City of LyndenAmbulance Utility Cost of Service and Rate

Study

Fire Chief Gary Baar

Presented by

RCW 35.21.766 Ambulance Utility Requirements and Approach

Project Tasks 2014 Fire Department Budget and

Responses Cost of Service Analysis and Results Alternative Rate Scenarios Questions

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Agenda

Provides for ambulance service to be operated as a public utility

Authorizes the City Council to set and collect rates and charges for regulating, operating, and maintaining an ambulance utility

Requires that rates and charges be based on a cost of service study

Does not allow capital costs for construction, major renovation, or major repair of facilities

Categorizes costs by availability of ambulance service and the demand placed on the service

Exempts Medicaid eligible persons in a nursing home, boarding home, or adult family home and persons who receive in home services

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Key Elements In RCW 35.21.766

Availability costs include the basic infrastructure needed to respond to a single call for service and may include dispatch, labor, training, equipment, patient care supplies, and equipment maintenance costs

Demand costs are based on the burden placed on the ambulance service by individual calls, such as those costs associated with the frequency of calls, distance from hospitals, etc.

Availability costs are uniformly applied across customer classes, while demand costs are based on the calls for service by each customer class

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Ambulance Utility Approach

Conduct Kick-off Meeting Review and Analyze Fire Dept. Ambulance Costs

and Workload Data Develop Cost of Service Framework and Establish

Cost of Service Identify Customer Classes and Cost Allocation

Methods Calculate Availability and Demand Rates for Each

Customer Class Prepare Reports Make Presentation

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Consultant Project Tasks

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Lynden Fire Department 2014 Budget

Budget Category

General Fund

Personnel $1,333,069 Supplies & Services 144,500 Intergovernmental Services 318,854 Capital 90,000 Subtotal: 2014 Budget $1,886,423 Ambulance Utility Billing 15,250 Grand Total $1,901,673

2014 Budget Plus Additional Billing Costs

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2012 Number of Incident Responses

Type of Response

Emergency Responses

% of Total

EMS 1,098 87% Fire and Other calls 159 13% Total Calls 1,257 100%

An average of 2.9 full-time line staff and 1.1 volunteers are on duty 24/7

76% of the time spent by full-time line staff and 70% of the time spent by volunteers is for EMS/ Ambulance activities

Administrative staff time (i.e. Fire Chief, Assistant Fire Chief, and Support Services Manager) was split between EMS and Fire based on full-time line staff and volunteer hours, except for 10% of the Fire Chief’s time which is spent on fire plan review and inspections

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Key Cost Assumptions: Labor

EMS and Fire supplies, including EMS medical supplies, were split 60/40 between EMS and Fire

What-Comm 911 and Whatcom County Fire Agencies Radio System (FARS) dispatch services were distributed between EMS and Fire based on total calls for service

Dispatch services provided by the Prospect Fire Dispatch Center are associated with BLS transports to Bellingham and were assigned entirely to EMS

Fleet & equipment maintenance costs were split 44/56 and fuel costs 33/67 between EMS and Fire

Facilities (i.e. fire station) costs were split 40/60 between EMS and Fire

Also included $15,250 of new costs identified by the Finance Department for utility billing services

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Key Cost Assumptions: M&O

For full-time line staff costs, 85% was assigned to availability and 15% to demand. For volunteers, 78% was assigned to availability and 22% to demand

The costs of administrative staff were assigned entirely to availability

Ambulance billing services, EMS supplies, fuel, and Prospect Fire Dispatch Center were assigned to demand

Professional services such as insurance costs and biohazard waste disposal were distributed between availability and demand using the availability to demand ratio for full-time line staff

All other costs were assigned to availability

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Key Cost Assumptions: Availability vs. Demand

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Cost of Service Results

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Cost of Service Adjustments

Availability Demand Total

Ambulance Utility Costs 1,104,821$ 184,169$ 1,288,989$

Adjustments (Less Revenues) Total

Ambulance & Emergency Aid Fees (190,000)$ (190,000)$ Reimbursement for Fair/Rodeo (7,000)$ (7,000)$ DOH Trauma Care Grant (2,000)$ (2,000)$ SAFER Grant* (182,801)$ (182,801)$ Intrgov't - EMS 1/10th of 1% sales tax pass-through

(95,000)$ (95,000)$

Net Ambulance Utility Costs 825,020$ (12,831)$ 812,189$

*According to RCW 35.21.766, revenues from the direct billing of individual users of the ambulance service must be netted against the costs of demand.**The $241,743 in budgeted 2014 SAFER Grant revenue has been allocated between fire and EMS based on the results of the cost of service study. Based on the distribution of full-time staff hours, 76% ($182,801) was attributed to EMS, and 24% ($58,942) to fire.

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Customer Billing Units

Customer Class Regular Medicaid Total % Regular % Medicaid % Total

Residential 4,133 4,133 72.5% 0.0% 72%Multi-Family 921 921 16.2% 0.0% 16%Commercial 393 393 6.9% 0.0% 7%Nursing Home/Assisted Living 166 58 224 2.9% 1.0% 4%Public 30 30 0.5% 0.0% 1%

Total 5,643 58 5,701 99.0% 1.0% 100%

**

*

*Includes 72 independent living units at Meadow Greens.**Includes 85 rooms at Christian Health Care Center, 107 rooms at Lynden Manor, and 32 rooms at Meadow Greens.

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Customer Class Costs

Customer Class Availability Demand Total

Residential 594,857$ -$ 594,857$ Multi-Family 132,558$ -$ 132,558$ Commercial 56,564$ -$ 56,564$ Nursing Home/Assisted Living 23,892$ -$ 23,892$ Public 4,318$ -$ 4,318$

Total 812,189$ -$ 812,189$

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Full Cost Recovery Rates - $812,189

Customer Class Availability Demand2014 Annual

Rate/Acct2014 Monthly

Rate/Acct

Residential 143.93$ -$ 143.93$ 11.99$ Multi-Family 143.93$ -$ 143.93$ 11.99$ Commercial 143.93$ -$ 143.93$ 11.99$ Nursing Home/Assisted Living 143.93$ -$ 143.93$ 11.99$ Public 143.93$ -$ 143.93$ 11.99$

Full Cost Recovery 50% Cost Recovery SAFER Grant Cost Recovery 10 Month 2014 Cost Recovery

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Alternative Rate Scenarios

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Alternative Rates

Questions

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