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Section Twelve: Future Needs, Recommendations, and Service Improvement 1. Effectively meet more of the total ambulance transport demand within ASA I/4. Under thc current deployment of ambulance resources within the greater metropolitan area, large portions of Eugene's established ambulance service area lie closer to transport units operated by neighboring jurisdictions. The resulting cross- jurisdictional responses create service inefficiencies and represent significant revenue loss for Eugene. The implementation of paramedic first response capabilities on every Eugene fire engine has meant the need for the closest ambulance to respond is now limited to a small percentage of truly life-threatening emergencies. The City must work with all service partners to refine the current policy, thereby preserving needed ambulance resources within their own jurisdictions a greater percentage of the time, as well as preserving revenue. 2. Complete the EMS Redesign Project. Phase 3 of the plan called for the department to consolidate the improvements made by the first two phases, and then to develop and implement additional process efficiencies and new cost recovery modalities. This work includes updating ambulance ordinance language and the planned refurbishment of the existing membership subscription program. Implementing some of the anticipated changes will require the support of the greater City organization. 3. Seek a legislative remedy to federal CMS issue. The reimbursement reduction schedule implemented last year by the federal Centers for Medicare & Medicaid Services (CMS) has placed a significant financial burden on many health care providers in the country. The City should consider joining with other governmental agencies to lobby the federal government to revise the latest payment schedule to more accurately reflect true service costs by region. 4. Increase the General Fund (GF) support for the costs associated with providing quality first response paramedic functions to the community. The EMS Fund was originally created to support the operation of an ambulance transport service incorporated into the department's service package in 1981. Over time, the fund has been asked to assume a variety of costs that are not directly linked to ambulance service. Because the department is charged with providing first response EMS, with or without an ambulance component, and in light of the threats currently facing the service and fund, it is reasonable to suggest that the City increase the department's GF allocation to cover the costs of providing all first response EMS services. 5. Reduce service costs. The department continues to look for sustainable methods that can be employed to systematically lower the unit costs of providing ambulance transport services. To this end, we are evaluating different equipment, technology, and partnership opportunities. In order to take advantage of these, it may be necessary for the City to assist the department in procuring and developing these to optimize their payback potential. 83