Loading...
HomeMy WebLinkAboutStaff Report 4423 City of Palo Alto (ID # 4423) Finance Committee Staff Report Report Type: Action Items Meeting Date: 5/6/2014 City of Palo Alto Page 1 Summary Title: EMS First Responder Fees Title: First Responder Fee and Treat and No Transport Fee From: City Manager Lead Department: Fire Recommendation Staff recommends that the Finance Committee direct staff to reach out to stakeholders regarding the implementation of a First Responder Fee and a Treat and No Transport Fee and return to the Finance Committee with the results of the outreach plan and a recommendation for fee amounts, cost recovery levels, annual fee revenue estimates, and a fee implement ation plan. Background In FY 2013, staff embarked on a comprehensive cost of services study. Initially, the work was focused on assessing the cost recovery levels of fees outside of development services. This work has continued and with the FY 2015 Proposed Municipal Fee Schedule staff will present the cost recovery levels for certain fees. The cost of services study also is intended to review services for which the City currently does not assess any fees such as some first responder fees. Discussion The City of Palo Alto charges user fees related to ambulance transportation services only. The City does not charge a fee for first responding to calls nor for treatment and no transport of patients. In FY 2013, the Department collected approximately $3 .1 million in ambulance transportation related revenue. However, the revenue collected from the user fees only recovers a portion of the total costs for all Emergency Medical Services (EMS) provided by the Fire Department. In fiscal year 2013, the City responded to approximately 4,700 EMS calls. However, for approximately 3,500 calls, or 75.0%, of the total call volume, the City was able to charge an EMS fee. The remaining calls were for First Responder and/or Treat and No City of Palo Alto Page 2 Transport activities. Approximately 60% of total calls in fiscal year 2013 responded to residents and 40% responded to calls from non-residents. In the Bay Area, the City of Berkeley, the City/County of San Francisco, Alameda County, and the Novato Fire District charge first responder and/or Treat and No Transport Fees. Additionally, sixteen cities and county areas that comprise the Sacramento Metro Fire Department charge such fees. It should be noted that private insurance companies pay for such fees and that Medicare will not reimburse for First Responder fees and only for certain Treatment and No Transport fees. First Responder Fee The Fire Department operates eight first responder vehicles staffed with emergency medical technicians and paramedics (six fire engines and one ladder truck), one seasonal engine in the Foothills, and three paramedic ambulances. One of the ambulances is cross-staffed with a fire engine. A fire engine or ladder truck responds to all emergency EMS calls, often arriving first. These first responders begin emergency treatment prior to the arrival of the ambulances. The costs to deploy these first responder paramedics, emergency medical technicians and vehicles are not recovered currently and no fee exists in the current Municipal Fee schedule. For other Santa Clara County Fire Departments, the Santa Clara County Emergency Medical Services Agency financially supports every fire department’s first responder program except Palo Alto. The City does not receive a county subsidy due to the City maintaining its financial independence from the county by virtue of Section 1797.201 of the Health & Safety Code (201 Rights). 201 Rights are a statutory, non-discretionary obligation that allows the City to provide the level of EMS care that it determines best serves the community. The level of care shall not be less than the level provided prior to June 1, 1980. The county cannot unilaterally displace the City’s 201 Rights. These rights and obligations allow the City to provide superior EMS service to the community. The Palo Alto Fire Department’s 90th percentile ambulance response time is 8:00 minutes compared to 12:00 minutes for the county ambulance provider in the rest of Santa Clara County. Treat and No Transport Fee Treat and no transport is an EMS call for serv ice where a first responder and/or paramedic render aid and use medical supplies, but the patient is not transported to the hospital. This results in no cost recovery of those services. Patients sometimes refuse hospital transportation, known as “against medical advice” or “refusal of care”, or the Fire Department medical staff determines ambulance transportation is not needed. Of the approximately 4,700 EMS calls for service in FY 2013, 623 (about 13%) result in treat and no transport. City of Palo Alto Page 3 The Treat and No Transport fee is recommended for two reasons. Currently, costs for these services are not recovered and fully paid with general purpose tax receipts even though individuals receive a personal benefit from Fire and EMS staff, equipment and supplies. Second, Treat and No Transport fees will prepare the City of Palo Alto for the implementation of provisions of the Federal Affordable Healthcare Act (AHA). The AHA encourages alternate treatment options, particularly those that reduce costs. The current reimbursement model is based on only transporting patients. Part of the AHA is to reduce transports and encourage alternative models for medical care. The changes may decrease the need for transport and allow alternative access to medical care. Fees for service need to be established to allow reimbursement in the new program. Another goal would be to reduce costs for Palo Alto residents and visitors by offering them a lower cost option instead of transporting them to emergency departments. Treat and No Transport supports a long-term Fire Department strategy to implement a risk reduction program with Community Paramedics who would make preventative visits to at risk seniors and other community members. Community Paramedicine supports independence and reduction of unplanned, emergency care. Stakeholder Outreach Plan Prior to seeking approval from the Finance Committee and then the City Council, staff plans to reach out to stakeholders, as well as consult with the City Attorney’s office regarding legal risks, if any. Including community members in this decision and holding a series of community meetings to discuss these charges may be in the City’s best interest. The Department utilized a key group of community stakeholders, including neighborhood and business lead ers, large employer representatives and staff from Stanford University, in its Strategic Planning process in FY 2014 and would reach out to this group to participate in these discussions, as well as issue a general invitation to the public if they are interested in participating. Next Steps After completion of the outreach to stakeholders, staff plans to return to the Finance Committee with a summary of stakeholder input as well as a fee structure, cost recovery levels, fee revenue estimates, and implementation plan.