ambulances can be immediately placed into service during these emergency
- types of situations.
Our proposed EMS program includes the implementation of two (2) fire -based
ambulances; each staffed with two (2) firefighter paramedics. These units will be
strategically located in current fire stations throughout our community. Through
strategic deployment we can provide more efficient compliance with the
nationally recognized eight (8) minute response time over ninety-five (95) percent
of the time. These resources will be available twenty-four (24) hours a day and
will be solely dedicated to the 9-1-1 EMS system in all areas of the San Joaquin
County Ambulance Zone 4. The program as designed, and fully implemented,
will necessitate the hiring of seventeen (17) additional fire personnel.
The capabilities of cross -trained firefighting personnel will serve to enhance the
LFD fire suppression abilities, provide greater patient care, and will result in a
lower cost to our community. With four (4) current first responder engine/truck
companies strategically located throughout our community, BLS care will be
available on scene within four (4) minutes. In addition, the fifth company will
return to Fire Station #1 (downtown) in 2003/2004.
This EMS proposal provides a detailed list of the additional personnel, equipment
and training needs to accomplish this vision. The costs for these services will be
offset by the recovery of user fees from ambulance transportation. The system
will be designed so that all costs associated with this program will be directed
into an Enterprise Fund eliminating any direct impact to the City's General Fund.
This program as designed, will allow the City of Lodi to capture, and fully utilize
the ambulance transportation user fees within our community, rather than being
received by an out-of-state for-profit corporation. Our current commercial
provider, American Medical Response (AMR), is a subsidiary of Laidlaw Inc.;
Toronto, Canada, with USA headquarters located in Aurora, Colorado.
I✓
Fire based 9-1-1 transportation has been successful in numerous other
communities in California. Several examples of which are detailed in this report.
Each of these communities recovers costs without an impact to their respective
General Funds.
This report provides you with two (2) revenue projections, each of which are
based on LFD EMS call volume, AMR reported call volume, local payer mix, and
current San Joaquin County ambulance rates. For example, the average
ambulance bill today is $483.35 for BLS calls and $661.45 for an ALS call.
Average actual payments are estimated to be $348.64 per call, when you
consider recognition of non-paying calls. These collected fees, which will be
billed to patients and/or their insurance carriers, will be utilized to pay for our
staffing and equipment requirements.
In addition, staff is developing a subscription service program that would
eliminate out of pocket expenses for members. The program sets a nominal
annual fee. Revenues generated from fees are used to offset program costs and
can be adjusted by Council.
The following summary is a breakdown of all projected costs needed for
implementation of a 9-1-1 fire based emergency ambulance transportation
system. These costs reflect the first year expenses to place one ambulance in
service.
Summary Year 1
The following analysis will demonstrate the identified cost associated with placing
one ambulance in service, and projecting a daily average of five (5) calls for
service. The first year personnel allocation will include six (6) paramedics, one
(1) EMS Coordinator, and one (1) clerical position, which is further described as:
Personnel Cos!
Units
Amount
Paramedics
6
$ 426.996.00
EMS Coordinator
1
$ 78,500.00
Clerk
1
$ 45,495.00
Total
$ 550,991.00
In addition to the capital expenses, which will be described later in this section,
there are additional operating costs associated with placing an ambulance in
service. The following analysis will describe the fuel, maintenance, and
ambulance permit costs for the first unit. Additionally, there will be medical
supply costs associated with properly stocking the ambulance to meet county
protocols, and re -stocking the ambulance after each call for materials used for
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patient care. The analysis also provides for the cost of oxygen for patient care.
The operation costs are further described as follows:
Operating Expenditures
Units
Amount
Fuel
1
$ 5,248.00
Maintenance
1
$ 5,485.00
Ambulance Permits
1
$ 480.00
Medical Supplies
1
$ 19,226.00
Oxygen
1
$ 1,013.00
Cell Phone
1
1 $ 240.00
Total
$ 31,692.00
By providing ambulance based services, the City of Lodi Fire Department will be
able to seek reimbursement for the cost of providing the service. The first year of
service is anticipated to provide annual revenue of $701,790.68. Due to the
complexity of ambulance medical billing, we are proposing to out -source the
billing services. The ambulance billing industry suggests an average service cost
of 7% of net receivables collected. The anticipated billing cost is as follows:
Out -Source Expenditures Receivables , Billing Fee
Billing Cost @ 7% $ 701,790.68 $ 49,125.35
Total $ 49,125.35
The capital cost associated with placing the ambulance in service will comprise
of items that are based on a one-time investment. The capital costs are further
described as follows:
Capital Expenditures
Units
Amount
Ambulances
1
$ 111,347.00
Personal Protective Equip.
6
$ 10,800.00
Office Supplies
$ 5,829.00
Station Equipment
$ 2,600.00
Uniforms
$ 1800.00
Total
$ 132,376.00
First Year Summary
The following table illustrates a one (1) year cost and revenue projection. A more
detailed analysis of multiple year projections will be provided later in this report.
Program Summary
Amount
Revenue
Expenditures
$
$
701,790.68
764184.35
Total
$
62,383.67
The following departments report success with a fire -based 9-1-1 emergency
ambulance transportation system. Their initial revenue receipts have exceeded
expectations and all operate without the use of General Fund monies. Many of
the departments have been providing this service for over ten (10) years.
San Francisco Fire Department
Annual transport volume: 63,000. Gross charges $26.5 million, net
collections of $15.3 million. Net collection rate of 57%. SFFD offsets
approximately 60% of paramedic service costs. Contact: Division Chief
Ron Louie, (415) 561-5904.
City of Sacramento Fire Department
Annual transport volume: 26,000. Gross charges $16.1 million, net
collections of $9.3 million. Net collection rate of 57%. $7.4 million in fire
department cost. Contact: Deputy Chief Rod Chong, (916) 264-7368.
City of Berkeley Fire Department
Annual transport volume: 6,500. Gross charges $3.5 million, net
collections of $1.9 million. Net collection rate of 54%. BFD offsets
approximately 67%-75% of fire department costs. Contact: Ann -Margaret
Moyer (510) 644-6595.
San Rafael Fire Department
Annual transport volume: 2,700. Gross charges $2.1 million, net
collections of $1.5 million. Net collection rate of 71%. The paramedic
program is self-sufficient and does not rely on general fund revenues.
Contact: Chief Robert Marcucci, (415) 485-3304.
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Conclusion
• The City of Lodi wants to provide 9-1-1 emergency ambulance
transportation services that are exclusively dedicated to the local area
(Zone 4) served by our 9-1-1 system.
• Through the LFD, the City of Lodi can provide faster, more efficient and
less expensive ambulance service to the citizens of our community.
• The City of Lodi, not commercial ambulance providers, must be able to
mandate the level of service to our community.
• Through the LFD, the City of Lodi has the ability to staff reserve
ambulances with on -duty firefighters during peak periods or during
disaster conditions. The current commercial ambulance providers do not
have this ability.
• Existing commercial ambulance provider will continue to operate in the
City of Lodi. The immediate implementation of one (1) fire department
operated ambulance is to protect the citizens of Lodi and add to the
stability of the system.
• Upon approval of the City Council and San Joaquin County EMS agency,
the implementation of our program for 9-1-1 emergency ambulance
transportation will begin by placing one (1) ambulance in service as soon
as possible. The adding of additional ambulance units will be staggered in
the event our current commercial ambulance provider shuts down any
units, or is unable to cover current ambulance districts. This schedule will
conclude when two (2) transport units are in place. A third ambulance will
be purchased and used as a reserve vehicle. However, this vehicle can
be placed into service when necessary.
• The City of Lodi wants private commercial ambulance providers available
to provide all non -emergency ambulance services for the community and
as back up to the 9-1-1 system as needed.
10
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System Design Objectives
This list of objectives will allow the City of Lodi Fire Department (LFD) to
implement ALS fire based transport services. Through a multi -step transition, the
LFD will provide most ALS response and emergency 9-1-1 patient
transportations. The following objectives need to be met prior to implementation:
• The LFD will secure all necessary authorization from the California
Emergency Medical Services Authority (CEMSA) and the San Joaquin
County Emergency Medical Services Agency (SJEMSA) to provide
emergency 9-1-1 patient transportation services.
• The LFD will develop EMS Response and Transport Operating
Procedures. Quality Assurance programs will be planned, developed and
implemented. This program will follow the established standards of the
Commission on Accreditation of Ambulance Services (CHAS).
• The LFD will hire seventeen (17) additional personnel to include fifteen
(15) firefighter/paramedics over the next three (3) years.
• The City of Lodi will secure the needed apparatus, equipment and capital
improvements from current and prospective vendors to provide
emergency 9-1-1 patient transportation.
• The City of Lodi will assume responsibility for EMS billing. This function
will be contracted to an experienced third -party billing provider. The City
of Lodi will prepare a Request for Proposal (RFP) for billing services.
• The LFD does not plan to utilize our ambulances for non -emergency inter-
facility transfers. Private ambulance companies will continue to provide
this service. Private ambulances shall be pulled into the 9-1-1 emergency
- system during low ambulance status. Similar agreements have been
reached in San Francisco and Sacramento to provide for these issues.
• The LFD will provide a ninety five percent (95%) compliance rate of
response times under the current eight (8) minute urban and twenty (20)
minute rural level defined as beginning from the receipt of the call to
arrival on scene.
• The 9-1-1 emergency ambulance transportation system call volume per
unit should be evaluated by the Fire Department when the transport
volume exceeds ten point seven (10.7) transports per unit per day to
ensure adequate response times, system coverage and personnel work
load.
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• Private ambulance providers will continue to operate in the City of Lodi.
This report recommends the immediate implementation of one (1) fire
based emergency transportation unit to protect the citizens of Lodi and to
provide stability to the present system.
The implementation schedule for 9-1-1 emergency ambulance
transportation will begin by placing one (1) ambulance in service as soon
as possible. Additional ambulance units will be staffed if current private
ambulance providers fail to staff any units, or are unable to cover current
ambulance districts. This plan allows for the flexibility to implement
resources as needed.
Ambulance Response Zones
The County of San Joaquin is divided into eight (8) geographic Ambulance
Response Zones. The City of Lodi is located in Zone 4. The borders for these
areas as follows:
South border of Eight Mile Road extending east and west to the Solano and
Calaveras County lines, the north border is the Sacramento County line.
The City of Lodi will need to provide 9-1-1 emergency ambulance transportation
to all areas of this Zone by agreement with the SJEMSA. This report will provide
for the needed personnel, equipment and vehicles to accomplish this objective.
See Appendix A for all San Joaquin County Ambulance Zones.
Fire Department Staffing
The Lodi Fire Department consists of
deployment functions are divided into
which are: Administration, Fire and
Emergency Medical Services.
Administration
one overall department, however, the
several specific areas of responsibility,
Life Safety, Training, and eventually,
The administrative section of the department is led by the Fire Chief, and
supported by the department secretary. The administrative arm is further divided
into four divisions; Fire Marshall, Information Technology, Fire Suppression, and
Emergency Medical Services. The administrative services are described in the
organization chart below.
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Fire Suppression Division
The LFD now operates one (1) battalion and three (3) engine and one (1) truck
companies; which are staffed in a three -shift schedule format. Each company
shift is staffed with a Captain, Engineer, and firefighters, as described below.:
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Additionally, a minimum of three (3) firefighters for each shift is cross -trained as
emergency medical technicians (EMT). Truck 1 is staffed with four (4) EMT's.
Starting in July of 2003, three (3) additional firefighters will be hired to bring an
engine company back to the downtown area. Six (6) of the ten (10) firefighters
have already been hired and placed on engine and truck companies. The hiring
process will be completed by 2004.
Fire Department Based Ambulance Staffing
The LFD will eventually staff two (2) twenty-four hour (24) ALS ambulances.
Each ambulance will be staffed with two firefighter paramedics. A third
ambulance will be purchased and used as a reserve unit or may be placed into
service as needed.
With a current daily staffing level of 15 fire suppression personnel, reserve
ambulances can be immediately placed into service. During large-scale
emergencies, off duty personnel can be called back to staff reserve ambulances.
The implementation of each unit will be based on the public safety need until a
total of two (2) twenty-four (24) ALS ambulances are in place.
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EMS Coordinator
-- A 40 -hour workweek EMS coordinator position will be established. The EMS
coordinator will be assigned the following duties:
- Coordinate all EMS activities to include:
❑ On -Duty Quality Assurance.
o Training
- ❑ Accreditation of new paramedics.
❑ Supply procurement and distribution.
❑ Liaison to hospitals.
o EMS customer service coordination.
With the increased workload, one new clerical staff member will need to be hired
to assist with the additional duties in the EMS division. This position will work
under the direction of the Department Secretary and their primary responsibilities
will include billing and collections support, record management, data collection,
and other duties as assigned. The Fire Chief and Human Resources Director will
determine their exact position title.
Clerical Support Staff
❑ Provide clerical support for EMS Billing;
❑ Records management support
a Collection and dissemination billing data
❑ Other clerical duties as assigned
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Fire Department Divisions
The implementation of a fire -based 9-1-1
emergency ambulance transportation
system will affect all other LFD Divisions.
Each Division will need to analyze this
report and determine any increased
personnel, equipment and management
needs. The LFD Division of Training will
require additional resources and these have
been planned for to train new personnel.
This report does not address current and
anticipated fire suppression vacancies. This report recommends that an
Oversight Committee be formed at the onset of system implementation
review all system needs at a minimum of six (6) month intervals.
EMS
and
The current Record Management System (RMS) and Pre -Hospital Care Reports
(PCR) are not set up for emergency transportation billing. A comprehensive
billing form has not been developed. The 3`d party biller will assist in billing
compliance, calculation and design.
Paramedic Pa
Due to the expansion of the ALS emergency 9-1-1 transportation system, all
certified paramedics, from the rank of Captain to Firefighter, should be paid as
paramedics when assigned to an engine or ambulance company. This will also
allow more flexibility for personnel assignments when adhering to the two (2)
paramedic per ambulance minimum staffing levels. For the purposes of this
pian, the paramedic incentive in calculated at 15% of the Firefighter II pay
classification. Actual incentive pay will need to be negotiated.
Paramedic Staffincl Level Needs
To minimally staff and implement this fire based 9-1-1 emergency ambulance
transportation system, the LFD will need fifteen (15) licensed paramedic
positions. In addition, paramedic positions may be needed to staff engine and
truck companies to increase flexibility and prevent paramedic burnout.
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Hirina Practices
The City of Lodi has a current entry-level firefighter list established. This list
contains approximately 200 certified names, which include nineteen (19)
paramedics. The Fire Department has the option of establishing a lateral entry
list. This option will allow the LFD to hire the required personnel while meeting
defined standards and staffing goals previously set by Council.
Based on the need for additional paramedic personnel, lateral entry criteria can
be established to include paramedic and EMS experience. Currently, there are
- several members of the commercial provider on the existing LFD eligibility list.
Paramedic Training Program
Due to the increased need for paramedic trained personnel, the LFD Division of
Training may need to sponsor and conduct a State of California approved
Paramedic Training Program. The curriculum will follow the Department of
Transportation (DOT) National Registry Guidelines. Future in-house personnel
may teach the curricula. It is estimated that the expense for this program can be
- off set by charging outside students a tuition fee. Current public and private
training costs for like programs average $5,500 per student.
Paramedic Certifications
All paramedic personnel hired after July 01, 2003 will be required to maintain San
Joaquin County Paramedic accreditation for a period of not less than five (5)
years. This practice will ensure an adequate number of experienced paramedics
for the expanded, fire -based 9-1-1 emergency ambulance transportation system.
Training Plans
The training proposal included in this report represents one possible contingency.
This proposal does not represent other hiring and training needs to fill anticipated
fire suppression vacancies. This proposal allows for flexibility.
The Division of Training will be required to conduct additional joint training
academies with the City of Stockton Fire Department. This may require current
line personnel to be placed on a forty (40) hour week in the Division of Training.
Relief pool personnel will be utilized to backfill vacancies that are created by the
transfer of line personnel to a forty (40) hour week
Due to the large number of new personnel, the priority of the department needs
to be training. All non -emergent activities should be reviewed and prioritized
during this transitional period. If fifteen (15) additional firefighter paramedics are
hired, these training plans will need to be modified.
Training Option
This option allows the LFD to train employees over a one (1) year period. The
current joint SFD/LFD academy is sixteen (16) weeks in length. One (1) Captain
and two (2) Firefighters and/or Engineers will instruct the academy.
Academy One — Nine (9) candidates consisting of six (6) firefighter paramedics
and three (3) firefighter EMT's. This will provide staffing for one (1) transport
unit, and meet current established suppression staffing needs.
Academy Two — Seven (7) candidates consisting of six (6) firefighter paramedics
and one (1) firefighter EMT. This will provide staffing for two (2) transport units.
Academy Three — Three (3) candidates consisting of three (3) firefighter
paramedics. This will provide relief staffing and the ability to staff the third unit.
19
Cost of Additional Personnel
We estimate that the department
will need fifteen (15) new
paramedic positions to implement
fire department based
transportation program and full
- build -out of the system. These
figures include the necessary
positions used to fill vacancies
created by vacations, sick leave,
etc. In the tables below, we show
the estimated cost of these new
- hires. The following table
illustrates the cost per employee
of the proposed additions.
Paramedic Salary
Base Pay
$51,169.50
Paramedic Incentive
7,675.00
Uniform Allowance
600.00
Team Membership
1,410.38
Education Incentive
600.00
Medical Insurance
3,085.80
Dental Insurance
916.56
Optical Insurance
175.56
Medicare
741.96
PERS
4,605.26
Unemployment Insurance
94.66
CHP
91.56
Total
$71,166.24
20
Summary
The following is the annual cost of the Ambulance Management Personnel.
Management Personnel
# of FTE's
Cost
Total
EMS Coordinator (Salary/Benefits)
1
$78,500
$78,500
Clerical Staff (possible)
1
$45,495
$45,495
Office Equipment
3
$5,829
$5,829
Totals
2
$11,000
1 $129,824
Cost of Personal Protective Equipment
The LFD requires personal protective equipment (PPE) for each new position.
The chart below illustrates the cost per person. These numbers are based upon
current city contracts.
Personal Protective Equipment
Units
Cost
Total
Turnouts/Helmets/Gloves
Uniforms
6
6
$1,800
$300
$10,800
$1,800
Totals
12
$2100
$12,600
Cost of Vehicles and Equipment
The Department will purchase, through the City of Lodi Fleet Management, three
(3) ambulance units at a base vehicle price of $72,900. These ambulances will
be equipped in accordance with current San Joaquin County Policy.
Wheeled Coach Industries bases the costs per unit on a bid. All other costs are
based on current vendors. The cost summary is as follows:
Cost of Vehicles and Equipment
Units
Cost
Total
Ambulance: Type III E450
3
$72,900
$218,700
Cell Phone
3
$35
$105
ALS/BLS Equipment
3
$21,412
$64,236
Radios (Mobile / 2 Portables)
3
$11,000
$33,000
SCBA's (2 per Ambulance) (active)
4
$6,000
$24,000
Totals
$111,347
$340,041
21
Operational Costs
-- Operating ambulances involves costs for fuel, maintenance and medical
supplies. These numbers are based upon current City of Stockton contracts and
maintenance costs provided by Fleet Management of the City of Lodi. Medical
- supply amounts were calculated from our current vendor and include a one (1)
year supply for system start-up.
Operational Costs Units Cost I Total
Fuel / 3 Ambulances (Annual) 3 $5,2481 $15,744
Maintenance / 3 Ambulances (Annual) 3 $5,485 $16,455
County Ambulance Permit (3 Annual) 3 $480 $1,440
Medical Supplies (1,460 Transports) 1 $19,226 $57,687
_ Oxygen (Monthly per 3 units) 3 $1,013 $3,039
Annual Cell Phone Service (3) 1 3 $240 $720
Totals $31,692 1 $95,085
The City of Lodi will be able to join the purchasing programs of the Cities of
Sacramento and Stockton for the purchase of ambulances, equipment and
drugs.
Medical Supply Management
The LFD will need to update our current medical supply procurement process to
include the addition of three (3) ambulances.
Paramedic/EMT License Fee
All new ambulance employees will be required to have a paramedic license.
Paramedic Licenses Units I Cost I Total
Paramedic License 6 1$130 $780
Totals 15 1 1 $1,950
Billing Expenses
The cost for billing services varies greatly based on a number of factors. For the
purposes of this report, we have included a percentage rate based on net
collections, which we feel represents a realistic fee for this service. A rate of
seven (7) percent has been calculated.
The rates quoted are based on historical averages from other agencies with
similar call volume, demographics and gross collections. A rate of seven (7)
percent was chosen for this service based on a more conservative comparable
22
The rates quoted are based on historical averages from other agencies with
similar call volume, demographics and gross collections. A rate of seven (7)
percent was chosen for this service based on a more conservative comparable
fee for service from the City of Sacramento Fire Department, Sacramento
Metropolitan Fire District and the San Francisco Fire Department and two (2)
bids from AIS and Sky Med.
Net Service
Anticipated Cost of Billing
Services Collections Fee
Expense Summary
The following tables represent the first year expenses.
Costs Year 1
Personnel Costs
Summary -Personnel Costs Cost
Ambulance Staff (6) $426,997
Ambulance Management Staff (1) $78,500
Clerical (1) $45,495
Licensing/Certification (6) $780
Totals $551,772
Capital Costs
Personnel Cost Summary
The following table provides for a five (5) year comparison of personnel and
operational costs associated with the 9-1-1 emergency ambulance system. This
calculation is based on the historical wage increase of two point five (2.5) percent
per years 1 and 2, 3% years 3 and 4, and 3.5% for year 5 includes all projected
positions.
23
$12,600
Personal Protective Equipment
Vehicles/Equipment
$111,347
Office Supplies
$5,829
Station Equipment
$2,600
Totals
$132,376
Personnel Cost Summary
The following table provides for a five (5) year comparison of personnel and
operational costs associated with the 9-1-1 emergency ambulance system. This
calculation is based on the historical wage increase of two point five (2.5) percent
per years 1 and 2, 3% years 3 and 4, and 3.5% for year 5 includes all projected
positions.
23
Annual Personnel Costs
Year
Cost
2003
$550,992
2004
$1,002,474
2005
$1,237,332
Svstem Implementation
This plan will allow the LFD flexibility in providing emergency ambulance
transportation services for Zone 4. An initial recommendation is to place one (1)
ambulance in service to increase the level of public safety within our community.
Additional resources can be allocated to provide for the public safety need, as
private resources are deemed inadequate. The total implementation costs are
further described in the fiscal model on the following page.
24
Lodi Fire Department
Engine Company Firefighter/Paramedics Cost Analysis
Fiscal Year
2003/2004
2004/2005
2005/2006
Dollar
Addl.
Dollar
Addl.
Dollar
Cate ories
Units
Amount
Units
Amount
Units
Amount
Expenditures
Personnel
Paramedics
6
$ 426,996.00
6
$ 864,666.90
3
$ 1,105,128.57
EMS Coordinator
1
$ 78,500.00
$ 80,462.50
$ 82,474.06
Clerk
1
$ 45,495.001
$ 46,632.38
$ 47,798.18
Total
$ 550,991.00
$ 991,761.78
$ 1,235,400.82
Operating Expenditures
Medical Supplies
$ 19,226.00
$ 38,452.00
$ 57,678.00
Oxygen
$ 1,013.00
$ 2,026.00
$ 3,039.00
Cell Phone
$ 240.00
$ 480.00
$ 720.00
Total
$ 20,479.00
$ 40,958.00
$ 61,437.00
Total Expenditures
$ 571,470.00
$ 1,032,719.78
$ 1,296,837.82
Capital Expenditures
Personal Protective Equip.
6
$ 10,800.00
6
$ 10,800.00
3
$ 5,400.00
Office Supplies
$ 5,829.00
$ -
$ -
Station Equipment
$ 2,600.00
$ -
$ -
Uniforms
$ 1,800.00
$ 1,800.00
Is 900.00
Total
$ 21,029.00
$ 12,600.00
$ 6,300.00
Total Capital Expenditures
$ 21,029.00
$ 12,600.00
$ 6,300.00
Total Cost
1
$ 592,499.00
$ 1,045,319.78
$ 1,303,137.82
Lodi Fire Department
Ambulance Transportation Cost Analysis
Fiscal Year
2003/2004
2004/2005
2005/2006
Categories
Units
Dollar
Amount
Addl,
Units
Dollar
Amount
Addl.
Units
Dollar
Amount
Operating Expenditures
Fuel
Maintenance
Ambulance Permits
$ 5,248.00
$ 5,485.00
$ 480.00
$ 10,496.00
$ 10,970.00
$ 960.00
$ 15,744.00
$ 16,455.00
$ 1,440.00
Total
$ 11,213.00
$ 22,426.00
$ 33,639.00
Total Expenditures
$ 11,213.00
$ 22,426.00
$ 33,639.00
Capital Expenditures
Ambulances
1
$ 111,347.00
1
$ 111,347.00
1
$ 111,347.00
Total
$ 111,347.00
$ 111,347.00
$ 111,347.00
Total Capital Expenditures
$ 111,347.00
$ 111,347.00
$ 111,347.00
Net Reserves
$ 122,560.00
$ 133,773.00
$ 144,986.00
C�12V tq
i____.._
Lodi Fire Department
Ambulance Transportation Cost Analysis
Fiscal Year
2003/2004
2004/2005
2005/2006
Dollar
Addl.
Dollar
Addl.
Dollar
Categories
Units
Amount
Units
Amount
Units
Amount
Revenue
Prior Reserve
$ -
$ (62,393.67)
$ (344,167.97)
Fees for Service
$ 701,790.68
$ 964,858.57
$ 1,351,665.00
Total
$ 701,790.68
$ 902,464.90
$ 1,007,497.03
Total Revenue
$ 701,790.68
$ 902,464.90
$ 1,007,497.03
Personnel
Paramedics
6
$ 426,996.00
6
$ 864,666.90
3
$ 1,105,128.57
EMS Coordinator
1
$ 78,500.00
$ 80,462.50
$ 82,474.06
Clerk
1
$ 45,495.00
$ 46,632.38
$ 47,798.18
Total
$ 550,991.00
$ 991,761.78
$ 1,235,400.82
Operating Expenditures
Fuel
$ 5,248.00
$ 10,496.00
$ 15,744.00
Maintenance
$ 5,485.00
$ 10,970.00
$ 16,455.00
Ambulance Permits
$ 480.00
$ 960.00
$ 1,440.00
Medical Supplies
$ 19,226.00
$ 38,452.00
$ 57,678.00
Oxygen
$ 1,013.00
$ 2,026.00
$ 3,039.00
Cell Phone
$ 240.00
$ 480.00
$ 720.00
Total
$ 31,692.00
$ 63,384.00
$ 95,076.00
Out-Source Expenditures
Billing Cost
$ 49,125.35
$ 67,540.10
$ 94,616.55
Total
$ 49,125.35
$ 67,540.10
$ 94,616.55
Total Expenditures
$ 631,808.35
$ 1,122,685.87
$ 1,425,093.37
Net Operating Cost
$ 69,982.33
$ (220,220.97)
$ (417,596.34)
Capital Expenditures
Ambulances
1
$ 111.347.00
1
$ 111,347.00
1
$ 111,347.00
Personal Protective Equip.
6
$ 10,800.00
6
$ 10,800.00
3
$ 5,400.00
Office Supplies
$ 5,829.00
$ -
$ -
Station Equipment
$ 2,600.00
$ -
$ -
Uniforms
$ 1,800.00
$ 1,800.00
$ 900.00
Total
$ 132,376.00
$ 123,947.00
1
$ 117,647.00
Total Capital Expenditures
$ 132,376.00
1
$ 123,947.00
$ 117,647.00
Net Reserves
$ (62,393.67)
$ (344,167.97)
$ (535,243.34)
Lodi Fire Department
Ambulance Transportation Cost Analysis
Fiscal Year
2003/2004
2004/2005
2005/2006
Dollar
Addl.
Dollar
Addl.
Dollar
Categories
Units
Amount
Units
Amount
Units
Amount
Revenue
Prior Reserve
$ -
$ 145,450.17
$ 71,519.71
Fees for Service
$ 701,790.68
$ 964,858.57
$ 1,351,665.00
Membership Program
$ 223,488.00
$ 223,488.00
$ 223,488.00
Total
$ 925,278.68
$ 1,333,796.74
$ 1,646,672.71
Total Revenue
$ 925,278.68
$ 1,333,796.74
$ 1,646,672.71
Personnel
Paramedics
6
$ 426,996.00
6
$ 864,666.90
3
$ 1,105,128.57
EMS Coordinator
1
$ 78,500.00
$ 80,462.50
$ 82,474.06
Clerk
1
$ 45,495.00
$ 46,632.38
$ 47,798.18
Total
$ 550,991.00
$ 991,761.78
$ 1,235,400.82
Operating Expenditures
Fuel
$ 5,248.00
$ 10,496.00
$ 15,744.00
Maintenance
$ 5,485.00
$ 10,970.00
$ 16,455.00
Ambulance Permits
$ 480.00
$ 960.00
$ 1,440.00
Medical Supplies
$ 19,226.00
$ 38,452.00
$ 57,678.00
Oxygen
$ 1,013.00
$ 2,026.00
$ 3,039.00
Cell Phone
$ 240.00
$ 480.00
$ 720.00
Total
$ 31,692.00
$ 63,384.00
$ 95,076.00
Outsource Expenditures
Billing Cost
$ 49,125.35
$ 67,540.10
$ 94,616.55
Membership Collections
$ 15,644.16
$ 15,644.16
$ 15,644.16
Total
$ 64,769.51
$ 83,184.26
$ 110,260.71
Total Expenditures
$ 647,452.51
$ 1,138,330.03
$ 1,440,737.53
Net Operating Cost
$ 277,826.17
$ 195,466.71
$ 205,935.18
Capital Expenditures
Ambulances
1
$ 111,347.00
1
$ 111,347.00
1
$ 111,347.00
Personal Protective Equip.
6
$ 10,800.00
6
$ 10,800.00
3
$ 5,400.00
Office Supplies
$ 5,829.00
$ -
$ -
Station Equipment
$ 2,600.00
$ -
$ -
Uniforms
$ 1,800.00
$ 1,800.00
$ 900.00
Total
$ 132,376.00
$ 123,947.00
$ 117,647.00
Total Capital Expenditures
$ 132,376.00
$ 123,947.00
$ 117,647.00
Net Reserves
$ 145,450.17
$ 71,519.71
$ 88,288.18
. ....... r _ ...
Lodi Fire Department
Engine Company Firefighter/Paramedics Cost Analysis
Fiscal Year
2003/2004
2003/2004
2004/2005
2005/2006
Categories
Units
Dollar
Amount
Addl.
Units
Dollar
Amount
Addl.
Units
Dollar
Amount
Expenditures
$ 897,318.47
$ 1,257,048.45
Total Expenditures
Total Expenditures
$ 11,213.00
$ 571,470.00
$ 22,426.00
$ 1,032,719.78
$ 33,639.00
$ 1,296,837.82
Capital Expenditures
Total Capital Expenditures
Total Capital Expenditures
$ 111,347.00
$ 21,029.00
$ 111,347.00
$ 12,600.00
$ 111,347.00
$ 6,300.00
Total Cost W/Ambulances
-1,045,319.781
$ 133,773.00
$ 144,986.00
Total Cost E/C Paramedics
$ 592,499.00 1
$
1
$ 1,303,137.82
Lodi Fire Department
Ambulance Transportation Cost Analysis
Fiscal Year
2003/2004
2004/2005
2005/2006
Categories
Units
Dollar
Amount
Addl.
Units
Dollar
A mount
Addl.
Units
Dollar
Amount
Operating Expenditures
3 652,665.33
$ 897,318.47
$ 1,257,048.45
Total Expenditures
$ 11,213.00
$ 22,426.00
$ 33,639.00
Capital Expenditures
Total Capital Expenditures
$ 111,347.00
$ 111,347.00
$ 111,347.00
Total Cost W/Ambulances
$ 122,560.00
$ 133,773.00
$ 144,986.00
Total Operating/Capital Cost $ 715,059.00 $ 1,179,092.78 $ 1,448,123.82
Revenue
2003/2004
2004/2005
2005/2006
Fees for Service
$ 701,790.68
$ 964,858.57
$ 1,351,665.00
Billing Cost
$ 49,125.35
$ 67,540.10
$ 94,616.55
Net Receivables
3 652,665.33
$ 897,318.47
$ 1,257,048.45
Total Reserves 1 $ (62,393.67) $ (344,167.97) $ (535,243.34)
Cost Recovery Projections
For the purposes of this report, we have included
- two (2) independent revenue projections from Sky
Med and Allied Information Services.
- Cost recovery will require the use of a third party
billing company due to the complexity and timing
needs of medical billing. The following revenue
- projections are based upon our current transport
volume, hospital payer mix study and year 2000 San
Joaquin County approved ambulance rates.
We have also included a successful subscription /
program from Huntington Beach, CA. This program
was developed in Eugene/Springfield, Oregon. The
program allows a member to pay a voluntary annual fee
The fee covers any out of pocket expenses encountered in using the Lodi Fire
Department ambulance. For the purposes of this plan, a $36.00 annual fee was
used. Moreover, a 30% enrollment population was used. See Appendix D
We have used two revenue projections in the business plan. The initial
projection assumes the City will provide 100% of the service to its citizens. The
second projection assumes an average call volume of 5 calls per day and a
collection rate of less than 65%. Both billing companies we have spoken top are
certain that the collection rate will exceed 70%.
Reimbursement Definitions
Assignment is mandatory under the new fee schedule. The City of Lodi will need
to accept the Medicare amount as payment in full and may only bill the patient for
unmet co -payment and deductible amounts, not the full charges. The definitions
of the individual rates are as follows:
BLS: Basic Life Support transport to include intravenous line placement when
local protocols allow for this procedure.
ALS1: Advanced Life Support transport when an ALS assessment or the
provision of one (1) ALS intervention is administered.
26
ALS2: The administration of at least three (3) different medications and the
- provision of at least one (1) of the following procedures: defibrillation,
endotracheal intubation, central venous line, cardiac pacing, chest
decompression, surgical airway or intraosseus line. Dextrose, Normal Saline or
- Ringers Lactate IV Solutions are not medications under this rule.
BLS/ALS Emergency: Emergency response qualifies for higher payment and is
defined as 9-1-1 immediate response.
27
Appendix A
►:
2002 AMBULANCE RECEIVABLE PROJECTIONS FOR LODI FIRE DEPARTMENT
TYPE
OF CALLS RUN PER YEAR WITH AMOUNTS
BLS 02
25%
AVERAGE PAYMENT PER CALL
Cancelled in route
Description
Charge
Extended
Total extended
% of Calls Calls
Medicare @
981', Medical @
98"/,,
Private @ ;i.
Insu. @ 98%
$462.14 $2,310.70 $3,234.97 $4,621.39 $5,033.
Average miles =
6
Average Night BLS
38% 1511
BY CALLS RUN PER DAY iYEARLYt
NOTES
'3 '(
ALS 1 -A0427
$580.00
$580.00
$876,255.30
50%
$486.96
$279,562.91
$118.20
$37,500.71
$580.00 $113,913.19
$245,351.48
Mileage -A0425
$12.30
$73.80
$111,495.93
$10.28
$35,410.38
$3.55
$6,757.74
$12.30 $14,494.47
$31,218.86
Night Charge
$61.00
$61.00
$9,215.79
$0.00
$0.00
$9.88
$313.46
$61.00 $1,198.05
$2,580.42
Oxygen - A0422
$46.00
$46.00
$17,374.03
$32.06
$4,601.40
$9.88
$783.64
$46.00 $2,258.62
$4,864.73
Yearly Total
$1,014,341.05
X313 183 '0
S44 448 44
S43 511 i:',
_ ' "i:?5 18
Average Net Payment
5449.75
.or,v t:, Av"'utr
o Po horn"". Z rvwetr i:,: odvnt:.
:.1$
10% 398
ALS 2-A0433
$580.00
$580.00
$230,593.50
$516.64
$78,053.20
$118.20
$9,868.61
$580.00 $29,977.16
$64,566.18
Mileage -A0425
$12.30
$73.80
$29,341.04
$10.28
$9,318.52
$3.55
$1,778.35
$12.30 $3,814.33
$8,215.49
Night Charge
$61.00
$61.00
$4,850.42
$0.00
$0.00
$9.88
$164.98
$61.00 $630.55
$1,358.12
Oxygen- A0422
$46.00
$46.00
$18,288.45
$32.06
$4,843.58
$9.88
$824.89
$46.00 $2,377.50
$5,120.77
Yearly Total
$283,073.40
N) 370 99
S 1:' 384 09
S 12 14', 8
_ G75 34
Average Net Payment
5484.37
!t,;! .r Avvi qf,
Paymc,iW
52% 2067
BLS -A0429
$395.00
$395.00
$816,619.05
$292.83
$230,049.65
$118.20
$51,316.75
$395.00 $106,160.48
$228,653.33
Mileage -A0425
$12.30
$73.80
$152,573.38
$10.28
$48,456.31
$3.55
$9,247.44
$12.30 $19,834.54
$42,720.55
Night Charge
$61.00
$61.00
$6,305.54
$0.00
$0.00
$9.88
$214.47
$61.00 $819.72
$1,765.55
Oxygen - A0422
$46.00
$46.00
$23,774.99
$32.06
$6,296.65
$9.88
$1,072.36
$46.00 $3,090.75
$6,657.00
Yearly Total
$999,272.96
4, '05 56
S60 314 00
42,c6 ;
200.50
Average Net Payment
ate,
S317,69
10
GRAND TOTAL (Yearly)
$2,296,687.41
100% 3976
$682,660.74
$117,446.52
$98,527.89
$630,211.02
Grand Total of Average Net Payments
5384.54
BASIC FIGURES FOR CALCULATION AN77C1_PATE-D REVENUES SECTION
AVERAGE AMOUNT OF CALLS RUN PER YEAR PERCENTAGE OF OTHER CHARGES BY CALLS RUN PER DAY
ime @ 9.3% of population (57,000) = 5301 Average ALS 102 25% 5 7 10 10.89
lsport 75% 3976 Average ALS 2 02 100% 50% of receivable is $288.84 $1,444.19 $2,021.86 $2,888.37 $3,146.15
Non -transport
20% 1060Average
BLS 02
25%
Cancelled in route
5% 265
Average Night ALS 1
10%
TOTAL & CROSS CHECK
100% 5301
Average Night ALS 2
20%
80% of receivable is
$462.14 $2,310.70 $3,234.97 $4,621.39 $5,033.
Average miles =
6
Average Night BLS
5%
BY CALLS RUN PER DAY iYEARLYt
NOTES
CALLS PER DAY times
365 5 7 10 10.
50%
$527,127.53 $737,978.54 $1,054,255.05 $1,148,343.
80% $843,404.04 $1,180,765.66 $1,686,808.08 $1,837,349.92
5 7 10 10.89
BY AVERAGE NET PAYMENTS S701 790 68 S982 506.95 S1 403 581 35 S'1 528 846.181
CREATED BY SKYMED AMBULANCE BILLING BY PAYMENTS DiViD[:f1 BY PAYORS r4; tn1 8',
2003 AMBULANCE RECEIVABLE P�OJEC1'IONS FOR LODI FIRE DEPARTMENT
TYPE OF CALLS RUN PER YEAR WITH AMOUNTS
Volume @ 9.3% of population (58,140) =
5407
Average ALS 102
AVERAGE PAYMENT PER CALL
Transport 75%
4055
Description
Charge
Extended
Total extended
% of Calls Calls
Medicare @
8",.
Medical @
98",.
Private @
"%
Insu. @ 98'%
Average Night ALS 2
20°h
Average miles =
6
38% 1541
50X
10
11.11
BY AVERAGE NET PAYMENTS
5689.184 00
S964.85857
S1 37&369 39
ALS 1 -A0427
$580.00
$580.00
$893,777.10
$457.12
$267,679.46
$118.20
$38,250.58
$580.00
$116,191.02
$250,257.59
Mileage - A0425
$12.30
$73.80
$113,725.43
$9.26
$32,534.72
$3.55
$6,892.87
$12.30
$14,784.31
$31,843.12
Night Charge
$61.00
$61.00
$9,400.07
$0.00
$0.00
$9.88
$319.73
$61.00
$1,222.01
$2,632.02
Oxygen - A0422
$46.00
$46.00
$17,721.44
$24.52
$3,589.59
$9.88
$799.31
$46.00
$2,303.79
$4,962.00
Yearly Total
$1,034,624.04
92`+,- T TO
S4533, 24
44 ' 85 37
,)22 900 84
Average Net Payment
$435.66
,rr;; ;r Averr:(je ;yr +ww, i.)
:;y r:;;;
21.91
10% 406
ALS 2 - A0433
$580.00
$580.00
$235,204.50
$517.67
$79,772.69
$118.20
$10,065.94
$580.00
$30,576.59
$65,857.26
Mileage - A0425
$12.30
$73.80
$29,927.75
$9.26
$8,561.77
$3.55
$1,813.91
$12.30
$3,890.61
$8,379.77
Night Charge
$61.00
$61.00
$4,947.41
$0.00
$0.00
$9.88
$168.28
$61.00
$643.16
$1,385.27
Oxygen - A0422
$46.00
$46.00
$18,654.15
$24.52
$3,778.52
$9.88
$841.38
$46.00
$2,425.04
$5,223.16
Yearly Total
$288,733.80
S90 <70 72
`:12 631 72
31',_ 015, 68
S 37 19,2228,55
Average Net Payment
5479.67
fii!•r.'r;tr e r>: ;.'ir rr i "I f?;
36
52% 2109
BLS -A0429
$395.00
$395.00
$832,948.35
$295.25
$236,588.96
$118.20
$52,342.90
$395.00
$108,283.29
$233,225.54
Mileage - A0425
$12.30
$73.80
$155,624.27
$9.26
$44,521.19
$3.55
$9,432.35
$12.30
$20,231.16
$43,574.80
Night Charge
$61.00
$61.00
$6,431.63
$0.00
$0.00
$9.88
$218.76
$61.00
$836.11
$1,800.86
Oxygen -A0422
$46.00
$46.00
$24,250.40
$24.52
$4,912.08
$9.88
$1,093.80
$46.00
$3,152.55
$6,790.11
Yearly Total
$1,019,254.65
S281i:10; -7)
:vit `;260!i
;(:•
c,ri83.47
Average Net Payment
3315.61
GRAND TOTAL (Yearly)
$2,342,612.49
100% 4055
$668,300.20
$119,795.01
$100,498.08
$642,812.87
Grand
Total of Average Net Payments
5377.64
AVERAGE AMOUNT OF CALLS RUN PER YEAR PERCENTAGE OF OTHER CHARGES
Volume @ 9.3% of population (58,140) =
5407
Average ALS 102
25°/
Transport 75%
4055
Average ALS 2 02
100°/
Non -transport 20%
1081
Average BLS 02
25°/
Cancelled in route 5%
270
Average Night ALS 1
100%
TOTAL & CROSS CHECK 100%
5407
Average Night ALS 2
20°h
Average miles =
6
Average Night BLS
50X
NOTES
Medicare's rates were calculated useing a two (2) percent CPI over the previous years rates
The CPI was not used for Medical allowable rates.
Population was calculated at two (2) percent increase over the previous years population.
CREATED BY SKYMED AMBULANCE BILLING
BY CALLS RUN PER DAY
5 7 10 11.11
50% of receivable is $288.84 $1,444.19 $2,021.86 $2,888.37 $3,209.06
80% of receivable is $462.14
$2,310.70
$3,234.97
$4,621.39
$5,134.49
BY CALLS RUN PER DAY (YEARLY]
CALLS PER DAY times 365
5
7
10
11.11
50%
$527,127.53
$737,978.54
$1,054,255.05
$1,171,306.24
80%
$843,404.04
$1,180,765.66
$1,686,808.08
$1,874,089.99
5
7
10
11.11
BY AVERAGE NET PAYMENTS
5689.184 00
S964.85857
S1 37&369 39
Si 5 ! 406.16
BY PAYMEN''S DIVIDED #.3Y PAYORS
41
I 1 i I 1
2004 AMBULANCE RECEIVABLE( k0JECTIIONS FOR LODI FIRE DEPARTMENT
TYPE OF CALLS RUN PER YEAR WITH AMOUNTS
ANTICIPATED REVENUES SECTION
AVERAGE PAYMENT PER CALL
Description
Charge
Extended
Total extended
% of Calls Calls
Medicare @
98`i, Medical @
98$0 Private @
Insu. @ 9811/0
7
10
11.33
Transport 75% 4135 Average ALS 2 02
38% 1571
50% of receivable is
$288.84 $1,444.19
$2,021.86
$2,888.37
$3,271.97
Non -transport 20% 1103 Average BLS 02
ALS 1 -A0427
$580.00
$580.00
$911,298.90
$425.72
$254,179.49
$118.20
$39,000.45
$580.00 $118,468.86
$255,163.69
Mileage -A0425
$12.30
$73.80
$115,954.93
80% of receivable is
$8.19
$29,339.43
$3.55
$7,028.00
$12.30 $15,074.14
$32,467.38
Night Charge
$61.00
$61.00
$9,584.35
11.33
$0.00
$0.00
$9.88
$325.99
$61.00 $1,245.97
$2,683.62
Oxygen -A0422
$46.00
$46.00
$18,068.86
$16.67
$2,488.24
$9.88
$814.98
$46.00 $2,348.95
$5,059.28
Yearly Total
$1,054,907.04
5280 287 01
$843,404.04
546,226 04
545255 51
5289 466.49
5
7
10
11.33
4:"
BY AVERAGE NET PAYMENTS
Si,iS 832 38
5946.165.33
S1 3.51 C,6,1 I -F
",1 5? 1176.95
CREATED BY SKYMED AMBULANCE BILLING
BV PAYFV., :NTS AVfDE(-, i3Y PAYOR
Average Net Payment
$420.85
Tot,p elf Av et,lge fli)yn7F,'n2 : [)l V;dod "y f)s1'iir
10% 413
ALS 2-A0433
$580.00
$580.00
$239,815.50
$518.33
$81,440.27
$118.20
$10,263.28
$580.00 $31,176.02
$67,148.34
Mileage - A0425
$12.30
$73.80
$30,514.46
$8.19
$7,720.90
$3.55
$1,849.47
$12.30 $3,966.88
$8,544.05
Night Charge
$61.00
$61.00
$5,044.40
$0.00
$0.00
$9.88
$171.58
$61.00 $655.77
$1,412.43
Oxygen -A0422
$46.00
$46.00
$19,019.85
$16.67
$2,619.20
$9.88
$857.88
$46.00 $2,472.58
$5,325.56
Yearly Total
$294,394.20
,., ±.'144 7E=,
S
- > Z,^
3 12 879
, c'>c :
o
> 0.781 77
Average Net Payment
5474.60
I t.
toti,f of Avtv(jc' t-';ipoc r; P;
52% 2150
BLS -A0429
$395.00
$395.00
$849,277.65
$297.54
$243,098.09
$118.20
$53,369.04
$395.00 $110,406.09
$237,797.74
Mileage -A0425
$12.30
$73.80
$158,675.17
$8.19
$40,148.69
$3.55
$9,617.26
$12.30 $20,627.77
$44,429.05
Night Charge
$61.00
$61.00
$6,557.71
$0.00
$0.00
$9.88
$223.05
$61.00 $852.50
$1,836.16
Oxygen -A0422
$46.00
$46.00
$24,725.81
$16.67
$3,404.96
$9.88
$1,115.24
$46.00 $3,214.35
$6,923.23
Yearly Total
$1,039,236.33
3 2
o1 i)
44 :_
„". 166 45
Average Net Payment
5313.34
GRAND TOTAL (Yearly)
$2,388,537.57
100% 4135
$651,150.48
$122,143.50
$102<,468.26
$655,414.71
Grand Total of Average Net Payments
5370.32
BASIC FIGURES FOR CALCULATION
ANTICIPATED REVENUES SECTION
AVERAGE AMOUNT OF CALLS RUN PER YEAR PERCENTAGE OF OTHER CHARGES
BY CALLS RUN PER DAY
Volume @ 9.3% of population (59,280) = 5513 Average ALS 102
25%
5
7
10
11.33
Transport 75% 4135 Average ALS 2 02
100%
50% of receivable is
$288.84 $1,444.19
$2,021.86
$2,888.37
$3,271.97
Non -transport 20% 1103 Average BLS 02
25%
Cancelled in route 5% 276 Average Night ALS 1
10%
TOTAL 8 CROSS CHECK 100% 5513 Average Night ALS 2
20%
80% of receivable is
$462.14 $2,310.70
$3,234.97
$4,621.39
$5,235.15
Average miles = 8 Average Night BLS
5%
CALLS PER DAY times 365
BY
5
CALLS RUN PER
7
DAY (YEARLY/
10
11.33
NOTES
Medicare's rates were calculated useing a two (2) percent CPI over the previous years rates.
50%
$527,127.53
$737,978.54
$1,054,255.05
$1,194,268.79
The CPI was not used for Medical allowable rates.
Population was calculated at two (2) percent increase over the previous years population.
80%
$843,404.04
$1,180,765.66
$1,686,808.08
$1,910,830.06
5
7
10
11.33
BY AVERAGE NET PAYMENTS
Si,iS 832 38
5946.165.33
S1 3.51 C,6,1 I -F
",1 5? 1176.95
CREATED BY SKYMED AMBULANCE BILLING
BV PAYFV., :NTS AVfDE(-, i3Y PAYOR
8
I
I 2005 A6ULANCE RECEIVABLE PROJECTIONS FOR L06 FIRE! DEPARTMENT
TYPE OF CALLS RUN PER YEAR WITH AMOUNTS
BASIC FIGURES FOR CALCULATION
AVERAGE PAYMENT
PER CALL
Volume @ 9.3% of population
Description
Charge
Extended
Total extended
% of Calls Calls
Medicare @
98%1: Medical @
98`x,
Private @ 3 3' .,
Insu. @ 98%
50% of receivable is
Non -transport
20%
1124
38% 1601
25%
Cancelled in route
5%
281
? '
ALS 1 -A0427
$580.00
$580.00
$928,820.70
5619
$392.78
$239,021.44
$118.20
$39,750.32
$580.00 $120,746.69
$260,069.80
Mileage -A0425
$12.30
$73.80
$118,184.43
$7.07
$25,814.17
$3.55
$7,163.13
$12.30 $15,363.98
$33,091.64
Night Charge
$61.00
$61.00
$9,768.63
$0.00
$0.00
$9.88
$332.26
$61.00 $1,269.92
$2,735.22
Oxygen - A0422
$46.00
$46.00
$18,416.27
$8.49
$1,291.62
$9.88
$830.65
$46.00 $2,394.12
$5,156.56
Yearly Total
$1,075,190.03
S260 204 6k
',47.114 84
`46 12-5 6,)
X15 032 14
137
Average Net Payment
S405.31
tJ t; l; i,f ^✓i"r.:ir.J%*
P�iyrn�r!h: Ulvi�.'�.'iI : ' Fl.l; ��
24.94
10% 421
ALS 2-A0433
$580.00
$580.00
$244,426.50
$518.63
$83,054.19
$118.20
$10,460.61 $580.00 $31,775.45
$68,439.42
Mileage -A0425
$12.30
$73.80
$31,101.17
$7.07
$6,793.20
$3.55
$1,885.03 $12.30 $4,043.15
$8,708.33
Night Charge
$61.00
$61.00
$5,141.39
$0.00
$0.00
$9.88
$174.87 $61.00 $668.38
$1,439.59
Oxygen - A0422
$46.00
$46.00
$19,385.55
$8.49
$1,359.60
$9.88
$874.37 $46.00 $2,520.12
$5,427.95
Yearly Total
$300,054.60
° _' ,?
:; 275 1-'% 3a
:;34.98
Average Net Payment
5469.16
t.,; ::, , .:r.;uo
1';7.0.44
52% 2191
BLS - A0429
$395.00
$395.00
$865,606.95
$299.69
$249,562.59
$118.20
$54,395.18 $395.00 $112,528.90
$242,369.95
Mileage -A0425
$12.30
$73.80
$161,726.06
$7.07
$35,324.65
$3.55
$9,802.18 $12.30 $21,024.39
$45,283.30
Night Charge
$61.00
$61.00
$6,683.80
$0.00
$0.00
$9.88
$227.34 $61.00 $868.89
$1,871.46
Oxygen -A0422
$46.00
$46.00
$25,201.22
$8.49
$1,767.48
$9.88
$1,136.68 $46.00 $3,276.16
$7,056.34
Yearly Total
$1,059,218.02
.,280 ,2 i 63
864 2`'5u 1 �5 4 .=.4G 4`1
',0 649 43
-3
Average Net Payment
5310.88
GRAND TOTAL (Yearly)
$2,434,462.65
100% 4214
$631,109.17
$124,491.98 $104,438.45
$668,016.55
Grand Total of Average Net Payments
S362.59
40
icare's rates were calculated useing a two (2) percent CPI over the previous years rates
CPI was not used for Medical allowable rates.
ulation was calculated at two (2) percent increase over the previous years population.
CREATED BY SKYMED AMBULANCE BILLING
ICALLSPERDAYti,,,
50%
ANTICIPATED REVENUES SECTION
BY CALLS RUN PER DAY
5 7 10 11
$288.84 $1,444.19 $2,021.86 $2,888.37 $3,334
$462.14 $2,310.70 $3,234.97 $4,621.39 $5,335.81
BY CALLS RUN PER DAY iYEARL'Y.!
365 5 7 10 11.55
$527,127.53 $737,978.54 $1,054,255.05 $1,217,231.33
80% $843,404.04 $1,180,765.66 $1,686,808.08 $1,947,570.12
5 7 10 11.55
BY AVERAGE NET PAYMENTS S661.731.62 $926.424.27 S1 323 463.24 51.528 056.15
BY PAYMENTS DIVIDED Bv PAYORS 34
BASIC FIGURES FOR CALCULATION
AVERAGE AMOUNT OF CALLS RUN PER YEAR PERCENTAGE OF OTHER CHARGES
Volume @ 9.3% of population
(60,420) =
5619
Average ALS 102
25%
Transport
75%
4214
Average ALS 2 02
100%
50% of receivable is
Non -transport
20%
1124
Average BLS 02
25%
Cancelled in route
5%
281
Average Night ALS 1
10%
TOTAL & CROSS CHECK
100%
5619
Average Night ALS 2
20%
80% of receivable is
Averane miles =
6
Average Night BLS
5%
icare's rates were calculated useing a two (2) percent CPI over the previous years rates
CPI was not used for Medical allowable rates.
ulation was calculated at two (2) percent increase over the previous years population.
CREATED BY SKYMED AMBULANCE BILLING
ICALLSPERDAYti,,,
50%
ANTICIPATED REVENUES SECTION
BY CALLS RUN PER DAY
5 7 10 11
$288.84 $1,444.19 $2,021.86 $2,888.37 $3,334
$462.14 $2,310.70 $3,234.97 $4,621.39 $5,335.81
BY CALLS RUN PER DAY iYEARL'Y.!
365 5 7 10 11.55
$527,127.53 $737,978.54 $1,054,255.05 $1,217,231.33
80% $843,404.04 $1,180,765.66 $1,686,808.08 $1,947,570.12
5 7 10 11.55
BY AVERAGE NET PAYMENTS S661.731.62 $926.424.27 S1 323 463.24 51.528 056.15
BY PAYMENTS DIVIDED Bv PAYORS 34
Lodi Fire Department
Year 1 Expenses
Expense Revenue Comparison
Year 1 Revenue
Personnel
Total Expenses
Paramedic Salary
$426,997.44
EMS Coordinator
$78,500.00
Clerical Staff
$45,495.00
Personal Protective Equipment
$46,718.18
Tu rnouts/Helmets/Gloves
$10,800.00
Uniforms
$1,800.00
Vehicle & Equipment
$605,124.69
Ambulance: Tpe III E450
$72,900.00
Cell Phone
$35.00
ALS/BLS Equipment
$21,412.00
Radios
$11,000.00
SCBA's (2 per Ambulance)
$12,000.00
Operational Cost
Fuel
$5,248.00
Maintenance
$5,485.00
County Ambulance Permit
$480.00
Medical Supplies (1,825 Transports)
$18,250.00
Oxygen
$1,013.00
Annual Cell Phone Service
$240.00
Paramedic License Fee
$780.00
Misc.
Office Equipment
$5,829.00
Station Equipment
$2,600.00
Billing Expense
$42,358.73
Total Expenses
$763,223.17
Transport Volume
1,825
Gross Billing
$1,135,880.00
Cash Receipts
Medicare
$239,678.59
MediCal
$46,718.18
Insurance
$277,972.55
SelfPay
$40,755.37
Net Revenue
$605,124.69
Lodi Fire Department
Year 2 Expenses
Personnel
Paramedic Salary
EMS Coordinator
Clerical Staff
Personal Protective Equipment
Tu rn o u is/H el mets/G loves
Uniforms
Vehicle & Equipment
Ambulance: Tpe III E450
Cell Phone
ALS/BLS Equipment
Radios
SCBA's (2 per Ambulance)
Operational Cost
Fuel
Maintenance
County Ambulance Permit
Medical Supplies (3,650 Transports)
Oxygen
Annual Cell Phone Service
Paramedic License Fee
Misc.
Office Equipment
Station Equipment
Billing Expense
Total Expenses
Expense Revenue Comparison
Year 2 Revenue
$78,500.00
$45,495.00
$10,800.00
$1,800.00
$72,900.00
$35.00
$21,412.00
$11,000.00
$12,000.00
$10,496.00
$10,970.00
$960.00
$36,500.00
$2,026.00
$480.00
$1,560.00
$0.00
$2,600.00
$82,168.18
255,697.06
Transport Volume
3,650
Gross Billing
$2,271,760.00
Cash Receipts
Medicare
$442,939.00
MediCal
$93,436.35
Insurance
$555,945.11
Self Pay
$81,510.75
Net Revenue
$1,173,831.21
Lodi Fire Department Expense Revenue Comparison
Personnel
Paramedic Salary
EMS Coordinator
Clerical Staff
Personal Protective Equipment
Tu rn o uts/H el mets/G loves
Uniforms
Vehicle & Equipment
Ambulance: Tpe III E450
Cell Phone
ALS/BLS Equipment
Radios
SCBA's (2 per Ambulance)
Operational Cost
Fuel
Maintenance
County Ambulance Permit
Medical Supplies (3,741 Transports)
Oxygen
Annual Cell Phone Service
Paramedic License Fee
Misc.
Office Equipment
Billing Expense
Total Expenses
$78,500.00
$45,495.00
$5,400.00
$900.00
$72,900.00
$35.00
$21,412.00
$11,000.00
$12,000.00
$15,744.00
$16,455.00
$1,440.00
$37,410.00
$3,039.00
$720.00
$1,950.00
$0.00
$81,604.85
473 498.45
Transport Volume 3,741
Gross Billing $2,328,398.40
Cash Receipts
Medicare $416,669.08
MediCal $95,765.86
Insurance $569,805.66
Self Pay $83,542.93
Net Revenue $1,165,783.53
LODI FIRE DEPARTMENT BALANCE SHEET SUMMARY
Personnel
$1,191,488.60
Cash Receipts
Personal Protective Equipment
$6,300.00
Medicare
Vehicle & Equipment
$117,347.00
MediCal
Operational Cost
$76,758.00
Insurance
Misc
$81,604.85
SelfPa
Total Expenses
$1,473,498.45
Net Revenue
$239,678.59
$46,718.18
$277,972.55
$40,755.37
$605,124.69
$442,939.00
$93,436.35
$555,945.11
$81,510.75
1,173,831.21
$416,669.08
$95,765.86
$569,805.66
$83,542.93
Net Revenue
Gross Billing
Gross Collection Rate
Net Collection Rate
Transport Volume:
Non -Billable: 8%
Total Billable Volume:
Lodi Fire Department
Year 1 Revenue Projection
1,825
146
1,679
$605,124.70
$1,135,880.00
53%
73%
— Paver Mix:
Medicare 38% 638
MediCal 21% 353
Insurance 28% 470
_
Self Pay 13% 218
1,679
_ Estimated Fee Schedule
Rate Usage
Weighted Average
ALS
$580.00 52%
$301.60
BLS
$395.00 48%
$189.60
- Night Charge
$61.00 40%
$24.40
Oxygen
$46.00 50%
$23.00
Mileage (6 miles@ $12.30 per)
$73.80 100%
$73.80
_ Nonreusable supplies
$10.00 100%
$10.00
$622.40
Reimbursement Reimbursement
Cash Receipts Rate per bill
Volume
Cash Receipt
Medicare $375.66
638
$239,678.59
— MediCal $132.50
353
$46,718.18
Insurance 95% $591.28
470
$277,972.55
Self Pay 30% $186.72
218
$40,755.37
_
$605,124.70
Assumptions:
_ Transport volume 1,825 (Per Fire Department, based on 5 calls per day)
Average transport is 6 miles. (Provided by Lodi Fire
Department)
Medicare reimbursement is based on second year implementation of New Medicare Fee Schedule
(60% old allowable / 40% new allowable)
Payer mix based on hospital data (Provided by Lodi Fire Department)
Rates are based on County allowable Fee Schedule.
ALS/BLS mix based on demographic area.
AIS Revene Projection Updated August 2002
_ Net Collection Calculation:
Gross Billing
$1,135,880.00
Less Statutory Adjustments:
Medicare $136,580.94
MediCal $172,733.84
$309,314.78
Adjusted Gross Billing
$826,565.22
Total Cash Receipts
$605,124.70
73%
AIS Revene Projection
Updated August 2002
Lodi Fire Department
Year 2 Revenue Projection
Net Revenue
$1,175,831.21
Gross Billing
$2,271,760.00
Gross Collection Rate
52%
Net Collection Rate
73%
Transport Volume: 3,650
— Non -Billable: 8% 292
Total Billable Volume 3,358
- Paver Mix:
Medicare 38% 1,276
MediCal 21% 705
Insurance 28% 940
Self Pay 13% 437
3,358
Estimated Fee Schedule
Rate Usage
Weighted Average
ALS
$580.00 52%
$301.60
BLS
$395.00 48%
$189.60
— Night Charge
$61.00 40%
$24.40
Oxygen
$46.00 50%
$23.00
Mileage (6 miles@ $12.30 per)
$73.80 100%
$73.80
Nonreusable supplies
$10.00 100%
$10.00
$622.40
Reimbursement Reimbursement
Cash Receipts Rate per bill
Volume
Cash Receipt
Medicare $347.12
1,276
$442,939.00
— MediCal $132.50
705
$93,436.35
Insurance 95% $591.28
940
$555,945.11
Self Pay 30% $186.72
437
$81,510.75
$1,173,831.21
Assumptions:
Transport volume 3,650 (Average 5 transports per day / per unit)
Average transport is 6 miles. (Provided by Lodi Fire
Department)
Medicare reimbursement is based on third year implementation of New Medicare Fee Schedule
(40% old allowable / 60% new allowable)
Payer mix based on hospital data (Provided by Lodi Fire Department)
Rates are based on County allowable Fee Schedule.
ALS/BLS mix based on demographic area.
AIS Revene Projection Updated August 2002
Net Collection Calculation:
_
Gross Billing
$2,271,760.00
Less Statutory Adjustments:
Medicare $312,744.64
- MediCal $345,467.68
$658,212.33
Adjusted Gross Billing
$1,613,547.67
Total Cash Receipts
$1,173,831.21
73%
AIS Revene Projection
Updated August 2002
Lodi Fire Department
Year 1 Expenses
Personnel
Quantity
Cost per
Total Cost
Paramedic Salary
6
$71,166.24
$426,997.44
EMS Coordinator
1
$78,500.00
$78,500.00
Clerical Staff
1
$45,495.00
$45,495.00
Personal Protective Equipment
Turnouts/Helmets/Gloves
6
$1,800.00
$10,800.00
Uniforms
6
$300.00
$1,800.00
Vehicle & Equipment
Ambulance: Type III E450
1
$72,900.00
$72,900.00
Cell Phone
1
$35.00
$35.00
ALS/BLS Equipment
1
$21,412.00
$21,412.00
Radios
1
$11,000.00
$11,000.00
SCBA's (2 per Ambulance)
2
$6,000.00
$12,000.00
Operational Cost
Fuel
1
$5,248.00
$5,248.00
Maintenance
1
$5,485.00
$5,485.00
County Ambulance Permit
1
$480.00
$480.00
Medical Supplies (1,825 transports)
1
$10/transport
$18,250.00
Oxygen
1
$1,013.00
$1,013.00
Annual Cell Phone Service
1
$240.00
$240.00
Paramedic License Fee
6
$130.00
$780.00
Misc.
Office Equipment
$5,829.00
Station Equipment
$2,600.00
Billing Expense (7% of Net Collections
of $605,124.70)
$42,358.73
Total Expesnse $763,223.17
Assumptions:
Implementing one ambulance and crew full time with an average of 5 calls per day
Lodi Fire Department
Year 2 Expenses
- Personnel
Paramedic Salary
12
EMS Coordinator
1
Clerical Staff
1
Personal Protective Equipment
2
Turnouts/Helmets/Gloves
6
Uniforms
6
Vehicle & Equipment
2
Ambulance: Type III E450
1
Cell Phone
1
ALS/BLS Equipment
1
Radios
1
SCBA's (2 per Ambulance)
2
Operational Cost
Cost per
$71,166.24
$78,500.00
$45,495.00
$1,800.00
$300.00
$72,900.00
$35.00
$21,412.00
$11,000.00
$6,000.00
Fuel
2
$5,248.00
Maintenance
2
$5,485.00
County Ambulance Permit
2
$480.00
Medical Supplies (3,650 Transports)
2
$10/transport
Oxygen
2
$1,013.00
Annual Cell Phone Service
2
$240.00
Paramedic License Fee
12
$130.00
Misc.
Office Equipment
Station Equipment
Billing Expense (7% of Net Collections of $1,173,831.21)
Total Expesnse
Assumptions:
Maintain original ambulance and implement second ambulane and crew,
Average 5 transports per day per unit.
Lodi Fire
Total Cost
$78,500.00
$45,495.00
$10,800.00
$1,800.00
$72,900.00
$35.00
$21,412.00
$11,000.00
$12,000.00
$10,496.00
$10,970.00
$960.00
$36,500.00
$2,026.00
$480.00
$1,560.00
$0.00
$2,600.00
$82,168.18
$1,255,697.06
Personnel
Quantity
Cost per
Total Cost
— Paramedic Salary
15
$71,166.24
$1,067,493.60
EMS Coordinator
1
$78,500.00
$78,500.00
Clerical Staff
1
$45,495.00
$45,495.00
Personal Protective Equipment
Tu mouts/Helmets/G loves
3
$1,800.00
$5,400.00
Uniforms
3
$300.00
$900.00
_ Vehicle & Equipment
Ambulance: Type III E450
1
$72,900.00
$72,900.00
Cell Phone
1
$35.00
$35.00
ALS/BLS Equipment
1
$21,412.00
$21,412.00
Radios
1
$11,000.00
$11,000.00
SCBA's (2 per Ambulance)
2
$6,000.00
$12,000.00
Operational Cost
Fuel
3
$5,248.00
$15,744.00
Maintenance
3
$5,485.00
$16,455.00
County Ambulance Permit
3
$480.00
$1,440.00
Medical Supplies (3,741 Transports)
3
$10/transport
$37,410.00
Oxygen
3
$1,013.00
$3,039.00
Annual Cell Phone Service
3
$240.00
$720.00
Paramedic License Fee
15
$130.00
$1,950.00
Misc.
Office Equipment
$0.00
Billing Expense (7% of Net Collections of $1,165,783.53)
$81,604.85
Total Expesnse
$1,473,498.45
Assumptions:
Two full time units. Hire additional 3 paramedics
and purchase
reserve ambulance.
Estimating 2.5% increase in call volume.
Net Revenue
Gross Billing
Gross Collection Rate
Net Collection Rate
Transport Volume:
- Non -Billable: 8%
Total Billable Volume:
Lodi Fire Department
3,741
299
3,442
_ Payer Mix:
52%
$301.60
Medicare
38%
1,308
MediCal
21%
723
Insurance
28%
964
_
Self Pay
13%
447
$10.00
100%
3,442
- Estimated Fee Schedule
ALS
BLS
— Night Charge
Oxygen
Mileage (6 milesO $12.30 per)
_ Nonreusable supplies
$1,165,783.53
$2,328,398.40
50%
72%
Rate Usaoe Weiohted Averaoe
$580.00
52%
$301.60
$395.00
48%
$189.60
$61.00
40%
$24.40
$46.00
50%
$23.00
$73.80
100%
$73.80
$10.00
100%
$10.00
$591.28
964
$622.40
Cash Receipt
$416,669.08
$95,765.86
$569,805.66
$83,542.93
$1,165,763.53
Assumptions:
Transport volume 3,741 (Estimating 2.5% increase per Fire Department)
Average transport is 6 miles. (Provided by Lodi Fire Department)
Medicare reimbursement is based on fourth year implementation of New Medicare Fee Schedule
(20% old allowable / 80% new allowable)
Payer mix based on hospital data (Provided by Lodi Fire Department)
Rates are based on County allowable Fee Schedule.
ALS/BLS mix based on demographic area.
AIS Revene Projection Updated August 2002
Reimbursement
Reimbursement
Cash Receipts
Rate
per bill
Volume
Medicare
$318.59
1,308
MediCal
$132.50
723
Insurance
95%
$591.28
964
Self Pay
30%
$186.72
447
Cash Receipt
$416,669.08
$95,765.86
$569,805.66
$83,542.93
$1,165,763.53
Assumptions:
Transport volume 3,741 (Estimating 2.5% increase per Fire Department)
Average transport is 6 miles. (Provided by Lodi Fire Department)
Medicare reimbursement is based on fourth year implementation of New Medicare Fee Schedule
(20% old allowable / 80% new allowable)
Payer mix based on hospital data (Provided by Lodi Fire Department)
Rates are based on County allowable Fee Schedule.
ALS/BLS mix based on demographic area.
AIS Revene Projection Updated August 2002
Net Collection Calculation:
_
Gross Billing
$2,328,398.40
Less Statutory Adjustments:
Medicare $361,111.46
MediCal $354,080.71
$715,192.17
Adjusted Gross Billing
$1,613,206.23
Total Cash Receipts
$1,165,783.53
72%
AIS Revene Projection
Updated August 2002
RESOLUTION NO. 2002- _ ?,A 14-
r
A RESOLUTION OF THE LODI CITY COUNCIL
APPROVING THE CITY OF LODI FIRE DEPARTMENT
PARAMEDIC BUSINESS PLAN (AMBULANCE
TRANSPORTATION PROGRAM)
NOW, THEREFORE, BE IT RESOLVED, that the Lodi City Council does hereby
approve the Lodi Fire Department Paramedic Business Plan, thus allowing the City of
Lodi to provide paramedic services to the community and implement an emergency
transportation program.
Dated: September 18, 2002
-----------------------------------------------------------
-----------------------------------------------------------
I hereby certify that Resolution No. 2002- was passed and adopted by the
Lodi City Council in a regular meeting held September 18, 2002 by the following vote:
AYES:
COUNCIL MEMBERS —
NOES:
COUNCIL MEMBERS —
ABSENT:
COUNCIL MEMBERS —
ABSTAIN:
COUNCIL MEMBERS —
SUSAN J. BLACKSTON
City Clerk
2002-
September 9, 2002
The Honorable Mayor
& City Council Members
City Council of Lodi
City Hall
Lodi, California
Dear Council,
RECEIVED
2002 SEP 16 Q� rr: p r
of 1 7• CL L.
CI i Y OF L uUl
After much consideration and separate review by our Government
Relations Committee and the Board of Directors, the Chamber Board is
formally going on record in opposition to the current proposal to
establish a City run ambulance service.
Our reasons for this position are not without recognition that the Lodi
Fire Department is second to none and we are confident the
department would operate an exemplary emergency transport service.
We find the plan to be unfavorable to private business, for which the
Chamber stands. Those identifiable and defining needs, which would
call for a City operated service have yet to be proven through our
investigation or to our satisfaction. The "state of the market" for
emergency transport, is driven by competition from other service
providers as well as County government's control of the system under
which transport must operate. This makes income truly unpredictable.
Therefore, we believe this is an unnecessary risk of tax dollars.
We believe, it has not been satisfactorily proven the current provider
American Medical Response, (AMR), has performed poorly, thus
putting in jeopardy the citizenry and the employee workforce of Lodi.
County Emergency Medical Service verifies AMR to be meeting or
exceeding their mandated criteria and service levels.
If, in your minds this is about service, safety and protection... add
paramedics to current firefighting equipment. If it is about a source of
revenue, our Board is concerned about the dependability of a positive
3S South School Street • Lodi. California 95240 • Telephone: 209.367.7840 9 Fax: 209.334.0528 9 www.lodichamber.com
Page 2
cash flow from such a service. We believe the opportunity to recoup
all associated costs providing emergency transport service is more
determined by the number of providers in the market, County
configuration of service and non -emergency transport billing contracts.
Even expertly operated by our City Fire department personnel,
considering these factors are out of Lodi's control, how can anyone, no
matter how good, be confident of a profit?
If "breakeven" is not achieved, then City ambulances will be subsidized
by tax dollars. Why risk entering a new business field with
uncontrollable market determinants, if we do not have to?
In conclusion, if AMR has been negligent in their levels of service, then
bring public pressure to bear. As our City Council, you are capable of
galvanizing a community's focus as well that of the media's, to
demand the people and businesses of Lodi be adequately protected at
acceptable levels. We have not heard that degree of tenacious
resoluteness from this Council, nor from the Fire Department, nor from
the County Emergency Medical Services regarding AMR's service.
Why?
We remain open to be supportive of other plans should they be
developed.
Sincerely,
Pat Patrick
President / CEO
On behalf of The Lodi Chamber of Commerce
Board of Directors and its' 660 member businesses.
09/18/2002 09:30
2093397654
LODI MEMOPIAL HOSPT
PAGE
02
975 S. Fairmont Avenue - P.O. Box 3004 • Lodi, California 95241 • 209/334-2411 - 209/369-3745(fax)
Via Facsimile
September 17, 2002
Mike Pretz, Chief
Lodi Fire Department
217 West Elm Street
Lodi, CA 95240
Dear Chief Pretz;
This letter will represent Lodi Memorial Hospitals support of improving the ambulance
services in the Lodi area. As you know, Lodi Memorial Hospital has experienced
significant growth in the number of ambulance arrivals to our Emergency room over the
past few years. The increase in arrivals was 15% greater for 2001 compared to 2000 and
averaged 13 per day for 2001. The increase has only been 2% for the first six months of
2002, yet this growth is substantial and challenges our resources to provide good quality
care.
Although the increases in ambulance arrivals are not solely from the Lodi area, all of the
ambulance stations that bring patients to us have increased. As we plan for our future, we
anticipate that this increase in ambulance arrivals will continue.
We are not in a position to determine the economic irnpact of another ambulance service
in. the Lodi area, but would be supportive of any move to increase the response time and
duality of care delivered to Lodi residents. I trust that our City Council will give your
proposal sufficient thought and make the appropriate decision for the Lodi community.
r-
Sincetely�;.'"
j�s6h :P. H n, CEO
HADc3hop FolderslBODlfire dept_9_17 02.doc
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all
Priority One Medical
Transport is committed to
providing a safe and
secure environment
while attending to the
special needs of our
patients in a caring, kind,
and professional manor.
It's this commitment to
excellence that makes
Priority One Medical
Transport the leader in
the Medical Transport
Industry.
y
Priority One Medical )NI
Transport was founded by . N c E
Michael D., Parker, President
and Carol A. Schill, Executive
Vice President. Both are
former Sheriff's Deputies
who studied at California
Southern Law School and
obtained their certificates in
Paralegal Studies.
_�j wr_w.■. __ ._.
Their dedication to service and
professionalism has driven them to
employ only the industry's finest
workforce and use only state-of-the-
art equipment. This philosophy
allows our company to maintain a =
streamlined efficiency and gives us
the ability to seamlessly integrate
our systems with other existing
medical authorities.
Whether we're responding to your emer-
gency or prescheduled call ... Our Dedication
to Response Excellence Exists. To promote
this excellence, we utilize a state-of-the-art
dispatch communications system. This sys-
tem allows us to monitor all internal commu-
nications systems within California. In the
communications center, the National
Association of Emergency Medical
.Dispatchers (NAEMD) trains each dispatcher
and call taker. This training allows us to
assist you with arranging an immediate
triage of your critical patient. Our computer
system allows us to accept your call within
30-45 seconds of the initial telephone con-
tact as well as track the closest unit available
to handle your call. In your facility, we have
the capability of installing a "Red Line" which
is a direct telephonic link to our communica-
tions center; this allows for an even faster
transmission of your call information. In the
field, every unit is deployed with a Mobil
Data Transfer (MDT) computer system. This
system allows a virtually instantaneous
transmission of your call information directly
to the unit facilitating a quick and effective
response. Combine all of these essential
elements, and you have one of the most
proficient communications centers in the
nation... Response Excellence!
We understand the strict rules and regula-
tions that our providers face under new
managed care networks. As a result, we
have committed ourselves to providing a very
cost-effective means of patient transporta-
tion while maintaining a high standard of
care. To this end, we deploy the newest
ambulances and use only state-of-the-art
equipment. Our Billing Division has been
specially trained by the Nova Institute of'
Learning. This specialty training allows our
billing and insurance specialists to be experts
in the fields of Medicare, Medical, HMO, PPO
and Workers' Compensation issues. You can
rest assured thatwe are committed to handle
the reimbursement of your patient's trans-
portation requirements.
j :Il=%0=1 --
From the EMT -B to our Medical Director,
everyone plays an integral role in our
commitment to quality and diversity in
patient care. Our unsurpassed services in
the realm of Basic Life Support, Advanced
Life Support, Paramedic Support and
Neonatal Transport Services provide an
excellent basis for this quality and diver-
sity that we strive to maintain. Our Chief
Medical Director, Dr. Milton A. Miller, M.D.
oversees the Clinical Care Inter -facility
transports and offers clinical expertise as
both an E.N.T. and E.R. Physician. All
Registered Nurses have at least their
Bachelor of Science in Nursing degree
and bring years of Critical Care interven-
tion experience on board the ambulance.
To promote a high standard of care, the
county or state certifies all of our EMTs.
Many of these EMT's back their expertise
with college degrees and can provide yet
another level of understanding and com-
munication with providers.
Our commitment to quality and community is
clearly displayed by the diversity of services we
offer:
• Emergency and Non -Emergency Ambulance
Transportation
• Critical Care Transportation
• Neonatal Transportation
• Paramedic/ALS Services
• Disaster Readiness/Response
• S.M.A.R.T Specialized Medical Assessment
Response Team
• B.E.A.T. Bicycle Emergency Assessment Team
• 24-hour EMD certified Communications
Center
• 24-hour Specialized Billing and Insurance
Personnel
• On-site provider and community First -Aid
and CPR Training
• Wheelchair Transportation Services
• Provider Contract Services
Priority One understands the needs of our patients and
their providers. We also understand that in this highly
competitive ambulance industry, you have a choice; a
choice to use an ambulance company that can meet your
needs. As the President of this company, I am dedicated to
making surePriority One is that company.
"Thank You For ChoosingPriority One. "
Michael D. Parker
iEMS
`r
'r
i4
San Joaquin
Emergency Medical Services Agency
A Division of Health Care Services
APPLICATION FOR LICENSE TO OPERATE
CHECK ONE
Emergency Ambulance Permit (Fill out complete application.)
Non -Emergency Ambulance Permit (Fill out only those items marked with one asterisk *)
i
A change in any item requested on this application must be reported to the Emergency Medical Services Agency
within ten (10) days. Item A6 and D1, marked with double asterisks **, must be reported immediately.
A. TYPE OF APPLICATION
Initial V"" Renewal Change of Ownership
* 1. COMPANY NAME
-i -
DBA (doing business as)
*2. MAILING ADDRESS
8,3b Axich , baja 4Lz.'418 &IOW -45a.
' Street (PO Box) City State Zip
*3. LEGAL OWNER (person, firm, company, association, or corporation)
WL 1,e-Ktom- y"m
' *4. SERVICE ADDRESS (for each zone of application)
Zone ALS BLS Address Cross Street
f 11 �� 3 lGll� M16 K1Z x►biw!j 61 )
A !S /d l.S t'� &DixiS ae,)
' P. O. Box 1020 • Stockton, California 95201 • 209-468-6818
I6:\winw0rd\mike\amb-1\1ic-fi1e 1240
Page 4 of 4
b. All policies shall contain a provision requiring a thirty (30) day notice to be given to
the Permit Officer prior to cancellation, modification, or reduction of limits.
C. All insurance policies shall contain an endorsement naming the County and the cities
which have adopted this ordinance and in which the permittee provides services as an
additional insured. Such policy shall provide that the County and the affected cities
are indemnified, defended, and held harmless from and against all costs, expenses,
and liability arising out of, or based upon, all property damage, or damages for
personal injuries, including death, which results or is claimed to have resulted from
any act or omission on the part of ambulance provider or ambulance provider's agents
or employees.
d. Indication of Workman's Compensation Insurance for all employees.
*5. A list of the Company's charges for all ALS and BLS service and the rate structure of the
Company.
*6. A description of the training and orientation program for all attendants, dispatchers and
drivers.
*7. The Company's financial statement, prepared by a Certified Public Accountant, for the
previous fiscal year. (Financial Information will remain confidential).
*8. List of ambulances to be issued vehicle permits. Appendix B
*9. List of ambulance personnel. Appendix C
' E. It is agreed that the licensed activity will be conducted in compliance with all applicable laws and
regulations. It is understood that violation of any law or regulation adopted by the State of California
or the County of San Joaquin pertaining thereto may result in the filing of a criminal action in a court
of law or the filing of an administrative action to suspend or revoke the license. It is also understood
that misrepresentation of a material fact in conjunction with this application constitutes grounds for
denial or revocation of the license.
' As Authorized Representative (Applicant) for the Company, I agree to the above statements and have
provided the attachments necessary for completion of the application. I also hereby authorize the release of
' information for investigation to the San Joaquin County Emergency Medical Services Agency pertaining to
the operation, background, and compliance in policy, procedure, or regulation of the Company.
Signature Title r.L,
Printed Name Nk\c�- `fl • '+r' eyQ.iE R Date 'L.
GAwinword\mike\amb-1\lic-file 12100