CITY COUNCIL: Resolution to Adopt a Fire Department Emergency Medical Service Fee

Meeting Date: August 2, 2011
Prepared by: John Goss

City Council
Agenda Summary

Name: Consideration of a Resolution to adopt a Fire Department Emergency Medical Service Fee.

Description: This Resolution would establish an Emergency Medical Service Fee to reimburse the City for expenses related to the Fire Department’s response to medical emergencies within the City of Carmel-by-the-Sea.

Overall Cost:
City Funds: N/A
Grant Funds: N/A

Staff Recommendation: Adopt the Resolution.

Important Considerations: This fee would allow the City to obtain reimbursement for Fire Department EMS calls from insurance companies, government health programs, and individuals. This fee would help cover the costs of Fire Department EMS calls. At a fee of $250 per call, which is the low end of the range of this fee collected in other California
cities, it is estimated that the City would obtain an estimated $42,640 in annual revenue to support Fire Department emergency medical services.
Decision Record: The City Council, during its June 2011 budget workshops, indicated an interest in considering the adoption of this fee.

Reviewed by:

________________________________ ________________
John Goss, Interim City Administrator Date

TO: MAYOR AND MEMBERS OF THE CITY COUNCIL
FROM: INTERIM CITY ADMINISTRATOR JOHN GOSS
DATE: AUGUST 2, 2011
SUBJECT: CONSIDERATION OF A RESOLUTION TO ADOPT A FIRE DEPARTMENT EMERGENCY MEDICAL SERVICE FEE _____________________________________________________________________

A potential fee for supporting emergency medical services provided by the Carmel Fire Department was suggested in the budget transmittal letter and was discussed during the budget workshops. The proposed fee is called an Emergency Medical Service (EMS) fee.

PURPOSE
The purpose of an EMS fee is to reimburse the City for the expense of its Fire Department in responding to medical emergencies within the City of Carmel-by-the-City. While general tax dollars are used to support the availability of three fire fighters and an engine 24 hours a day, seven days a week, specific service is provided for short periods of time to those who receive emergency medical service. The proposed fee will cover a
portion of this expense.

Part of the rationale for such a fee is that just as general tax dollars should not be required to support ambulance transport services, the response to emergency medical calls by the Fire Department also should not be subsidized by general tax dollars. It should be noted that the City currently is unable to obtain reimbursement for Fire Department EMS calls from insurance companies, government health programs (Medi-Cal), and individuals because there is no fee structure in place. The City can recover the cost of this service by establishing a fee for service and by billing the appropriate agencies.

How Will This Fee Work? When there is a medical emergency in the City of Carmel-by-the-Sea, usually the fire engine with a three-person crew will arrive first on the scene and will begin treatment at the Basic Life Support (BLS) level. All of the City’s fire fighters are certified Emergency Medical Technicians (EMTs) and can perform service at the BLS level. This level of service can include the application of a number of emergency medical skills and services depending upon the situation found at the scene.

These include:
• Evaluate the ill and injured;
• Obtain diagnostic signs including temperature, blood pressure, pulse and
respiration rates, level of consciousness and pupil status;
• Perform CPR, if needed, including the use of mechanical adjuncts to this process;
• Use of different types of adjunctive airway breathing aids, such promoting airways, basic oxygen delivery services, and manual and mechanical ventilating devices designed for pre-hospital use;
• Use of stretchers and body immobilization devices;
• Initial pre-hospital emergency care of trauma;
• Administer oral glucose or sugar solutions;
• Extricate entrapped persons;
• Perform field triage;
• Assist ALS procedures upon arrival and with the direction of a paramedic.

After the Fire Engine with its three-person crew arrives and provides emergency medical care, which can include some or all of the above described services, there may be a need for Advanced Life Support (ALS). This can be provided by the subsequently arriving ambulance which is staffed by paramedic fire fighters. If ALS service is not required, the
fire engine crew will complete medical aid at the scene in a “treat and release” mode.

After the service is rendered, the insurance company and/or Medicare is billed. This billing function would be consolidated with the staff who currently files ambulance charges. It is suggested that the same debt collection agency used by CRFA also be used for these bills. This would promote the efficiency of the billing function and add only an incremental cost to bill collection, with most of that expense absorbed by existing staff.

Amount of the Fee. The cost of providing BLS service is estimated to cost $300 per call. This expense is based on the hourly salary and benefit rate of the three fire fighters plus administrative overhead. There is also included an hourly engine rate based on California Emergency Management Agency’s reimbursement rates. The expense per call is somewhat greater than the proposed $250 per incident fee for this service.

Any resolution adopted by the Council implementing this fee should make it clear that the fee is only for the cost of firefighter time and their engine in responding to and addressing a medical emergency and does not cover the cost of medical supplies, medical equipment, specialized medical radio communication equipment, and the training and certification of first responders. It also does not apply to paramedic ambulances staffed
with at least one paramedic. These expenses cannot be reimbursed by this fee since they are already covered by funds collected and distributed by CSA 74 via a MOU of which Carmel is a signatory. The source of the CSA 74 funds is a $12 parcel tax; therefore a fee cannot be charged to cover these CSA 74 MOU expenses.

As pointed out earlier, this fee will allow the City to recover this expense from insurance and Medi-Cal, with its collection accomplished by the same process and personnel by which ambulance charges are collected.

Comparable Practice. While no cities in Monterey County collect this fee, many cities in the state charge an EMS fee of $250 – $350 per call. In some cities this is called an “assessment fee” but the fire department service is often substantially beyond an initial assessment.

Some of these cities began charging this fee in 1990, so it is not a new concept in municipal finance. Examples of southern California cities which charge this fee include the following:
• Newport Beach
• San Clemente
• Fountain Valley
• Anaheim
• Fullerton
• Orange
• Huntington Beach
• Santa Ana
• Costa Mesa
• Downey
• Compton
• Long Beach

These cities include both Charter and General Law cities. Therefore, there is no requirement that the fee can only be collected by Charter cities. General Law cities like Carmel-by-the-Sea may also can implement this fee.
FireMed. Other cities also offer an additional program, which is not proposed in this report, called FireMed. This is a voluntary subscription service. For an annual membership fee, all people who live at a residence or own and are employed by a business are not charged for the emergency medical response by the fire department. The City can charge the insurance company or Medi-Cal the incurred cost, but this “gap” insurance covers additional costs not covered by insurance or Medi-Cal. This membership program costs as little as $30/year per household or business.

Some cities have extended this membership program to both fire emergency response and ambulance service. In Huntington Beach, for example, this subscription program costs $65/year per household or business. Incredibly this city of slightly more than 200,000 people has an approximately 30% signup rate, producing $1.5 million annually to support its EMS fire response and ambulance programs.

This program is not proposed at this time since many details would need to be examined to determine its feasibility in Carmel-by-the-Sea. The proposed EMS fee could be viewed as Step One in this program, with FireMed as a possible Step Two. Step One, of course, can be accomplished without the need to implement Step Two.

Estimated Revenue. Initially, in Supplemental Budget Memo #2 a rough estimate of revenue from this fee was $92,285. It was pointed out that this was a “rough” estimate, particularly since the EMS incident data would need to be refined. There were more than 800 EMS calls reported in 2010, and a limited number were eliminated as clearly not applicable to this fee (arrival at scene with no victims, for example). But there was a
need to further refine the incident calls to determine which ones were applicable to this fee. This review process has now reduced the number of EMS incident calls to 388 during 2010.

Using this number the estimated revenue from this new fee is a projected $42,640. This is based on 388 calls with a collection rate of .47 which is similar to the rate collected for the local ambulance service as well as other cities with this program. The revenue from this fee is estimated with 388 incidents x $250 x .47 = $45,590 less $2,963 for collection expense = $42,627.

Implementation. Besides the normal steps of setting up the billing process for this fee, it is suggested that, if adopted, implementation of this fee be delayed one month in order to inform the public about the fee.

RECOMMENDATION
It is recommended that the City Council adopt the Resolution implementing a fire department emergency service medical fee.

CITY OF CARMEL-BY-THE-SEA
CITY COUNCIL
RESOLUTION 2011-
A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF CARMEL-BY-THE-SEA ESTABLISHING A FIRE DEPARTMENT EMERGENCY MEDICAL SERVICE FEE

WHEREAS, the Carmel-by-the-Sea Fire Department responds to emergency medical service calls; and

WHEREAS, these emergency medical service responses involve specialized medical services ranging from basic medical evaluation and treatment including obtaining diagnostic signs and performing field triage, to performing CPR, using breathing aids and devices, administering oral glucose or sugar solutions, using stretchers and body immobilization devices, and providing initial pre-hospital emergency care of trauma; and

WHEREAS, responding City fire personnel are all trained emergency medical technicians (EMTs) qualified to perform these specialized emergency medical services; and

WHEREAS, the cost of providing this specialized medical service in terms of staff and equipment hours and appropriate overhead is estimated at an average of $300.00 per call; and

WHEREAS, other cities in the State which levy such a fee have established a fee ranging from $250 - $350 per call; and

WHEREAS, emergency medical calls by the Fire Department should not be subsidized by general tax dollars; and

WHEREAS, the establishment of this fee will permit the City to recover this expense from insurance companies and government health programs; and

WHEREAS, this fee does not recover emergency medical expenses related to the cost of medical supplies, medical equipment, specialized medical radio communication equipment, and the training and certification of first responders, or the cost of paramedic ambulances staffed with at least one paramedic;

NOW, THEREFORE, BE IT RESOLVED THAT THE CITY COUNCIL OF THE CITY OF CARMEL-BY-THE-SEA does hereby resolve to:

1. Establish a Fire Department emergency medical service (EMS) fee of $250.00 per call.

PASSED AND ADOPTED BY THE CITY COUNCIL OF THE CITY OF CARMEL-BY-THE-SEA this 2nd day of August 2011, by the following roll call vote:

AYES: COUNCIL MEMBERS:
NOES: COUNCIL MEMBERS:
ABSENT: COUNCIL MEMBERS:

SIGNED:

_______________________
SUE McCLOUD, MAYOR

ATTEST:

______________________
Heidi Burch, City Clerk