Item 1: Future Ambulance Transport Funding

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ATTACHMENT A Put simply, the new national fee schedule, which covers 60 to 70 percent of all transports, does not allow most ambulance providers to recover the cost of providing the service. Instead, where we once had the ability to collect the full reasonable charge (which has risen over the years from $535 to $1,600 per transport), we are now reimbursed between $200 and $400, depending on the type of call. Medicaid, the state of Oregon’s health insurance program, reimburses similarly. While Medicare and Medicaid reimbursement reductions are the primary reason that emergency medical transport in our region has become a revenue-negative enterprise, two national trends are also contributing to the problem. One is the growing number of individuals eligible for Medi- care. The other is the economy generally, as the provider agencies – which do not refuse trans- port because of inability to pay – are being forced to write off more and more bills as uncollecti- ble. The Eugene Fire & EMS Department has taken many steps to try to keep the ambulance service self-sustaining including increasing the transport rates; reducing ambulance coverage for non- peak times; and cutting costs for administrative staff, materials and supplies. The department has also worked closely with City Finance staff to identify the appropriate cost split between the Ambulance Transport Fund and General Fund to ensure the ATF is not supplementing General Fund services. In addition, with Eugene’s ambulance system capacity very thin, the department elected to sub- contract much of its non-emergency transport work to a private provider through an RFP process as a cost avoidance strategy. With inadequate revenue to increase the number of advanced life support ambulances on the street, the department elected to privatize this portion of the service and match a more appropriate level of resource with particular non-emergent call types. Springfield Fire & Life Safety staff has focused on maximizing existing revenue sources for all three providers through the joint FireMed program and development of new revenue sources through Mobile Health Services research and design. However, none of these adjustments individually or in whole has created a sustainable fund dur- ing any 6-year financial forecast period. Eugene’s Ambulance Transport Fund reserves have de- creased from $1.1 million in FY07 to $165,000 in FY09. The financial goal is to maintain a re- serve equal to two months’ operating expenditures. For Eugene, this total for FY10 is $1.16 mil- lion. At this point, the projections show the fund will be out of reserves by the end of FY10. Additionally, for FY10, the fund is unable to support its medic unit replacement reserve resulting in lengthening the time for fleet replacement. Springfield’s Ambulance Transport Fund reserves were depleted as of FY09. The City Council allocated up to $500,000 in General Fund support, of which approximately $300,000 was needed. An additional $300,000 in support is allocated for the current fiscal year. The Lane Rural Fire/Rescue District was granted an Ambulance Service Area (ASA) encompass- ing the northwest portion of Eugene’s ASA in 2001 and in 2002 began providing emergency medical transport in addition to fire and rescue services to that area, resulting in a reduction of ambulance transport revenue as well as FireMed membership revenue for Eugene. As a pre- existing taxing authority, Lane Rural has been able to augment its overall revenue with ambul- ance fees and FireMed revenue, but not to the extent that the ambulance service is fully self- 3