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Hearing to consider adoption of Resolutions 188-2007 and 193-2007 establishing the ambulance rate schedule for County Service Areas 3 and 7 to provide advanced life support ambulance services within the legal boundaries of said County Service Areas. (Cont'd 7-17-07, Item 41)
FUNDING: Fee assessment.
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Fiscal Impact/Change to Net County Cost: Adoption and implementation of these proposed rates will generate additional revenues. There is no net County cost and no impact on the General Fund.
Background: The County of El Dorado, through the Public Health Department, oversees the delivery of all emergency and non-emergency ambulance services in the County. The actual service is provided under contracts with two separate Joint Powers Authorities, one on the Western Slope and one in South Lake Tahoe. The Public Health Department bills for these services through its contract with Wittman Enterprises.
In 2006, the Public Health Department conducted a full review of ambulance service rates and the Board of Supervisors adopted the recommended rate schedule. The Board directed the Department to conduct a full review of the rate schedule every two years. In the intervening year the Department recommends adjusting the rates by the Medical Consumer Price Index (CPI-U) in order to keep abreast of cost increases. The attached schedule recommends a 6% adjustment based on CPI-U.
Additionally, during the County's review of ambulance rates in 2006, the Board directed staff to research two additional potential fees: 1) a fee for non-residents and 2) a fee for treatment-no transport. As a result of this review in addition to the 6% adjustment for increase in the medical CPI, separate non-resident fee categories have been created for all base charges by adding $25 to each base charge. This amount is similar to the annual assessment/tax paid by an El Dorado County homeowner for ambulance services.
A new fee for "Treatment - No Transport" of $300 has also been added to the rate schedule based on a review of similar fees currently charged for other billing clients by Wittman Enterprises. The criteria that would be used in assessing this fee is outlined below in the attached table.
Reason for Recommendation: The Department has evaluated its current rate structure and, based on the Medical Consumer Price Index (CPI-U) increase of 6% for 2006-2007, identified a need for rate increases. Additionally, five new rates have been proposed to be added to the schedule including four nonresident rates calculated by adding $25 to the proposed adjusted fee for the current rates plus a treatment-no transport fee. The proposed rate schedule is presented in contrast to the current rate schedule below and as Attachment A. Staff will answer any questions regarding these proposed changes.
2007 EL DORADO COUNTY
AMBULANCE RATE SCHEDULE
EFFECTIVE AUGUST 21, 2007
|
Description |
Current Rate |
Proposed Rate |
|
ALS Emergency Base Rate1 - Resident |
$752 |
$797 |
|
ALS Emergency Base Rate - Nonresident* |
-- |
$822 |
|
ALS Non-Emergency Base Rate2 - Resident |
$752 |
$797 |
|
ALS Non-Emergency Base Rate - Nonresident* |
-- |
$822 |
|
ALS Level 23 - Resident |
$1,089 |
$1,155 |
|
ALS Level 2 - Nonresident* |
-- |
$1,180 |
|
Mileage |
$15/mile |
$16/mile |
|
Facility Waiting Time (per 1/4 hour) |
$175 |
$186 |
|
Oxygen Use |
$50 |
$53 |
|
Standby (Per Hour) |
$129 |
$138 |
|
Critical Care Transport4 - Resident |
$1,287 |
$1,365 |
|
Critical Care Transport - Nonresident* |
-- |
$1,390 |
|
Treatment - No Transport5 |
-- |
$300 |
|
Medical Supplies & Drugs6 |
Market Cost + 15% |
Market Cost + 15% |
1 ALS Emergency Base Rate: This base rate is charged for all emergency transports for which the patient was transported to an acute care hospital or rendezvous point with an air ambulance at least 0.1 mile from the pick up location.
2 ALS Non-Emergency Base Rate: This base rate is charged for non-emergency transfers from a private residence, convalescent care, skilled nursing facility, or hospital and does not require an emergency response (i.e., red lights and siren) to the pick up location.
3 ALS Level 2: This charge applies when there has been a medically necessary administration of at least three different medications or the provision of one or more of the following ALS procedures: manual defibrillation/cardioversion, endotracheal intubation, central venous line, cardiac pacing, chest decompression, surgical airway, or intraosseous line.
4 Critical Care Transport: This charge applies when a patient receives care from a registered nurse during transport from a hospital to another receiving facility.
5 Treatment - No Transport: This charge applies when the patient receives an assessment and at least one ALS intervention (i.e., ECG monitor, IV, glucose, etc.), but then refuses transport or is transported by other means (i.e., private car, air ambulance, etc.)
6 Medical Supplies & Drugs: Medical supplies and drugs are billed at provider’s net cost plus a handling charge of 15% to cover the costs of materials, ordering, shipping and inventory control.
* Nonresident: Charge applies only to a patient whose home address includes a city, state or zip code located outside El Dorado County
These fees shall continue to be subject to adjustments annually based upon increases or decreases in the CPI-U for all urban wage earners and clerical workers in the San Francisco/ Oakland area published by the United States Department of Labor Bureau of Labor Statistics (CPI-U), or successor index for the period March - February of the prior year. This proposed rate change shall go into effect on August 21, 2007.
Public notices of a hearing at this meeting, and prior to the Board's consideration of this matter, were placed in the Mountain Democrat and Tahoe Tribune as current statute requires.
Action to be taken following Board approval: Chair to sign two (2) copies of each Resolution; Board Clerk to return one copy of each Resolution to Department; ambulance contractors to be notified that rates are to be changed, effective August 21, 2007; and Department to institute new rate schedule, effective August 21, 2007.
Contact: Dan Buffalo
Concurrences: