Item 1: Future Ambulance Transport Funding

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ATTACHMENT D AMBULANCE SERVICE FUNDING OPTIONS Option A1 – General Fund Support. Elected officials have agreed that ambulance service is and should remain a “core” public service. However, the service has historically been self-supporting, and providing General Fund support would mean reducing other public services. Municipalities are already facing steep General Fund shortfalls. Lane Rural Fire/Rescue and the City of Springfield are now providing limited General Fund support to ambulance transport, but only out of necessity. It should be remembered that General Fund support would augment ambulance transport fees, not replace them. Fees would still be required, both as an offset to taxation and as a deterrent to abuse of the service. Option A2 – Form a Fire District that Provides Ambulance Service. Under this option, which would require voter approval, some portion of central Lane County would form a new tax-and-service district, or annex into an existing one. The cities of Eugene and Springfield would no longer be responsible for fire and ambulance service in their jurisdictions. Such a merger could also include the Lane Rural Fire/Rescue District. Under this proposal, the cities would no longer be required to allocate General Fund support to the fire departments, and city taxes could be reduced to that extent. Instead, the new entity would tax property owners as necessary to provide adequate fire protection and financially stable ambulance service. Again, an ambulance transport fee would still be required, but could potentially be reduced. Option A3 – Form a Special Health Taxing District. Under this option, which would also require voter approval, a limited county-wide taxing district would be formed to support all eight of Lane County’s ambulance service districts. Although more analysis would be needed to determine the exact amount of property tax needed, early estimates place the range between 35 and 45 cents per thousand dollars of assessed value. Privatize the Service. To maintain the high quality of service enjoyed by the current system, and to continue to enjoy the utility afforded through the use of cross-trained firefighter/paramedics that can respond to a broader range of emergencies, the Task Force has removed this option from consideration at this time. Continue to Raise Ambulance Service Fees. This is not considered a viable long-term option, because the full fee is so seldom collected. Prior to the Medicare reimbursement reductions, rate increases were used successfully to balance the budget. Now, however, even a substantial increase only produces a limited amount of revenue and buys a small amount of time, because the majority of patients are either covered by Medicare or are unable to pay. Option B4 – Change Service Area Boundaries. Under Oregon law, ambulance service areas are assigned by each county’s Board of Commissioners. The Lane County Board of Commissioners could act to change the existing boundaries so as to provide for more of an urban/rural split of service areas between Eugene and Lane Rural; Springfield would not be affected. With such a change, Eugene would have options for changing its transport service model, possibly reducing costs, because a paramedic fire engine already responds to medical calls in the metro area. Lane Rural, at the same time, would add call volume which could add to its financial base. This option does not necessarily raise revenue or reduce cost, but it would redistribute responsibility for service with the potential of adding stability to the system. All automatic and mutual aid agreements would remain in force and provide for back-up coverage between the jurisdictions. Option B5 – Mobile Health Care System. This refers to the creation of a new network of emergency and non-emergency health care response vehicles and caregivers designed to better match the needs of the patient with the level of response. The goals would be to improve access to health care, improve the quality of care, reduce the overall cost by sorting the type of illness or injury and matching the care with the type of illness or injury, and create a new source of revenue that would contribute to the system. If successful, the new design could become an important ingredient for the success of health care reform efforts. However, the model is untested and would require start-up funding to prove that it will achieve the desired outcomes. Other Options – The Ambulance Transport System Joint Elected Officials Task Force is interested in hearing additional proposals that have potential to stabilize ambulance transport funding in our region on a long-term basis. The list above presents the most viable options that have been identified to date. More and better solutions may exist.