CC Minutes - 01/27/09 Joint Elected Officials

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Commissioner Sorenson asked if Lane County using its taxing authority to levy a real property tax in support of ambulance EMS was an option since raising fees for service was not the answer, Chief Groves responded that Lane County providing taxing authority would be addressed through creation of an ambulance service district. Raising current rates was not cost effective because it cost six dollars to increase rates one dollar. Additionally, as rates increase, the service would become less affordable for more people, turning the cost from a debt that could be paid to a bad debt. Commissioner Sorenson asked what amount of property tax was needed to prevent a fee for service increase. Chief Groves said the number was not available. However, the Lane Fire Defense Board, an organization comprised of all of the fire chiefs in Lane County, had agreed to contract with the Lane Council of Governments (LCOG) to conduct an ambulance district study. The study was deferred until after the Ambulance Transport Summit to have some direction from the elected officials. Chief Murphy observed the Western Lane Ambulance District was funded by the district’s tax support, user fees, and a program that cooperated with FireMed called Life Care. Commissioner Fleenor thanked Mayor Piercy and Councilor Ortiz for arranging for the summit. He asked why the reasonable charge method was changed to a fee for service method. Chief Murphy said reasonable charge and fee for service were Medicare terms. Reasonable charge was equivalent to reduced Medicare reimbursement rates across the board. Medicare broke the bank. He suggested elected officials would need to compare all ALS ambulances in Lane County with ambulances that were BLS with a driver who was not even a basic Emergency Medical Technician (EMT) and response times not considered legal in Oregon on the east coast of the United States to determine if charges were reasonable. He opined Congress’ intent was not to pick on 9-1-1 services, but rather balance the entire Medicare system. Commissioner Fleenor asserted costs could be reduced by increasing response time. He asked who established minimum response time requirement standards. Chief Groves stated local jurisdictions set the standards by working with the local medical control boards. There were longer response times related to how far people lived from service providers. Outcomes for critical care cases were proportional to patients’ distance from service providers. Chief Murphy added the BCC through its ambulance service area designation established response time standards for urban, suburban, rural and frontier locations. Those standards were currently realistic and followed by the providers. In order to save a life, the agencies were heavily dependent on first responders in seventeen rural fire districts surrounding central Lane County that provided care prior to arrival of ambulances from the urban area. Inside the cities, by ordinance, the response times were set by the cities of Springfield and Eugene. Commissioner Fleenor asked theoretically if the budget could be balanced by increasing the response times. MINUTES—Joint Elected Officials— January 27, 2009 Page 8 Lane Board of County Commissioners, Lane Rural Fire/Rescue Board of Directors and Eu- gene and Springfield City Councils