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Home My WebLink About0314.093i - Joiay 2{J, 1993 HONORABLE CITY COUNCIL Pale Alto, Califorr.ia Attention: Finance Committee p~~rc STAFFING Membe.rs of the CO\l.ncil: Report in Brief 1""'\ BUDGET 93-·94 This repar t responds to questio:1s asked by the Finance Committee regarding the request of $30),684 to add a second paramecic w~it which will operate l2 hours each day_ Bacltgrow;~ The Fire Department eV=lluated alternative parainedic service delivery methods to meet the current as well as future demands for service in the Palo Alto service area. The evaluation provided an analysis and overview of existing ser.fi.::e levels, paramedi c program tx-ends, ser ... i·:;e del i v,;!ry and finance o'p~iGns fro!T: ',,;l;ich sta::f could make rec'.:Jm:necc.aticr.s to be::t~r meet current and futu:::-e: servi::"e dem;;"nds. The study identified several key factors re.lating to the existing paramedic program and the proposal was based upon these fir.dings. l~ Existing d~ds for service exceed the capabilities of a single 24 hour paramedic unit. A. Future Emergency Medical Service (EMS) calls are estimated to rise~ The projected patient transport deman~ will increase 28 percent to reach 2~330 calls by 1935. 3. The City of palo Alto P.r~dic fees were found to be th~ lowest of the surrounding aarvice area8. 1 - .-.,. 1. In the preparation of the proposal to increase the paraJIl~dic 8erviee8~ where other alternatives coneidered? Ar .. swer: Staff consid'2red the fo!lC'""ing service delivc-ry alternacives b~for,=-recommending addlrlg a seco:ld paramedic 'lnit G'Llring the higr.. derr.and period from S a.~. t,:) E. p_!Tl. Staff sel~ct-e.d th]s prcpusal over the othEr alternatives listed D€Ca!..;.se of ir.:provec cc'st reccvery and more efficier .. t use of existin,; pe.rsonn'2"l 8:1d eq'.;ipment. • CO!1tinUQllsly staff Medic-2 by adding t\\.'o pon'a~edics per shift (requires six n~w positii:ms'/. • Discontinue providing paramedic se:r:vlces_ Seek a private ambulance company to provide service to Palo Alto. Sf~ll t::he. eq .. ..J.ipment and vehicles. Reouce t!:e '::r:e paS! t ion added, EMS COGrdinator, to implement th~ original program_ • Sta::f Medic-2 foO-:-24 hours as a two piece engine company_ 15 Staff Medic-l and Medic-2 for 24 hO":.lrs as two piece units with Truck-l and Rescue-l. • St:aff Medic-l and Medic-2 with 1 parar.tedic and on", firefiq'nt*==r on each a'nbula.nce and assign a paramedic on four engine compan_1.es. • Staff Medi.c-l with t ...... o paramedics and asslgr. t> ... ·o paramedics on two engine companies. Seek a pri\~ate ambulance {rlo .... .i-pararnedic} provider to transport a:i.l patients Medic-l cannot. serve. • Staff Medic-l with two paramedics and assigrl tw,:, paramedics on two ~r.gine companies; which are modified to carry a patier.':. • Staff seven e:;:;gine ccmpa;J.ies ~·i t2"J ~ ",~ paraT'1edi cs each a:1:::l see:': a private aTwl:.la:l.ce tnon-p.a..:-ae',ecici previder to tr,:'nspc.!"t all patients. • Staff seven engine companies wi th t ...... o paramedics en each engine and st3ff Me6ic-l, Medic-2 and Me,:3ic-3 with one firefigr.te.! on each unit to transport all patients. 2. What are the elements of the stsffing arra.ngement, including the requirezent of ov.rtime costs. J\...'""!swer: The st.affing arrangement as p't"of'osed, is ae:signed to meet the service demand ment:.oned earlier by operating a second paramedic ambulance d~ring the peyiod froffi 8:00 a.m. to S:00 p.m. The current Firefighters MeT!loranrj'Jm of Agreert'ient language requires minimum staffing levels of t.hree peysc,ns pel' fire engine, ladder tr1..lCK, rescue unit and two persons per paramedic unit. Placing the second 2 - paramedic unit in sen,-ice as proposed, requires two aoditio:1al paramedic perso;ls in addition to the mi:::ir.:w.m staffing fo::-th'2 seven -2noines, one ladder-!::ruck and one resc'.Je unit. The additicndil staffing, as p-:.-oposed: · .... ill utilize exis':.ing personnel to ins.t"ease minimum staffing and will cost $200, G (: C i'r'. a ... r:ual o·.~erti'i1e expenciitures. 3. Bow will tbe increase in paramedi~ fees which are proposed to offset the additional cost of the secona paramedic unit? Do the proposed fees compare favorably with fees ~f other paramedic providers? Answer: The proposed fee chap.ges will i~creasE fees f~r specific services already in the fee schedule, and add r!e .... · fees fox supply charges ~re as follows: ~~-r~ent Fees Proposed Pees ALS Base Rate $ 325.00 $ 425.D(] BLS Ease Rate 325.00 325. ')0 Night 25.0C 4C.OO Mileage 7.00 8.1'0 Oxygen 25,OD 4-0.00 EKG 40.00 40.00 Code 3 19.00 25.00 Airway Suction 0 ~O.OO ne'W fee Esophageal .a.irway 0 40.00 new fee Endotracheal Airway D 40.00 ne.., fee IV Solution 0 -40.00 new fee Medications 0 40,00 new fee Spinal Imob. G 40.00 new fee Splint.ing 0 40.GC ne..-fee DB Kit 0 ?C. OJ n€,'iool foee Burn S!-"eet 0 ~ Q. ':'c ne:",' fee The propo3ed fees a.re in keepir~g 'ollith Cou'n.·;::il d.irection and the philosophy that user fees should be reasonably set to recover a,ct.ual costs to provide the service. The table belm .. · reflects .::omparable r:urrent fees by other r<:gional pardmedic proyiders. The Sa':1ta Clara, San Mat-eo I Alameda and Contra Costa County providers are private arnbw.lance companies. 3 q-;",e - ',' i ", - Paramedic Service Fees I - :::'ee Pa~o Santa Sa.::l ~~la1t',-eda C0:.1tr;:;. Pa"!.o Alto Cla.rd Hateo C::;.ur. t y I Cost.3, Altv Curr~nt. CQunty Coun~y C::)';J..r.ty Propose --t 441.16 ALS 32:'.00 457.CO 637.77 441.16 425.0(1 Ease ELS 325.00 276.00 j 262.=,0 .2 73.81 273.8: 325.CJ Ba8e Mileage 7.00 10.35 14.31 9.70 9.70 7.00 Night 25,00 48. C 0 50. CO 49.2 S -49.28 40.00 OX"j'gen 25.00 4 8.00 5':1. CJ-] 43.75 43.75 40.00 RKG 40.00 45.00 00. -:·0 58.GO 58.00 40.00 Code 3 18.00 25.1)0 I) Cr • 0 {) 38.00 38.00 25.00 Supply No Yes Yes I Yes Yes Yes Charges i (as per abov-e) A review of pararr.edic fees in the !say Area; dF?"r"-::nst~ated that of ('vUTlty run pr'ograms~ Santa Clara County has the lowest fees for para.medic sen~ices in the Bay Area. City of Palo Alto fces 3::-~ currer.tly lower than Sa.nta Clara County fees. Base rate f~es range from a low in Palo Alto of $325~DO to a high of $637.00 in San !-1ateo County. In additicn to a lower base rate, the Ci ty tlas not histcrically chayged fees :'or medical supplies, dru9s~ and other allow-ab} e chaT3es · ... ·'.nich many t-nl.rd p:arty pay,,"rs cover in whole or in pan:. Of t~e abc-ve b<3se rate :~eS tha::: are c'..:.rrently i.r~ plac~ I,ie. ;r\il('.ag~. nig1:-~':. c-al~s. CX)'ge.,., E¥:'3, a:>d Code 3 responses}, the City of Palo Alto rates are sig~ifica~tly less i~ ea~~ category. Tr~e fee sC'!1ed:.11 e c:urrer.t:_y p:'aces a ma.x.l..m'.lTn cha.::ge of .$4·H'I. C'G fc-:r-the base rate pl ..... s additi_onal services delivered. Medicare approved payments for th~ City of Palo Alto had been about hal': of what other providers wouI d consider the minimum approved amount should be. This was due .in part to an earlier phi1,-:sophy at the program's inception of providing paramedic services difEeLently t.han private providers and in a ~.armer simi 1'3!" to at-her £ir~ ser-vices, at a )',ign service level and low cost, which historically ;,as been subsidized by the general fund. '!his philcsophy 1" .. a.s 'kept para':l'.edic fee.s lOlo,ler t.ha::. preva.iling rate~ fer the same services elsewh.r~:re. Iri addition, Medicare's Profile for the City is based in part on what fees the City currently charges and what t-hey were in 1983, along with .::t.her facto!"s. This has kept what Medicare wi 11 pay the ('i r.y unreasonably low when .. , . , 4 •.. t· .. ~ - C'ompa::-ed to other :!;.rcvi,jers" S::r.;:s-approximate:y 4(' to -'5::;' pel-cer:: o~ para.1'!".edi,::-D:l1s in Palo Alto -'ire paid by Medica~e, these fact:ors have ha·j a significant impact on the amOU::-lt c: reven"..le ,;enera.ted. Ie; additinn, City philoeop:tj-'" has bee::. to ,",-c(:..:-pe this 10\ .. 'er rate p::dd i,"Iy r-1edic:are as payment in full, ..... hile ether-providers t)'Pi cally will bill U'.e pa':.ier::: for the differel'.<::e bet ... een wha~ Medicare ' .... ill pay ana the amO;.J.:)t 0: the bill. The net results of the abm?e sta~ed cor::d:t:ior:s · ... ·ere a large bad debt and City subsidy, and a less cos': effective p::.-o.:rraIT.. r~~i2 has rece:1tly ch~nged with u:.:" .. 'ard adju.s::.mer.ts cbtetined by the Fir~ a~d Finance Departm2.:1ts r appeal to the Medicare ;:,rcgram. 4. Wh~t: will be the n~t cost to an indi ..... idual under the new fee structure? A"lSWer; Patients covered by private ins~ran(:e .",re typica:ly covel·ed for eith!:r 80 or laC percent of the allo .... 'abl<:! charges. The new fees will be within the allm ... able charges defined by the insurance compar:ies. For a casic transport a patient with private ins .... rc;.nce wO\.lid therefore pay either $0 or $93. Medicare pays approximately 80 perce::1t of wbat tn.€:·y consid~r the 11 allO\.;able charges 1\ for basic trc..r1sport. Under the old fee at~Jcture, this amount ... ·as $292. or 3D percent of the r:ransport tee of $365. Under t:!:e new fee st.ruct,ure, ~he trar.sport fee will incr~a8e to at least $455. however, Medicare will still continUE to pay $232, unless tbe City is abl~ to negotiate a higher allowable charge. The patient is billed the difference bet ... ·een the amOU!'lt of Medicare reifll.bur:::em~nt received by t.he City an:l d' .. e allc: .. able charge, Consequent.ly, the patient. ..... ill not pay ar:y more under t:te new fee st.n.::cture than they a!"e curre'l.tly pay:::'.-ng. The Ci'ty will wri te off the differe •• ce between the amount billed to Medicare and the. arnour.t. received from Me·jicare and the patient. Therefore the ~ite-off will increase with the new fee stru~ture, There aro:! some ne ...... fee:: that are proposed i r. add: t :i.e;]. to the cas ic transpcr-t charge Medicare 'IIIill rei 1"fburse. Exa.r:l,.:ples ir,·::h:de fees for airway $'..1CtiQD cr I .\1. ~·:::·Jutior.:. 5. What is t.he breakdown of the service population wit.h regard to medicare and/or private insurance coverage? AI:.swer: Based on payment.s recej ·.~ed this fiscal year, approximate) y 62 percent of patient transports .are covered by Medicare. An additional S perc.3!1t are not cQveTed or the City is U:;-!,'3.ble to bi 11 because no address is available. The remaining 30 pe::.-cent of transports are covered by private ~nsurance. 6. Wbat are Bome options to the propoeed user fee which other cities use? Answer: In addition to the PAFD l.:se-r fee for patierJ.t transports it was found that one rapidly growing method of financing paramedic 5 - ----------- programs ir-~ California is inplernent.C:i::ion of sl"'!bscript i.G~ fee services or EMS ,s"2rvice Dist: ict"s. House[:.Qlds and businesses h3ve the option of j a ir-.i ng a mer:thership pr-og.r-arn fer a:::. es~ablished fe.:-. This fee CQv€rs all or part of a paramedic ti II should the subscrjber '..It,ilize the s~rvice:s anyc.ime dw.!-ir_g th~ su:t.:scr-ipti.on period. 7'he subscription s2.rvice is u3'..lally v·:;.lur:':.ary. HO\ .. 'e~lI~er, a similar ma!'ldatcz-y prog:ra~ cO'.lld be impl,c-mented th:ough fO!'T!1at.ion -:.f a pararlledic s2.r'.ricE' district by a callQt meaS'...IYe. Exa.rr,ples c,f rn.andat':lry fee programs it. our area include 3erkel~y. San Hafael ar..d Sonoma. 80th ::nandat.ory and voluntary prograT;"s "Would require an effective market:i!1g prograrr. and tar.gib:e value added ser"i~es to the subscribers. The Departroent has reviewed the following Cal i fornia cities tbat prcyide fire department paramedic service and utilize: either a subsc~iption fee or a assessment fee. ~ User Fee? Sub or Assmt? collect i 0:-1 Anaheim Yes Yes $36 Utility ci11 Berkeley Yes Yes $26 Cor:.tractc·r Downey Yes Yes $15 !l.'ater bill Fullerton Yes Yes $16 utility bill Hawthorne Yes Yes $35 util i ty bill Huntingt-on Beach Yes Yes $:;; Utility bill Monterey Park Yes Yes $30 Contractor Orange Yes Yes $24 City bill San Rafael Yes Yes $29 City bill Santa Ana Yes Yes $35 City bi 11 Sonoma Y~s Yes $35 Utility bill 7. What are the altarnatives to tbe current County mandata which has lad to the Deed for the addition of the second paramedic unit? Answer: Whe:n. the lO:lgstandi.ng practice of triagir.g injuri02s and illnesses of a mi::;or nature from f-aY3r!1edic level to basic life support (BLS> level was dis::,:;,.::inued as a result 0: a dire-::,:jvE' from the count.y EMS agency ar.d the county medi<:'al di_re:::tor, a signif-!_'~ant operat ional impact. resulted. Tnere 1 s n~ q-:.lestion that true ~medical control" issues rightly belong with a medjcal authc~ity. The issue at hand is r:1ultifaceted, ar:d raises the follow:ng key questions. Should operational policies and service levels relating to emergency medical responses be deterT:1ined by lo,:ally el~cted officials or by a county administrative agency? Is the transportation method of patients wj th minor inj '.lries and illnesses (such as sprai~.s, s'Crains, a~d similar 'Tlinor co:-,dit:ons; a policy question or medical issue? Is the "all parame:Uc level ~ trs.nsport policy of the county an eff.icier~t and effective one? 7riaging of patients with minor injuries had been routine for many years withouL any adverse outcome to pati.:nts. The practice helped te· keep cc'sts down for the patient, medical insurance providers, and 6 'L • - '-.,. --------------------------------- the City. ?atier'.t t.ri.age is still O',:H'.e ;..::-)'::i~.r CO'..l:'.ty '7'.-e.dical a"..lthorit)' else ... ·hcre jn tr.e stat-e. It appears evident that tr:e CO'",.l."1~y Er-1S agency · ... 'ou!d li;ce tOo exercise rtlore control ever local m\.:ni::':pal iss':Jes relatlns-to ~i"':1erge~,::y me1ic;al responses. "It i:; not clear if chat is also the p·:;·sition of the CQur-~ty Administracor or the Beard ()f S'.:pe:nrisor:-s. Staff :-. .3.5 joined other area cities in ~a~ching rela:ed legislation. 8. Does the adjustment of resourC9S to meet the high demand perioci from 8:00 &.m4 to 9:00 p.m. place the City in any additional liability? Answer: been a polic;e No. Increasing reSQUrCe8 to common p;..!blic safety practice departments, as well as wit~ companies. meet high demand periods has far many years in municipal pri vate paramedic ambulance Altho'u:gh, not traditionally utilized in the fire service, peak period staffing i:l.creases are a -::ost efficie::1t and operationally effective ~ay of meeting changing senTi ce demands. In acdition r the City prevailed in litigation last year rega.rding t.he liabi 1 iti' question reI ating to st.-3ffing levels. 9-. 18 there !l trend fc't cttiea (fix:e departments) regardin9 the provision of paramedic .8rvices~ similar to Palo Alto? Answer: More fire departments are now providing or considering to provide paramedic level service. Because exist.ing firefighters are cross-trained and utilized to i:-r.plement the programs, an operat-ional advantage is gained, as well as a financial advantage to general funds by paying for som.e oE the exist.ing firefighting personne.l costs from paramedic transport revenues. This is true even when programs are not reco·.~ering 100 percent of program costs (ass'Jm.:ir.g existing personnel cos~s are tr':;':-l.sferrea to the paramed_'_ C pro'9"::ra:c.) . In Palo Al tc fOL exa1"!'.plo:.. only one posl t ion ... ·as added ·.,.lr.e."1 t':1e parame:di:: program 'Was started, yet. fh~e tirefig~~ter pesi t. ions ar~ cUTI"er:tly paid by paranedic program revenues. a ccs~ savings of fou: paS! tions. The following fire departments currently operate sirr.ilar paramecil.c programs: Alameda :F'ire, Aptos/L-:;' Selva Fire District, Berkeley Fire, Do1..lghel:-ty Regional Fire Authority, Florin Fire lJistrict,. Georgeto .... 'Tl Fire Frotection. Dist.rict., Lucerne Fire, ~arin County Fire. Carmel Valley Fire Protection, Novato Fire Prot~cticn District, Crinda Fire Protection District, Pet.aluma Fir.:., Pieawortt:. Fjre, Sacramento Count}' Fire District~ San Rafael Fir.:, Sanger Fire, South Lake county Fire Di strict, South Placer Fire District, South San Francisco Fire, Vacaville Fire, Stockton Fire, Tar,oe City Fire Protecti:m District. Napa. Fire, Roseville Fire, American Rive::-Fire District, Fremont Fire, Fresno Fire, Los Angeles County Fire, and more. 7 ~----------- - -,- 10. O.lr.l-ently. several s:...lTrounding fire departm0.nts are ::on.sider J.ng implementing ne .... · prograrr.s d~pending en the oc.tcome of ct.:rrer,t legislation going thro~gh the California Assernbly and 2r::nat'=_ These incl'lde; Menlo Park Fire Protecc:iOT"l District, San .. Jose Fire Department, Santa Clara Fire !:;eparttt1<:'::'1t, and Hilpi t as Fi re Department. If the number of medical incidents continues to increase, as predicted, how will the Fi~. Depa~tment~e proposal me8t long term neeels? Answer-: The DepartF.lent ..... ·ill monitcr t.he derni:lnd need for program enhancements to meet that: follolt:ing criteria as perfoIT.".ar.ce i:Jdic-ators: for service and the de'J'.and using the .L. Respond to e17le_!'gency medical requests .... ith basic 1 ife support (BLS) level of sendee with EMT-O caiJabilities within 4 minutes or less 90 percent of the time (excluding foothills;; 2. Respond to the remairdng 10 percent of €\':',ergency ~edical req'..leS~3 within an average of 10 minutes 0:-less ",oIi th EMT-D level of service; 3" Respond to emergency rned~cal reque:ets with advanced life support iAI..S) level of service with paramedic capabilities within 6 minutes or less 9D percent of the tirl'1€ (excluding foothills; ; 4. Respond to the :terr:a.in::.ng ll~ re.quests wit.hin a~ average 10 l.e,,~el of servicE:. pe.:cenc:: c,f err:ergen;:;y <nedical mi~~tes or less with paranedic 5. Evaluate service demands wben the number of patient transp<)rts e:xceo?ds an average -4 per shift per 24 h0U~ unit Qve.! a six month period cr call volume €xce~ds 8 per s~ift per 24 hour unit over a 6 month period. 11. What are ~~e detailed coats and revenues fc. the seeond paramedic un.i t? Answer: The discussion below outlines the calculations to arrive at the net cost to the General Fund of adding the second paramedic unit. The net cost figure of $35,000 includes an increase in fees, 8 - increase in tran.sp,=,rts, additional C03t.5 to r'J.:1 the secol"'.d u,.it and adj u~tmen':s ir. the reimbursement frolT1 Stanfo!"d Uni versi ty for fire ser-.rice-.;. Imb-edde:) i::'l tris figY.ire is a", increase in expe':"l.ses of $303,000 to run the unit. UPBNSES The budget request to add a sec0:'ld parame,j.i-:; unit:. for 12 bo'.l.rs a day includes the following: capitol Budget. A.".bula£Jce Operati.ng Budget: Overtime Paramedic Cla.S':.sificatj on Differen~ ia Is Vehicle Maintenance (Il Training (2) Teols and E~Jipme~t (3) .5 Paramedic billing clerk (4) 'lotal Operating Budget $75,COO $21]0, COQ 43,5{)C 2,000 20,000 10,000 22,184 303.684 (1) Will increase to approximately $9,SOO in the second year. In addition, there "'ill be vehicle replacement costs of approximately $19,000 beginning it:: the second yea:!,. (2) Training costs will decrease teo $5,000 in th( second ye.ar. (3) Tools ap..cr Equipment costs will decrease to $5, ,jOe) in the second year. (4) The.S Faramedic billing cl~rk is proposed to be loca:ad in tf'.e Finance Depa.t-tmE[,~;: and cr.arged to the r'ire Departfiu;nt thro'.lgh the oYerheacl alloc:atior. p::.-ocess. The origir.al 1993 -94 budget prcposal for paramedic revenues ..... as $535,000 in =evenue, offset by $50,OGO in bad debt expenditures, for a net of $485, GOO. The prc'posed adj-i.lstm,::uts to the Par'amedic Pz-cgram will increase the revenUE-C() $1,054, cJao and the bad debt to $219,000, to bring the net revenue to $835,ODO. 9 t'S"We - \;.: (".;: ~: ~F' -, ... " ~::. . . _ .. _--2.~ .. _. Revenue changes in the paramedic prog:!:"a"fl. for 1992-94 are Que to three factors. i'irst, raVerl',-2S are proposed to be adj usted f:ro,-, the original 1993-94 budget to more accurately reflect current actuals. This increase ($75,000 i~ revenues and $50,000 in bad debt) parallels the adjustments made i~ the 1992-93 Mid-fear Repert. Secorld, there is <l prQposed increase in fees for 1993-94. Th.:? increase i!'.1 fees '",.ould hav8 b-ee~ prclpcsed rE:gardless of the statl.;S of the secclDd parame.dic '..!nit, as staff feels that the fee increase is appropriate. Th.: fees that are proposed tQ be i::crea.3ed \ll'ill generate an additional $1aO,000 i~ revenue and an offsetting $'75,000 in bad debt., for a net "lr.creas:e of $lCS,GeO (based on the current n~rr~er of transports] _ Third, if the new paramedic unit is added, there will be an iccrease in transports. The inc:rea.se in transp·.;.rts j;..;ith the fee increase] is projected to generate an increase in re',n,mues of $264,000 and an increase in bad debt of $69,000, for a nst increase of 195,000_ The revenue proposals build off of the o.r-igir..al b:Idget of $535,000 in revenues and $50,000 of bad debt and can be summarized as follo",,'s: TOTAL .~dj u.s t-rflent s Fee Fee PROPOSED to Budget Increases Increases & BUDGET 2nd Unit Revenue $1,054. aClo $75,000 $lBO,QOO $264, DDD Bad Debt~ 219,000 25,000 75,000 69,000 NET REVEN'G"E 835,000 50,000 lO5~OOO 195,000 • Bad de::.t is not a direct percentage of reven'..:e; it varies t;.3<=.'-ed 0:). assumpt ions cc,ncerning reimbursement. I><:<ACT OF REIMBURSEMENT FROM STANFORD The City of Palo Al to has a cor-tract with Stanford :Tniversity to provide fire and comm"u.nications services. ";)"i th a fe'ow· contra':;.-t excltoe'ions, Stanford reimburses the City for 3~'.3 percent cf the Fire Department's budget. Farame~ic revenue is cr~dited against the Fire Department's expenditures before the reimbursement is calc~lated, in order to give Stanford ncredi~~ for the share of 10 L - ---,~, ,~.,. paramedic transports it g~nerdtes. The rever.ue, irlcl'...!ding the offsetting b""d debt. ar"~d expenses fer the Pa:':drr.edic P:.:·cgram, with fee increases only ,Uld with fee increases a,::d th.2' se:-ond unit ('l,nd the irnpClct of the reirr>burs~mer.t fz'oT:' 8tanf,:-::rd are d~tailed belo· .. ·; Net Revenue (includes bad debt" Expenses \includes overhead) Net Stanford Charge Increase T-:;tal Cost Fee Increases 640,ODG 702,500 [62,500) 15.338 (4"3, 5E,J) Fee I:-.'~Lea.iScs &. 2nd Unit 94.8,000 (ll3 . .o00) 34,239 178,751,1 Sir..ce s~aff ·,01,:;,.uld recommend the increase in fees, regardless c-f the seco::?Q unit; the loss to the General Fund as a result of add.ing the second paramedic unit is the difference between a cost of .$43.=63, a cost of $78,761 or an additional cost of $35,199. cos T RECOVERY The proposed increase in unit will i~,prove the compared to the curre.nt COEt Recovery 1992-93 72 \ fees and addition ,::,f the second paramedic CDst recQ"!-ery of tte paramedic program fiscal year. 93-94 Fee Increas~s 89% Fee-Increases & 2!'"ld Unit The F~re Department has undertaken 2 s':.~dy to revie",' the actual time allocated to pal.-ame:ciic activities and tirr.e spent on sl..<ppre;o:;si.on activities by the staff responsible for the Para:-n.cdic ?l"()c]r-aT,. Based an t.h':'s, 2.5 FTE of salary do!lars have beer.. :'t'.a·w~ed fLom the paramedic Program to Fire Suppress~on. In addit~o~, if L~e City did not provide Parai'\!.edic services, all existing Paramedic st".aff, except the Tra1.ning Captain added to 9upp-~rt the Paramedi c PrQgram, would revere back to Fire Supp:cession dut i.es due to mininlurr. staffing contract obligations. This would lower expenses in the Fire Department by .$571,00e ar.d redlJ,:e revenues by $735. COD [including 11 the a.djustmer,t in the r.;;-.i~"J.r~ement (rorn 5.:anford). . rhere-fc,;re I the net loss to th~ City by elirrdnating the Pa:ra..:edic progr&m wOI.11d be $164,O{}C r includir.g t.he reirrl:-uIsement. fro<i'. Scanfe,rd fc;;r Fire Services. Respectfully 5"1.::btdtted, /i ~·~'~Jjd~ ERT R. W 1" --- ,., " <:hi .. f . \ !1:lE ~Y ~ger CMR 314,93 12 I 1 • , 1 • t