ORANGE COUNTY FIRE AUTHORITY PRE-HOSPITAL CARE BUSINESS MODEL

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1 ORANGE COUNTY FIRE AUTHORITY PRE-HOSPITAL CARE BUSINESS MODEL Advance Life Support (ALS) and Medical Supply Reimbursement Fees Board of Directors July 26, 2012 Presented By: Scott Brown, Battalion Chief Emergency Medical Services Jim Ruane, Finance Manager/Auditor

2 ALS/BLS RATE SETTING BACKGROUND: The Orange County Board of Supervisors (BoS) sets maximum Advance Life Support (ALS) and Basic Life Support (BLS) billing rates BoS approved a 2.7% increase on July 24, 2012 The OCFA Board of Directors sets the OCFA ALS paramedic and BLS Medical Supply reimbursement rates Reimbursement rates cannot exceed: The same annual percentage increase of ALS/BLS maximum billable rates that are approved by the BoS, and Cost of service (marginal cost only) Current cost recovery is only approximately 60% of the OCFA s marginal cost

3 ALS/BLS RATE SETTING BACKGROUND: Current & Proposed Rates Billed by Private Ambulance Provider: Approval Authority County OCFA County OCFA Maximum Rate* Basic Life Support (BLS) Billing Rate OCFA Medical Supply Reimbursement Rate Ambulance Revenue Advanced Life Support (ALS) Billing Rate OCFA ALS Paramedic Reimbursement Rate OCFA Medical Supply Reimbursement Rate Ambulance Revenue CURRENT $ <$29.26> $ $1, <$261.93> <$29.26> $ *Does not include mileage or oxygen and is subject to Medicare/Medical caps. PROPOSED w/ 2.7% INCREASE $ CHANGE NOTES $ $18.85 Approved by BOS 7/24 <$30.05> <$0.79> Pending: Tonight's Approval $ $18.06 (1) $1, <$269.00> <$30.05> $ $28.83 <$7.07> <$0.79> $20.97 (1) Approved by BOS 7/24 Pending: Tonight's Approval (1) If OCFA s Board of Directors does not approve the reimbursement rate increase, then the patient will still receive a higher bill, and the ambulance company will be able to retain the full revenue increase.

4 * Not all Orange County jurisdictions follow this exact model. BLS=Basic Life Support ALS=Advance Life Support PUBLIC/PRIVATE PRE-HOSPITAL CARE SERVICE DELIVERY MODEL DISPATCH TO A 911 CALL Closest Fire Paramedic Unit Private Ambulance FOUR OPTIONS OF PRE-HOSPITAL CARE ACTIVITY NO TRANSPORT OR PARAMEDIC INTERVENTION REQUIRED BLS EMERGENCY TRANSPORT NO ALS ASSESSMENT No paramedic assessment or intervention required. Transport with EMT Basic only. BLS EMERGENCY TRANSPORT WITH ALS ASSESSMENT Paramedic assessment completed on scene. Transport BLS. ALS EMERGENCY TRANSPORT WITH PARAMEDIC ACCOMPANY Paramedic assessment or intervention completed on scene, paramedic escorts during transport.

5 1 No Transport MAXIMUM PATIENT COST *SET BY COUNTY BOARD OF SUPERVISORS No Cost to Customer NO INTERVENTION OR AMBULANCE TRANSPORT OCFA MAXIMUM REIMBURSEMENT $0 *SET BY OCFA OPERATIONAL OCFA and Private Ambulance units immediately available

6 * Excludes mileage and oxygen. 2 MILD STATUS PATIENT -BLS TRANSPORT- -NO ALS ASSESSMENT- No paramedic assessment or intervention required. Transport with EMT Basic only (BLS) MAXIMUM PATIENT COST *SET BY COUNTY BOARD OF SUPERVISORS Current/Proposed with +2.7% OCFA MAXIMUM REIMBURSEMENT *SET BY OCFA Current/Proposed with +2.7% OPERATIONAL Max Billing Rate Billed by Private 911 Ambulance Provider $ / $ BLS Rate * $29.26 / $30.05 (medical supplies) OCFA Paramedic Unit immediately available upon Private Ambulance transport

7 3 MODERATE STATUS PATIENT BLS EMERGENCY TRANSPORT WITH ALS ASSESSMENT Paramedic assessment completed on scene MAXIMUM PATIENT COST *SET BY COUNTY BOARD OF SUPERVISORS Current/Proposed with +2.7% OCFA MAXIMUM REIMBURSEMENT *SET BY OCFA Current/Proposed with +2.7% OPERATIONAL Max Billing Rate Billed by Private 911 Ambulance Provider $1, / $1, BLS and ALS Rate $29.26/$30.05 (medical supplies) + $261.93/$ (Paramedic Reimb. Cost * ) OCFA Paramedic Unit immediately available upon Private Ambulance transport * OCFA rate is based on covering the cost of providing paramedic services & supplies. OCFA does not charge or receive reimbursement for the full cost of the response.

8 4 ACUTE STATUS PATIENT ALS EMERGENCY PARAMEDICS CONTINUE TREATMENT AND ESCORT TO HOSPITAL Paramedic assessment or intervention completed on scene, paramedic accompanying patient MAXIMUM PATIENT COST SET BY COUNTY BOARD OF SUPERVISORS Current/Proposed with +2.7% OCFA MAXIMUM REIMBURSEMENT *SET BY OCFA Current/Proposed with +2.7% OPERATIONAL Max Billing Rate Billed by Private 911 Ambulance Provider $1,067.99/ $1, BLS and ALS Rate $29.26/$30.05 (medical supplies) + $261.93/$ (Paramedic reimbursement cost) Both OCFA and Private Unit unavailable until departing the hospital * OCFA rate is based on covering the cost of providing paramedic services & supplies. OCFA does not charge or receive reimbursement for the full cost of the response.

9 * Current **Proposed SUMMARY NO INTERVENTION MILD MODERATE ACUTE No transport No paramedic level intervention needed Paramedic assessment completed on scene Paramedic level intervention required for the duration of the call MAX PATIENT COST No cost to customer Max billing rate $698.22* / $717.07** $18.85 Increase Max billing rate $1,067.99* / $1,090.82** $22.83 Increase Max billing rate $1,067.99* / $1,096.82** $22.83 Increase OCFA MAX REIMB. $0 reimbursement Max reimbursement $29.26* / $30.05** $0.79 Increase Max reimbursement $29.26* / $30.05** $261.93* / $269.00** (paramedic marginal cost) $8.36 Increase Max reimbursement $29.26* / $30.05** $261.93* / $269.00** (paramedic marginal cost) $8.36 Increase OPERATIONAL Units immediately available OCFA Unit immediately back in service OCFA unit immediately back in service Both OCFA and Private unit unavailable until departing hospital

10 ADDITIONAL SUPPORTING DETAIL INDEPENDENT REVIEW OF PROPOSED REIMBURSEMENT RATES: Reviewed by the Orange County Emergency Medical Care Committee (EMCC) Presented proposed rates to EMCC on June 22, 2012 The Committee is comprised of members from the public, representatives from the County Board of Supervisors, and various healthcare providers throughout Orange County. EMCC voted to recommend that the Board of Supervisors approve the proposed rates Reviewed by an Independent Certified Public Accounting firm Proposed reimbursement rates were developed by OCFA staff based on FY 2012/13 approved S&EB, S&S, and equipment and vehicle replacement costs Rate calculations were reviewed by Lance Soll & Lunghard (LSL), an independent firm of certified public accountants LSL determined that the proposed rates were a reasonable representation of OCFA s marginal costs. In addition, OCFA s actual costs exceed the amounts to be reimbursed under the proposed rates - LSL determined that the rates have been limited to the maximum 2.7% BLS billing rate permitted by the County

11 STAFF REPORT RECOMMENDATIONS: Authorize staff to increase OCFA s Advanced Life Support (ALS) and Basic Life Support (BLS) Medical Supply reimbursement rates by the same percentage increase (2.7%), approved by the Board of Supervisors, effective July 27, OCFA Maximum Reimbursement CURRENT PROPOSED $ CHANGE % CHANGE Medical Supplies $29.26 $30.05 $ % ALS Rate $ $ $ % If OCFA s Board of Director s does not approve the reimbursement rate increase, then the patient will still receive a higher bill, and the ambulance company will be able to retain the full revenue increase.

12

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