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HomeMy WebLinkAboutItem 1: Future Ambulance Transport Funding JEO OINT LECTED FFICIALS AIS GENDA TEM UMMARY Action: Future Ambulance Transport Funding Meeting Date: December 7, 2009 Agenda Item Number: 1 Department: Eugene Fire & EMS Dept. Staff Contact: Randy Groves, Chief Springfield Fire & Life Safety Dept. Dennis Murphy, Chief Lane Rural Fire/Rescue District Dale Borland, Chief ISSUE STATEMENT Owing to reduced Medicare reimbursements and other economic factors, ambulance transport operations in the central Lane County region are no longer able to operate on a self-sustaining basis, with user fees and FireMed memberships as their only sources of funding. BACKGROUND Throughout our region, the majority of patients transported are covered by Medicare. Before the implementation of the Ambulance Fee Schedule on April 1, 2002, ambulance suppliers received payment from Medicare on a “Reasonable Charge Basis.” Medicare would pay 80 percent of the allowable amount and the remaining balance was the responsibility of the patient. This allowed transport providers broad flexibility in setting rates and assured recovery of costs. The Balanced Budget Act (BBA) of 1997 added a new section 1834(1) to the Social Security Act which mandated the implementation of a national fee schedule. This section also required ambulance providers and suppliers to accept the Medicare allowed charge as payment in full; there was no longer the ability to bill the patient or another insurance provider for the balance of the reasonable charge. The new fee schedule took effect in 2002 and was phased in over a five-year period, with full implementation on January 1, 2006. 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 providers once had the ability to collect the full reasonable charge (which has risen over the years from $535 to $1,600 per transport), they are now reimbursed between $200 and $400, depending on the type of call. Medicaid, the State of Oregon’s health insurance program, reimburses similarly. Eugene’s Ambulance Transport Fund reserves have decreased from $1.1 million in FY07 to $165,000 in FY09. At this point, the projections show the fund will be out of reserves by the end of FY10. 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. Z:\CMO\2009 Council Agendas\M091207\S0912071.doc As a pre-existing taxing authority, Lane Rural Fire/Rescue District has been able to augment its overall revenue with ambulance fees and FireMed revenue, but not to the extent that the ambulance service is fully self-supported; instead, the district annually levies funds as necessary to provide all of its services, in effect providing some support to the ambulance service with general tax monies. For FY09 this requirement is estimated to be between $400,000 and $500,000, or approximately one-third of the district’s total revenue. In February of this year, at the conclusion of a Joint Elected Officials summit regarding this issue, the formation of the Ambulance Transport System Joint Elected Officials Task Force was authorized. The attached report from the Task Force provides additional background and a series of recommendations, which are: 1.That all three jurisdictions remain prepared to allocate a level of General Fund support as necessary for the continued high-quality provision of this core service. 2.That the Eugene and Springfield City Councils authorize initial steps toward merger of their fire departments. 3.That exploration begins immediately of more sustainable public funding options. 4.That marketing of FireMed subscriptions be enhanced and expanded in an effort to generate additional revenues to lessen reliance on general fund tax support. 5.That the Lane County Board of Commissioners act immediately to reconfigure the boundaries of the county’s Ambulance Service Areas so as to provide for an urban-rural split between Eugene and Lane Rural Fire/Rescue. 6.That work proceed as rapidly as possible regarding provision of a regional mobile health care system, featuring tiered levels of response (and cost) available to patients depending on the nature of the emergency with a report to elected officials by the end of calendar year 2010. 7.That public ambulance service provider agencies continue to lobby the Oregon legislature and U.S. Congress for larger-scale long-term solutions. RELATED CITY POLICIES City of Eugene Value #1: Safe community. City of Eugene Value #5: Fair, stable, and adequate financial resources. Springfield City Council 5-Year Goal #1: Provide financially sound, stable city government. Springfield City Council 5-Year Goal #2: Utilize resources efficiently and effectively to meet citizen needs for core services. Springfield City Council 5-Year Goal #5: Enhance public safety in Springfield. Springfield City Council 5-Year Goal #7: Partner with citizens and other public agencies to leverage resources. ELECTED OFFICIAL OPTIONS Elected officials are at liberty to adopt any or all of the recommendations presented by the Ambulance Transport System Joint Elected Officials Task Force. Adoption may be by the full JEO group or by the individual governing bodies of affected jurisdictions, as appropriate. Z:\CMO\2009 Council Agendas\M091207\S0912071.doc CITY MANAGERS’ RECOMMENDATION None; recommendations of the Ambulance Transport System Joint Elected Officials Task Force are presented in this document. SUGGESTED MOTION Motion to adopt selected (or all) recommendations. ATTACHMENTS A.Task Force Report B.Media Clippings C.Flier Announcing Public Forums D.Factsheet and Ballot Provided at Public Forums E.ASA Map F.Financial Graph Presented at Public Forums G.Public Input Results and Comments H.LCOG Overview of District Alternatives FOR MORE INFORMATION Staff Contact: Eugene Fire & EMS Chief Randy Groves Telephone: 682-7115 Staff E-Mail: randall.b.groves@ci.eugene.or.us Staff Contact: Springfield Fire & Life Safety Chief Dennis Murphy Telephone: 726-3737 Staff E-Mail: dmurphy@ci.springfield.or.us Staff Contact: Lane Rural Fire/Rescue Chief Dale Borland Telephone: 688-1770 Staff E-mail: dborland@lrfr.org Z:\CMO\2009 Council Agendas\M091207\S0912071.doc ATTACHMENT A M EMORANDUM November 25, 2009 TO: Mayor Kitty Piercy and Eugene City Council Members Mayor Sid Leiken and Springfield City Council Members Commission Chair Peter Sorenson and Lane County Commissioners President Larry von Moos and Lane Rural Fire/Rescue Board Members FROM: Ambulance Transport System Joint Elected Officials Task Force (Mike Clark, Andrea Ortiz, Dave Ralston, Hillary Wylie, Rob Handy, Larry von Moos, and Kevin King) SUBJECT: REPORT AND RECOMMENDATION SUMMARY In view of negative revenue experiences and projections for the ambulance service providers in central Lane County (Eugene Fire & EMS Department, Springfield Fire & Life Safety Depart- ment, and Lane Rural Fire/Rescue District), which were brought on by reduced Medicare reim- bursements and a number of other economic factors, our Task Force was charged earlier this year to study the problem and develop a recommendation, or set of recommendations, to provide for long-term financial stability for this service, without compromising the high quality of prehospit- al emergency medical care that our constituents expect and deserve. We acknowledge that the provider departments – and their governing bodies – have already ex- pended substantial effort to address this critical public concern, both by taking extraordinary steps to reduce expenditures and by passing extraordinary increases in user fees to offset decreas- ing revenue, but these measures have served only to slow, not stem the fiscal bleeding. Efficien- cies within the scope of each agency’s control have been or are now being implemented. This task force was formed because a solution to this crisis is beyond the capacity and authority of any one provider agency acting unilaterally. It is vital that the possible solutions recommended 1 ATTACHMENT A by this task force immediately be addressed at a regional level and given the highest possible priority for allocation of time and resources. Having studied this issue and the range of available options, having engaged the public at a se- ries of community forums and online, and having worked in concert with stakeholders including local fire and ambulance service professionals, hospitals, and firefighters’ unions, we recom- mend as follows: 1.That all three jurisdictions remain prepared to allocate a level of General Fund sup- port as necessary for the continued high-quality provision of this core service. 2.That the Eugene and Springfield City Councils authorize initial steps toward merger of their fire departments. 3.That exploration begin immediately of more sustainable public funding options. 4.That marketing of FireMed subscriptions be enhanced and expanded in an effort to generate additional revenues to lessen reliance on general fund tax support. 5.That the City of Eugene and Lane Rural Fire/Rescue analyze the possibility of recon- figuring the boundaries of the county’s Ambulance Service Areas so as to provide for an urban-rural split between Eugene and Lane Rural Fire/Rescue; and, if conditions appear favorable, that the Lane County Board of Commissioners be asked to enact such reconfiguration. 6.That work proceed as rapidly as possible regarding provision of a regional mobile health care system, featuring tiered levels of response (and cost) available to patients depending on the nature of the emergency with a report to elected officials by the end of calendar year 2010. 7.That public ambulance service provider agencies continue to lobby the Oregon legis- lature and U.S. Congress for larger-scale long-term solutions. BACKGROUND Throughout our region, the majority of patients transported are covered by Medicare. Before the implementation of the Ambulance Fee Schedule on April 1, 2002, ambulance suppliers received payment from Medicare on a “Reasonable Charge Basis.” Medicare would pay 80 percent of the allowable amount and the remaining balance was the responsibility of the patient. This allowed transport providers broad flexibility in setting rates and assured recovery of costs. The Balanced Budget Act (BBA) of 1997 added a new section 1834(1) to the Social Security Act which mandated the implementation of a national fee schedule. This section also required am- bulance providers and suppliers to accept the Medicare allowed charge as payment in full; there was no longer the ability to bill the patient or another insurance provider for the balance of the reasonable charge. The new fee schedule took effect in 2002 and was phased in over a five-year period, with full implementation on January 1, 2006. Year one (4/1/02-12/31/02) provided a blending of 20 per- cent fee schedule and 80 percent reasonable charge. The reasonable charge portion was then re- duced by 20 percent in each of the four subsequent years, so that as of 2006 only the fee schedule amount was payable. 2 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 ATTACHMENT A supported; instead, the district annually levies funds as necessary to provide all of its services, in effect providing some support to the ambulance service with general tax monies. For FY09 this requirement is estimated to be between $400,000 and $500,000 or approximately one-third of the district’s total revenue. The entire problem will be further exacerbated next calendar year. A temporary increase in the fee schedule provided in the Medicare Modernization Act of 2003 is scheduled to sunset Decem- ber 31, 2009. Also, for the first time, providers will not be allowed an annual inflationary ad- justment in the fee schedule. The calendar year 2010 impact of these two factors alone is esti- mated at $400,000 for Eugene and $300,000 for Springfield. In February of this year, at the conclusion of a Joint Elected Officials summit regarding this is- sue, the formation of our Task Force was authorized. EXPLANATION OF RECOMMENDATIONS General Fund Support 1. In Eugene and Springfield, since the cities assumed responsibility for providing am- bulance service in 1981, it has been established public policy that the service is to be self-supporting through fees collected (including FireMed membership fees). This, with the benefit of occasional fee increases, was sufficient until the Medicare reimbursement reductions took effect. Facing those reductions, the provider agencies took all steps available to them to con- tinue to provide service on a self-sustaining basis. However, the crisis worsened as Oregon’s Medicaid program enacted similar reductions, as the federal reductions be- came more severe, and as the national economy deteriorated. Lane Rural Fire/Rescue already supplements its ambulance fee and FireMed revenue with general tax revenue as necessary. In Eugene and Springfield, this has been re- quired to a limited extent in recent years, and fiscal projections indicate that the need for General Fund support is escalating at an alarming rate. The elected bodies could choose to make General Fund support the permanent solu- tion to the problem before us. However, the Task Force believes that, for the sake of preserving other local government services to the greatest extent possible, General Fund support should be viewed only as a short-term solution. In the long term, the public will be better served if ambulance and fire services are supported by a combi- nation of fees for service, FireMed membership fees, and some form of dedicated tax support. Fire Department Merger 2. During the time that our Task Force has been studying and deliberating on the ambul- ance funding issue, the Portland consulting firm ESCI was commissioned by the ci- ties of Eugene and Springfield to prepare a report regarding the possible benefits of 4 ATTACHMENT A further collaboration between Eugene Fire & EMS and Springfield Fire & Life Safe- ty, beyond that already occurring. The ESCI report, which has been presented to the two City Councils, concludes that merging the support functions of these departments would save the cities an estimated $850,000 per year through the elimination of redundant positions (via retirements and normal attrition). The consultants recommended such a merger. This proposal happens to align well with our other recommendations. With an inter- governmental agreement merging these departments as an initial step, not only will significant General Fund savings be realized immediately, but also, and more impor- tantly for the long term, the transition to a district will be a smaller, more manageable step. For these reasons our Task Force is in support of working toward the recom- mended merger. New Form of Taxation 3. This recommendation is based on our belief that continued and growing General Fund support for ambulance service is unsustainable, and that all other revenue-raising and cost-cutting measures combined are not sufficient to resolve this issue. Fire District – In most of Lane County, and increasingly throughout the United States, fire and ambulance services are provided by special-purpose districts. The growth in emergency service special districts in areas traditionally served by municipalities may be attributed to greater competition among public services for increasingly scarce re- sources, given these districts show a higher degree of success historically to secure public willingness to pass tax measures to fund high-quality fire, rescue, and emer- gency medical services. A general fire service district, including ambulance service, offers a significant public safety advantage over a district that provides ambulance service only, because – as is the case now in all three of our jurisdictions – ambulances can be staffed by cross- trained firefighter/paramedics who can, as necessary, supplement non-ambulance fire and rescue efforts. In a multi-unit response, the availability of these additional fire- fighters can make a life-saving difference. Health District or County Service District – A new limited special-purpose district could be formed in the region, or the region could annex to an existing health district, to provide ambulance service. Such a district would be governed by an elected board of directors. Alternatively, a county service district could be established. This type of entity would be governed by the Lane County Board of Commissioners. Under ei- ther of these options, any boundary could be drawn, as long as it did not overlap another district providing the same service. Either option would require an affirma- tive vote of the electors within the proposed district. Appendix H is an overview of district-related options for ambulance service funding, prepared in June by Lane Council of Governments. The Task Force also reviewed a full LCOG report regarding districts that was commissioned by the Lane County Fire Defense Board. 5 ATTACHMENT A In planning for formation of, or annexation to, a special district, many further, more specific decisions will be needed. Boundary issues, revenue requirements, and the possibility of tax rate compression will need to be addressed. An election will be re- quired. Because implementation of these options even at best speed will take a con- siderable period of time, we recommend the immediate formation of an intergovern- mental staff team to fast-track the study of the feasibility of implementing this solu- tion. Local Option Levy – We are identifying this option only as a temporary means of re- living the General Fund of the ambulance service funding burden. We believe it may meet with voter acceptance initially, but we have serious concerns about this form of funding due to its need for renewal in perpetuity. Enhance FireMed Marketing 4. Since its inception in 1985, the FireMed ambulance membership program has been marketed primarily as a form of protection against personal liability for an ambulance bill. While the program does serve that purpose for households, the revenue generat- ed has become essential to the continued provision of high-quality service. More and more in recent marketing, this latter fact has been mentioned, but the sup- port-for-the-service theme has always been subordinate to the cover-your-family theme. We believe the time has come to reverse this. In marketing for the FY11 membership year, we propose that FireMed advertising fo- cus on the opportunity to contribute to a safe community, and to a lesser extent, but still overtly, on the private benefits of membership. Staff analysis has shown that a significant percentage of members already subscribe on a public-support basis, and we believe more might do so if they saw the opportunity in that light. We are also recommending, for the upcoming campaign, a greater reliance on en- dorsements as a supplement to paid advertising. Toward this end, we are developing a program whereby endorsing organizations will be able to offer FireMed member- ships at a group rate below the new rate proposed for the upcoming enrollment cam- paign. Reconfigure Ambulance Service Area Boundaries 5. This recommendation can be adopted or rejected independently of the two above. We propose analysis of the possibility that the Ambulance Service Area (ASA) assigned to Lane Rural Fire/Rescue be extended to the south so as to abut the Cottage Grove ASA, reducing the territory of the Eugene ASA such that it includes only those areas within the Eugene Urban Growth Boundary plus special districts now served by Eu- (See ASA map, Appendix D.) gene Fire & EMS. This boundary change would have a twofold purpose. First, it would greatly reduce in-service times for a percentage of ambulance calls now handled by Eugene Fire & EMS, as Eugene’s ASA currently extends west to a point between Walton and Maple- 6 ATTACHMENT A ton. This would preserve Eugene rescue and transport resources for emergency avail- ability in the more immediate Eugene metro area. Second, the boundary change would allow for growth of the Lane Rural ambulance service, both geographically and in terms of revenue. It also would pave the way for possible placement of a Lane Rural ambulance in the Veneta area, although that dep- loyment decision would ultimately be made by the provider agency based on further analysis. The above objectives would not be achieved without some revenue impact to Eugene Fire & EMS, which would be transferring an estimated 850 calls per year to Lane Ru- ral. This represents revenue estimated at $500,000. That figure, however, represents raw revenue only. It should be recognized that, in expanding its service territory, Lane Rural would incur additional operating expenses that would offset the revenue to a great extent; conversely, Eugene’s actual net loss of revenue would be smaller because rural calls cost more operationally than urban ones, and also because fewer Eugene-based calls will need to be handled by other agencies. Actual calculations of the net effect would depend on deployment configurations subsequent to an ASA boundary change, and also on actual call experience under that scenario. Mobile Health Care System 6. A Mobile Health Care (MHS) system links prehospital emergency medical services with several types of non-emergency medical care in a network of 24-hour healthcare. In Central Lane County, these would include fire/paramedic first response fire en- gines and ambulances, a private non-emergency ambulance contractor, wheelchair transport vehicles, and a mobile primary care provider known as Med Express. The MHS system is designed to triage phone calls from the public for help on illness and injury and match the level of response more closely with the level of care needed. The responding caregiver determines if the patient can be safely treated and released without further care or needs additional care. If additional care is needed, the caregiver determines whether the patient must be seen immediately or later and whether the patient needs transportation to a doctor's office, clinic, or emergency department. The goal is to improve early access to advice and direct the patient to the most appro- priate level of care to match the nature and severity of illness or injury. This is de- signed to improve the quality of care while lowering the overall cost. Currently, only the fire units and private non-emergency ambulance service are linked. Grant funding is being sought to link all other parts of the system and demon- strate the efficacy of the MHS network. Continue to Lobby Congress for Relief 7. From a national perspective, the effect of the Balanced Budget Act of 1997 on am- bulance services has been very small in comparison to the effects on physicians, hos- pitals, and other health care providers. Nonetheless, ambulance associations and local 7 ATTACHMENT A governments have had some limited success in pushing for increases in the fee sche- dule (an example being the Medicare Prescription Drug, Improvement, and Moderni- zation Act (MMA) of 2003, which unfortunately is due to sunset on December 31 of this year). This lobbying should continue. OTHER OPTIONS CONSIDERED Continue to Raise Rates: Although this approach has been used in the past to forestall revenue deficits, our Task Force rejected it for simple mathematical reasons. Because the majority of pa- tients transported are covered by Medicare with its capitated reimbursement schedule, and be- cause a large percentage of the remaining patients are unable to pay, the full fee is seldom col- lected. Even an astronomical rate increase would result in only a minimal revenue gain, and would in all likelihood result in a negative patient care impact if cost became a deterrent to ac- cepting transport. Privatize the Service: The elected bodies to which we belong have identified ambulance trans- port as a core public service that should continue to be publicly administered. Therefore the op- tion of privatization was not studied by our group, and was not identified to the public as a viable option. Eugene Fire & EMS has contracted with a private provider to handle some non- emergency transports, but assignment of emergency prehospital care to this or any other private provider is not being considered. Under full privatization, the public would not only relinquish quality control, but also the emergency response versatility afforded by the firefighter/para- medics now staffing local ambulances. Market FireMed as an Alternative to Additional Taxation: This was suggested at one of the community forums. It is correct that, if a sufficient number of FireMed memberships were sold, that enhanced revenue stream could take the place of General Fund support. However, FireMed and fire service professionals have countered, and we as your Task Force believe, that this type of marketing would probably result in unfortunate public perceptions and could lead to a back- lash. Further, continued service would become dependent on adequate FireMed sales from one year to the next. Having said that, we are recommending enhanced marketing of FireMed, but with a positive approach. PUBLIC PARTICIPATION During our process, we directed staff to engage the public regarding this issue. We published an op-ed column in The Register-Guard explaining our charge, and nine community forums were organized within the three jurisdictions. The forums were announced via paid advertising, earned (unpaid) media (newspaper, television, and radio), and online. There were also presenta- tions made to the Eugene City Club, Eugene Chamber of Commerce, and Springfield Chamber of Commerce. In addition to the community forums, we set up an online survey providing the same information and options as were provided at the public forums. Documentation can be found in Appendices A through F, including a full transcript of written public comments received. In summary, the combined responses from the community forums and the online survey showed the most support for the formation of a general fire service district, while General Fund support 8 ATTACHMENT A (at the expense of other public services) was the least favored option. Numerical details regard- ing the responses are given in the appendix. Altogether, 116 responses were received and rec- orded. We recognize that this is not a statistically valid sample, but it does represent the views of those interested enough to participate. We considered the public response in the same light as public testimony received on any issue, and we are confident that the full elected bodies will do the same. CONCLUSION With the political will already expressed to continue emergency medical transport as a core pub- lic service, and with the existing revenue streams no longer adequate, there is little question that additional tax support will be required. The only questions are as to the form and magnitude of that additional tax support. Some of the measures recommended above can provide a degree of financial relief and/or service improvement. To directly address the larger and more critical central issue, however, we are compelled to report that General Fund support will probably be required to bridge the gap over the short to mid-term, and we conclude further that some new form of general tax support is the best solution for the long term, both from a fiscal and service standpoint. We recommend that further analysis of that option begin without delay. Please contact any member of the Task Force, or staff in the respective fire service agencies, if you have questions or would like any additional information. APPENDICES A.Media clippings B.Flier announcing public forums C.Factsheet and ballot provided at public forums D.ASA map E.Financial graph presented at public forums F.Public input results and comments G.LCOG overview of district alternatives 9 ATTACHMENT C Local Ambulance Service: What’s the Future? Ambulance providers across the United States are facing critical financial shortfalls, primarily due to reductions in Medicare reimbursements. Ambulance service in Lane County is no exception. A fundamental change is needed now. Make your voice heard on this issue. Attend and participate in one of the public forums listed below, where officials from the Eugene Fire & EMS Department, Springfield Fire & Life Safety, and Lane Rural Fire/Rescue District will explain the problem and some possible solutions and ask for your feedback. Everyone is welcome. Please join us and let us know what YOU think should be done. Tuesday, Sept. 15 – 7 p.m., Hilyard Community Center, 2580 Hilyard St. Wednesday, Sept. 16 – 7:30 p.m., Fire Station 51, 29999 Hallett St. Thursday, Sept. 17 – 7:30 p.m., Fire Station 11-1, 88050 Territorial Hwy., Veneta nd Tuesday, Sept. 22 – 7:30 p.m., Eugene Emergency Services Center, 1705 W. 2 Wednesday, Sept. 23 – 7 p.m., Churchill Estates, 1919 Bailey Hill Rd. th Thursday, Sept. 24 – 7:30 p.m., Springfield Library Meeting Room, 225 5 St. th Tuesday, Sept. 29 – 7:30 p.m., Fire Station 3, 1225 28 St., Springfield Wednesday, Sept. 30 – 7:30 p.m., Petersen Barn, 870 Berntzen Rd. Thursday, Oct. 1 – 7:30 p.m., Fire Station 6, 2435 Willakenzie ATTACHMENT D REGIONAL AMBULANCE TRANSPORT FUNDING History and Problem Statement: In central Lane County, ambulance service is expected to be self-supporting; historically, general tax support has not been authorized, and the service instead has been funded by fees (and supplemented by FireMed ambulance membership revenue). This region’s ambulance system has a history of state and national awards for excellence. However, specialized equipment and highly trained emergency responders come at a high price, and as costs rise, so do the fees. But the actual fee schedule is only a small part of the story. In fact, the majority of ambulance transports in our area are provided to individuals 65 and over, who are covered by Medicare. Federal laws enacted over the past decade have greatly reduced the amount of reimbursement an ambulance provider may collect from Medicare. There is a corresponding issue at the State level, with Medicaid. In addition, the downturn in the economy is resulting in a higher percentage of patients being transported who are uninsured, underinsured, or unable to privately pay their bills. As an overall result, the ambulance providers – Eugene Fire & EMS, Springfield Fire & Life Safety, and Lane Rural Fire/Rescue – are losing money on most transports. The full listed fee is hardly ever actually collected. We have now reached the point where there is insufficient revenue available to continue the service on a self-sustaining basis. Because our ambulance agencies have become a revenue-negative enterprise, something must be done. Recognizing this, the elected officials of the City of Eugene, the City of Springfield, Lane Rural Fire/Rescue, and the Lane County Board of Commissioners have formed the Joint Elected Officials Ambulance Transport Service Task Force. With input from the public, and with information from ambulance service administrators, fire officials, firefighters’ unions, patients, and other stakeholders, the Task Force will make a recommendation – or series of recommendations – to the four elected bodies. The change to a new funding system may be fast or slow. It may affect the level of service. It may affect other government services. Whatever the change is, it will have pros and cons. But change must come if we are to keep high-quality ambulance service available in our region. Some of the options the Task Force is considering are explained on the reverse. A form to provide brief written feedback to the Task Force is also provided. Thank you for your interest, and we encourage your participation. 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. ATTACHMENT D AMBULANCE FUNDING FEEDBACK FORM Please take a few moments to indicate your opinions to the Task Force studying this issue. Thank you! Option A1 – General Fund Support. 5 4 3 2 1 Good idea Not a good idea Option A2 – Form a Fire District that Provides Ambulance Service. 5 4 3 2 1 Good idea Not a good idea Option A3 – Form a Special Health Taxing District. 5 4 3 2 1 Good idea Not a good idea Option B4 – Change Service Area Boundaries. 5 4 3 2 1 Good idea Not a good idea Option B5 – Mobile Health Care System. 5 4 3 2 1 Good idea Not a good idea Additional comments: _____________________________________________________ _______________________________________________________________________ _______________________________________________________________________ _______________________________________________________________________ I live in: ___ Eugene ___ Springfield ____ Lane Rural Fire/Rescue District ____ Other Please contact me: Name ___________________________________________ Contact info ______________________________________ ATTACHMENT G Page: Ambulance Funding Feedback DownloadCreate Chart1. Please take a few moments to indicate your opinions to the Task Force studying this issue. Thank you! answered question 97 skipped question 3 1- Not a 5- Good Rating Response 2 3 4 Good Idea Idea Average Count Option A1 – General 25.5% (24) 24.5% (23) 12.8% (12) 12.8% (12) 24.5% (23) 3.14 94 Fund Support. Option A2 – Form a Fire District that 52.6% (51) 10.3% (10) 9.3% (9) 11.3% (11) 16.5% (16) 3.92 97 Provides Ambulance Service. Option A3 – Form a Special 30.4% (28) 18.5% (17) 7.6% (7) 21.7% (20) 21.7% (20) 3.38 92 Health Taxing District. Option B4 – Change 25.3% (21) 25.3% (21) 8.4% (7) 19.3% (16) 21.7% (18) 3.13 83 Service Area Boundaries. Option B5 – Mobile 38.5% (35) 23.1% (21) 12.1% (11) 18.7% (17) 7.7% (7) 3.26 91 Health Care System. DownloadCreate Chart1. Please take a few moments to indicate your opinions to the Task Force studying this issue. Thank you! 51 Hide repliesAdditional comments 50 responses per page < 1 > Any arrangement that does not create yet another elected or appointed board or Fri, Oct commission should be considered. Surely we have a sufficient supply of available 2, 2009 1. Find... elected mayors, commissioners, etc., to assume the political responsibility for 12:58 whatever area-wide ambulance service is set up. PM Fri, Oct 2, 2009 2. Merge fire districts where financially cost-effective. Find... 12:56 PM Fri, Oct Mobile health care an interesting idea. Need to stabilize funding for existing services 3. 2, 2009 Find... before piloting/developing futuristic solutions. 8:38 AM Fri, Oct 4. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:34 AM Fri, Oct 5. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:33 AM Fri, Oct 6. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:33 AM Fri, Oct 7. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:33 AM Fri, Oct 8. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:32 AM Fri, Oct 9. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:32 AM Fri, Oct 10. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:31 AM Fri, Oct 11. Eugene Chamber of Commerce straw poll Find... 2, 2009 DownloadCreate Chart1. Please take a few moments to indicate your opinions to the Task Force studying this issue. Thank you! 8:31 AM Fri, Oct 12. Eugene Chamber of Commerce straw poll 2, 2009 Find... 8:30 AM Although it is off the table, I think there should be more consideration given to a private provider taking over the ambulance service. Private enterprise can make a profit on Fri, Oct 13. transport because they are not tied to bloated benefit and compensation packages. A 2, 2009 Find... free market system works without a reduction in service-- just more efficient use of 5:48 AM resources and more realistic compensation expectations by the employee. If the financial challenges to all public safety providers (fire, ambulance, police, sheriff) received a comprehensive and collective discussion by our elected officials and citizens, perhaps a solution that would provide stable funding for all public safety services could be identified. If the funding for all public safety services was provided Wed, by a new taxing district, it could allow the cities and county to use general fund Sep 30, revenues for other "core" services. Formation of a new taxing district, for me, would 14. 2009 Find... only be successful if it addressed stable funding to all public safety service providers. 11:04 AM The real solution lies with constitutional changes to our current taxing structure. Any new taxing district will eventually be insufficient to maintain viable service provision. Any truly long-term solution should include repealing the tax limitation laws passed years ago. Tue, Sep Form a metro wide fire district - include all rural departments within 10 miles of the city 15. 29, 2009 Find... limits of both cities 4:52 PM Private ambulance service is a huge mistake - I worked in So Cal as an RN and the Tue, Sep 16. quality of care is so far below our level here with Firefighter Paramedics. They are all-29, 2009 Find... hazard heroes!! 4:50 PM Tue, Sep Merger will solve the problem with ability to deliver the service most cheaply but still 17. 29, 2009 Find... retain high quality 4:48 PM Merge the fire departments and redesign how the ambulances are funded - keep them Tue, Sep 18. part of the fire department but find better ways to use them with FF/Paramedics as 29, 2009 Find... dual role. 4:46 PM Tue, Sep Why the two fire departments aren't already in a fire district is a mystery. That is the 19. 29, 2009 Find... only stable approach to providing fire and EMS service 4:42 PM Tue, Sep A fire district is the most logical approach to all emergency services provided by Fire 20. 29, 2009 Find... departments. There is great economy of scale in this concept 4:40 PM Sun, Sep Ambulance service is essential to our community and should be considered a high 27, 2009 21. priority core service. I would prefer that government provide the service as opposed to Find... 10:00 privatizing the system. AM DownloadCreate Chart1. Please take a few moments to indicate your opinions to the Task Force studying this issue. Thank you! I used the ambulance service recently. Five people came to the rescue. Two did the work. Three stood around watching. The quality of work appeared quite high. The Sat, Sep billing seemed excessive. Since I had medicare and insurance the paperwork I 26, 2009 22. Find... received suggested that the insurers agreed with me in the allowed amounts paid. I 11:31 thought the service rendered was of excellent quality but the price a bit high. How do AM the charges relate to the real costs? Fri, Sep You need a diversification of equipment -- STOL/aircraft/helicopters/small & large 23. 25, 2009 Find... ambulances 9:17 AM Thu, Sep 24. General fund short-term, district long-term. 24, 2009 Find... 7:09 AM Thu, Sep Privatization should be considered! You have the highest fee schedule in the state and 25. 24, 2009 Find... can't even cover costs. Mobile health care option is not thoroughly explained. 7:07 AM Thu, Sep 26. Do not privatize ambulance! Core service! Essential! 24, 2009 Find... 7:06 AM Thu, Sep 27. We need you. I think that raising or creating new taxes is the way to go. 24, 2009 Find... 7:04 AM Wed, Can the case be made for increasing FireMed membership and can that raise enough Sep 23, 28. money to off-set the costs? Also, since inadequate Medicare reimbursement is the Find... 2009 root of the problem, can that issue be addressed at the Federal level?? 2:18 PM The task force would be wise to consider other options not listed. For instance there are current ambulance service providers, who service Eugene and Springfield, that are better able to survive with the current re-imbursement model described in the survey. These ambulance services specialize in Advanced Life Support inter-facility transports Tue, Sep and could ease a significant ambulance transport burden that is outlined in the survey. 29. 22, 2009 Find... This would reduce the overall amount of work load on Eugene and Springfield fire 8:23 PM ambulances and allow them to concentrate on the important 911 calls. This option would not violate any existing private ambulance response restrictions as inter-facility transports are not restricted ambulance transport services.This is just one example of many options that are not considered in your survey. I am sure that the "city officials" will look out for the best interest of the city. The Tue, Sep 30. Eugene medics complain on a daily basis about having to come to the "rurals." We 22, 2009 Find... want quality care by people who care. I am willing to pay for quality services. 1:28 PM Tue, Sep The worst thing that could happen would be for ALS to be taken over by a private 31. 22, 2009 Find... service. 1:26 PM Tue, Sep 32. I feel we are being exploited by Eugene in many ways. 22, 2009 Find... 1:25 PM DownloadCreate Chart1. Please take a few moments to indicate your opinions to the Task Force studying this issue. Thank you! Get rid of lazy stupid public officials and vote in some people who will recognize what Tue, Sep 33. the problems are and will get busy & solve them. Eugene area is 20 years behind the 22, 2009 Find... rest of the U.S.! 1:24 PM Tue, Sep Lane County Fire District #1 should be more involved with all this. And a possible EMS 34. 22, 2009 Find... transport unit out here in the Veneta area. (I live in Walton.) 1:23 PM Too complicated to understand in one evening. I think you should market the FireMed Tue, Sep insurance to increase people. Pointing out that $52 per year would take 32 years to 35. 22, 2009 Find... equal one $1,600 ambulance ride -- I never thought of it like this! By age 60 it should 1:20 PM be a good buy! Tue, Sep Push for federal & state health care, not insurance coverage! General tax support-- 36. 22, 2009 Find... there's lots of $$s for street & road repair. 1:19 PM Tue, Sep 37. Encourage more FireMed participation. 22, 2009 Find... 1:17 PM Re: Mobile Health Care System -- It's ABSURD that this is even a choice on this survey. Tue, Sep 38. 22, 2009 Find... Ambulance should be a core service just as Fire & Police. Core services should be 1:14 PM funded first with other services on the back burner. Tue, Sep Privatization with a private/public cooperative model is the best solution. It should be 39. 22, 2009 Find... on the table for discussion! 8:19 AM Tue, Sep 40. Cut waste -- get rid of about two-thirds of the PR people in Public Works and LRCS. 22, 2009 Find... 7:55 AM Mon, the ambulance fund needs to strictly pay for ambulance services, too many outside Sep 21, 41. Find... things are taken from the fund. 2009 9:23 AM Mon, I think it would be unwise to try B-5 until there is empirical data from other locations Sep 21, 42. Find... which have used it to support that it would be a viable model for this area. 2009 9:18 AM I probably like Option A2 the best, but only if there is in fact a fee still associated with Sun, Sep 43. the service. Otherwise, system abuse would become an issue. 20, 2009 Find... Would there still be a fee associated with Option A3? 4:51 PM Lane Rural has done an excellent job and we would welcome them here in Veneta. Do Sun, Sep 44. not attempt to sell out our area to a private company, we simply won't go for that, 20, 2009 Find... period. 3:38 PM 45. I have many comments. Sat, Sep Find... DownloadCreate Chart1. Please take a few moments to indicate your opinions to the Task Force studying this issue. Thank you! Option A1: In your mission and vision statements you mention community and service 19, 2009 area. Ambulance service needs to be recognized as a core service which benefits all 12:27 of the area. Many folks who work and own property in Eugene live beyond the city PM limits and there should be no limit to providing this service. It deserves general fund support. Option B4- This would only work if Lane Rural had another ambulance to help cover the added area. Maybe Eugene could donate one for the good of the patrons. My biggest thought is that aggressively promoting FireMed makes more sense than trying to form a new taxing district in the current political and economic climate. If a 60% membership rate would support ambulance service then go for that. I think there needs to be a whole new team approach to selling it which would promote the whole EMS system, emphasizing its quality of service and the low cost of membership. Promote the use of memberships as employee perks. Give a slight discount for renewals. Do school fundraisers where $10 per membership is given back to the school.(Better than gift wrap or chocolate) Promote gift memberships or tax deductible philanthropy. Every form of government in Oregon is cramped by tax measures and this is a form of funding which is basically non-political and does not require a vote. With the bottom line being the lack of payment for service, it seems that increasing funding in some way will need to be included in the solution. Amubulance transport is Fri, Sep an important service to our communities, and up to this point has been outstanding. 18, 2009 46. There is also the consideration of staffing ambulances with lower EMT levels to help Find... 12:30 offset the cost. While having the skills of a Paramedic is desireable, it seems in most PM instances that an Intermediate level EMT would be adequate for the needs of the patient, especially with the recent upgrade in skills. I attended the first meeting in south Eugene and before I can give you even an educated guess of my opinion on any of the options I really need more information Fri, Sep about the present cost of doing business for the fire and ambulance departments. Can 18, 2009 47. Find... I get budget figures? One option is to form a fire district that provides ambulance 10:46 service, would the cities then reduce there rates accordingly? Or continue to use there AM permanent rate to fund other activies? Ambulance service needs to be considered an essential service. Ambulance, fire and Wed, police, various components of public works, waste water management services should Sep 16, 48. Find... be the first priorities in the budget process. I think there should be a user fee for the 2009 ambulance program to decrease the use of the service improperly. 3:18 PM Wed, Sep 16, 49. Where is the private option? Find... 2009 1:13 PM Tue, Sep 15, 2009 50. What's the financial potential of charging fines to those who abuse the 911 system? Find... 6:39 PM DownloadCreate Chart2. I live in: DownloadCreate Chart2. I live in: answered question 88 skipped question 12 Response Response Percent Count Other 15.9% 14 Eugene 60.2% 53 Springfield 10.2% 9 Lane Rural 13.6% 12 Fire/Rescue District i do not reside in the cities but in the mckenzie valley area. i do not know enough about option Tue, Sep 15, 51. b5--that may be a decent option---one thing for sure--- private owned ambulance companies 2009 12:26 should never be discussed---they are too interested in the almighty dollar not service!!!!!!! PM ATTACHMENT H OVERVIEW OF SELECTED ALTERNATIVES FOR FUNDING AMBULANCE SERVICES Impact Type of Entity Applicable Creates Governing Election on Statutory Comprehensive Statutes New Body Existing Limitations Plan Impacts Revenues Districts Intergovernmental ORS 190 No Existing No No No Agreement Elected Bodies Formation of a new fire ORS 198 and Yes New Elected Yes, Yes Cannot have Perhaps district ORS 478 Board primary or overlapping district (Metro Plan has specific language about general formed under same special districts) election principal Act Formation of a new ORS 198 and Yes New Elected Yes, Yes Cannot have Perhaps health district ORS 440 Board primary or overlapping district (Metro Plan has specific language about general formed under same special districts) election principal Act Formation of a county ORS 198 and Yes County Board Yes, Yes Perhaps service district ORS 451 of primary or (Metro Plan has specific language about Commissioners general special districts) election Annexation to an existing ORS 198 and Yes, at Existing Optional Yes Cannot have Perhaps district principal Act established Elected Board overlapping district (Metro Plan has specific language about permanent formed under same special districts) tax rate principal Act Merger of like districts ORS 198 and No New Yes, next No Perhaps by cessation of district(s) principal Act Configured available (Metro Plan has specific language about being absorbed into Elected Board election special districts) surviving district Consolidation of 2 or ORS 198 and Yes New Yes, next Yes Perhaps more like districts into a principal Act Configured available (Metro Plan has specific language about new successor district Elected Board election special districts) LCOG: L:\BC\2008 LC FIRE DEFENSE BOARD\AMBDIST\AMBDISTREPORT\MATRIXFORAMS JEO.DOC