SPECIAL MEETING MINUTES EMERGENCY MEDICAL SERVICES ADVISORY BOARD 3 MAY 2010

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1 SPECIAL MEETING MINUTES EMERGENCY MEDICAL SERVICES ADVISORY BOARD 3 MAY May 2010 EMSAB Members: Marcia Banta Herb Boreson Dave Chenault Mary Heusinkveld Chani Kelly Carl Matthews EMSAB members, with the exception of Herb Boreson and Staff Liaison Travis Myklebust attended the May 3 special meeting in the Lewiston Fire Department Station 1 Training Room at 12:00 p.m. Also present were EMSAB Council Liaison Dennis Ohrtman, Fire Chief Gordon Gregg and Fire Department Secretary Stephanie Rudy, who took notes. A motion from Chenault to approve the April 8 minutes was seconded by Kelly and approved by the board. Chair Banta reported City Attorney Roberts did not believe the EMSAB policy regarding current ambulance service providers needed revised. This question was brought about by the recent opening of Life Flight, an air flight service. Former EMSAB member, Dave Kendrick will work with EMSAB to review and, possibly, update the current policies. Chenault informed the board he is a part-time employee of Life Flight. Medical Director Hunter s contract has not yet been revised. This review will be scheduled at a future meeting. Liz Waits and Carrie Graham from ambulance billing attended the meeting to answer any questions concerning the ambulance fee recommendation discussion. Banta shared a 2007 memo from Chief Gregg to former City Manager Krauss. The memo outlined the fee recommendation procedure and stated the city manager s belief that fees are tied to service. Chief Gregg reviewed changes to the fee schedule made by the council in February The chief explained the ALS charge stayed the same for residents but decreased for non-residents. The definition of resident also changed, so anyone living outside of Lewiston is a non-resident. Councilor Ohrtman stated the intent of the fee changes were to bring the amounts into line with market averages. The board questioned the possible impact of changing to a single fee schedule for the region, including the impact on the Nez Perce County EMS contract. Liz Waits commented the single pay system would work well with Medicare/Medicaid patients but the city may lose money with private pays because insurance companies charge at a percentage. Chair Banta suggested adjusting the single fee to the highest charge listed now. Waits commented the mid FY09 fee increases raised collections but also increased write-offs. Waits listed the following patient coverage percentages: 69% Medicare 9% Medicaid 17% Private Insurance 5% Self Pay

2 EMSAB 17 May 2010 Page 2 These percentages show any rate change would only affect 22% of billable calls. Medicare and Medicaid only pay a fixed amount. EMSAB s previous fee recommendations were based on cost of living percentage plus any increases needed to reach the average market rate. Carrie Graham added if the fees are increased by more than 5%, the city will have to hold a public hearing. Banta suggested taking the 2008 schedule and figuring what percentage it would have to increase to sustain the same revenue as the current fee schedule. After revising the schedule, the board must decide whether to raise the existing costs by COL and market averages or whether to change to a single fee schedule. Chair Banta will send an to Interim City Manager Dan Marsh articulating why the current fee schedule does not work and how EMSAB proposes to fix the problem. Chief Gregg commented the perception of some people is the foundation for the fees charged should reflect the cost of the service. In reality, the fees should be based on what the market can bear. Chief Gregg will create a baseline from the 2008 fee schedule. Council will need a final recommendation by mid-june at the latest. Banta did not receive a reply from Mayor Poole regarding the offer of an EMS overview by EMSAB. EMSAB will meet on May 20 at 11:00 a.m. before the board presents a fee recommendation to Council at the May 24 Work Session at 3:30 p.m. The meeting adjourned at 1:45 p.m. Submitted by: Gordon Gregg, Acting Staff Liaison Date Stephanie Rudy, Recording Secretary Date GGG:sr Attachments c: Kari Kuchmak, City Clerk Dan Marsh, Interim City Manager Dennis Ohrtman, Council Liaison Don Roberts, City Attorney

3 Advanced Life Support Rates (Non-Resident vs. Resident) Local, Non-Emergency Interfacility, Home and Medical Flight Connection Base Charge for Non-Resident ALS Out-of-Area Transfer Out-of-Area Transfer (Not originating/terminating within Lewiston service area) Lewiston Residents

4 LEWISTON FIRE DEPARTMENT AMBULANCE SERVICE Providing Regional Emergency and Nonemergency Ambulance Service since Emergency Services are available by calling 911. Local and Out-of-Area Nonemergency Patient Transports are available by calling hours every day. Advanced Life Support and Basic Life Support Medical Services are provided by teams of Firefighters from a pool of Paramedics, Advanced Emergency Medical Technicians and Emergency Medical Technicians responding to calls for assistance from three centrally-located Fire Stations. We bill Medicare, Medicaid and private insurance carriers. Please telephone for additional information. This complete listing of charges for Emergency and Nonemergency Medical Services as established by Lewiston City Code 7-1 is provided for convenient reference and comparison. BASE CHARGE NEW OLD Resident Nonresident - Basic Life Support Nonresident - Advanced Life Support ADVANCED LIFE SUPPORT SERVICE Resident MULTIPLE PATIENTS Each stretcher patient billed separately Sit-up patient (if stretcher not available) LOCAL, NONEMERGENCY INTERFACILITY, HOME AND MEDICAL FLIGHT CONNECTION Resident Nonresident Basic Life Support Nonresident Advanced Life Support OUT-OF-AREA TRANSFER Resident Nonresident Basic Life Support Nonresident Advanced Life Support Second Attendant OUT-OF-AREA TRANSFER not originating or terminating within Lewiston Ambulance service area Resident Nonresident Basic Life Support Nonresident Advanced Life Support MILEAGE per patient transport mile MEDICAL CONVENIENCE OR STANDBY TIME OXYGEN INFECTION CONTROL - added to base rate 3.57 EXTRICATION SUPPLIES not replenished by the receiving hospital Cost plus 10% EFFECTIVE 23 FEBRUARY 2009

5 FY08 Ambulance Adjustment Report Monthly Adjustment Detail Report & Other Totals October November December January February March Medicare $42, $49, $60, $50, $56, $48, Medicaid $19, $18, $21, $24, $20, $22, Insurance $ $3, $2, $2, $1, $4, NPCounty $ $1, $2, $2, $ $1, Collections $9, $10, $11, $15, $12, $10, Misc $1, $ $51.68 $1.02 $ $ Write Offs $ $ $1, $ $1, $ Recoups ($1,943.93) ($725.13) ($2,418.19) ($1,512.98) ($1,946.48) ($2,026.20) Total Adjustments $72, $83, $96, $94, $90, $86, Total Payments $142, $147, $167, $157, $157, $157, Total Charges $210, $227, $262, $249, $246, $244, # of Billable Calls

6 April May June July August September Medicare $62, $61, $43, $45, $46, $39, Medicaid $21, $20, $23, $20, $19, $21, Insurance $1, $2, $1, $2, $3, $3, NPCounty $1, $1, $2, $1, $ $1, Collections $16, $11, $10, $13, $14, $15, Misc $60.50 $3.91 $ $ ($234.27) $ Write Offs $ $3, $ $ $1, $1, Recoups ($1,089.66) ($1,030.17) ($1,938.65) ($1,269.85) ($477.21) ($1,678.34) Grand Totals Total Adjustments $102, $99, $81, $82, $84, $81, $1,056, Total Payments $166, $179, $146, $161, $152, $141, $1,879, Charges $269, $279, $227, $244, $236, $221, $2,919, # of Billable Calls Difference of $26, is refunds 4/27/2010

7 FY09 Ambulance Adjustment Report Monthly Adjustment Detail Report & Other Totals October November December January February March Medicare $58, $46, $64, $61, $43, $65, Medicaid $24, $16, $21, $24, $18, $32, Insurance $1, $3, $3, $2, $4, $6, NPCounty $0.00 $2, $0.00 $1, $ $ Collections $10, $17, $10, $11, $11, $20, Misc $ $ $ $ $9.81 $ Write Offs $1, $1, $ $ $ $1, Recoups ($1,654.22) ($343.12) ($1,775.06) ($1,841.60) ($949.48) ($1,466.99) Total Adjustments $95, $86, $99, $99, $77, $127, Total Payments $144, $134, $168, $157, $130, $159, Total Charges $238, $218, $269, $256, $209, $289, # of Billable Calls

8 April May June July August September Medicare $80, $85, $83, $82, $67, $74, Medicaid $29, $25, $30, $23, $22, $22, Insurance $4, $3, $3, $2, $2, $2, NPCounty $1, $1, $1, $ $0.00 $1, Collections $16, $10, $7, $14, $15, $15, Misc $69.66 $ $ $14.80 $1.43 $ Write Offs $1, $ $1, $1, $ $ Recoups ($1,502.79) ($723.68) ($254.53) ($726.55) ($1,016.83) ($1,323.89) Grand Totals Total Adjustments $132, $128, $129, $124, $107, $116, $1,325, Total Payments $168, $178, $173, $160, $144, $161, $1,881, Charges $306, $317, $308, $293, $257, $284, $3,249, # of Billable Calls $1,325, ,300, = 25, which is refunds as of 4/28/2010

9 (Billable BLS calls 1, Payments Adjustments 42, , , , ,124, , ) 20, , , , , , , , , , , , ) 1088) 43, , , ) 5, , , , , , , , , , , , , , , , Number ASOTIN, 1,884, of 303, , , ASOTIN Billable 1,274, , , , , , , , , , , , , , , , COUNTY, Calls Charges CLARKSTON, LEWISTON, NEZ PERCE COUNTY, OTHER Medicare EMS INFORMATION FY 2009 revised 4/28/10

10 location(billable (Total BlS calls Non Payments Adjustments 77, , , , , ) 145, ,880, , , , ) 55, billable 8, , , , , , ,300, , , , , calls Number ) 3,249, of 244, , Billable105, , , , , , , , Calls Charges Medicare an areas listed above) Medicare is an entitlement program funded entirely at the federal level. Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities. and people of all ages with end stage renal disease. The Medicare program provides Medicare Part A which covers hospital bills, Medicare Part B which covers medical insurance coverage, and Medicare Part D which covers prescription drugs. Medicare Part B is what ambulance charges are covered under. Medicare allows secondary health insurance providers to be billed as well. If any balance remains, the individual is billed accordingly. Medicaid is not an entitlement program, and it is not solely funded at the federalleve!. Eligibility is determined by income. States provide up to half of the funding for the Medicaid program. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. Private pav is defined as individuals who have health insurance of some sort or another. Ambulance billing has in excess of 500 different health insurance companies they have billed for services. The individual is still responsible for the balance of the account. Self pay is defined as individuals with no health insurance and are 100% responsible for the services rendered by the Lewiston Fire Department Irevised 04/28/10 I

11 Glossary Medicare - The adjustment is the difference between our charges and the allowed amount set by Medicare. This is a mandatory adjustment required by federal law. Medicaid - The adjustment is the balance left after Medicaid's payment. which is set by each state. This is a state law that we cannot bill the balance to anyone. Insurance - The adjustments include Blue Cross of Idaho (by contract), Veterans and other government plans required by law. Nez Perce County - Inmates which are booked into the jail at the time of transport per contract. Patient's who are approved as indigent by the County. These are patient's who do not have insurance and cannot afford their medical bills; however do not qualify for Medicaid. Collections - These patients cannot or will not pay their bill and have been turned over to the collection agency. Miscellaneous - These include rate adjustments; finance charge adjustment due to finding out they have insurance; account adjustment - taking a credit balance off of one account and applying it to the balance on another account for the same patient. Write offs - Deceased no estate; bankruptcy; small balance adjustment, under $5.00; and credit balance adjustment, under $5.00. Recoups - Adjustments occur when insurance pays and then takes back the payment for various reasons.

12 FY 09 Charge Codes & Reimbursement Rates for Idaho and Washington Charge Code Number of Calls Medicaid Payment Medicare Payment Medicaid Medicare Private Self Allowed Actual Diff. A0429 BLS Emergency Idaho Washington A0428 BLS Non-Emergency Idaho Washington A0427 ALS 1 Emergency Idaho Washington A0433 ALS 2 Emergency Idaho Washington A0426 ALS Non-Emergency Idaho Washington A4029 BLS Emergency Basic Life Support A4028 BLS Non-Emergency Basic Life Support Non-Emergency (Non-Emergent Interfacility Transport) A4027 ALS 1 Emergency 1 or more Advanced Life Support interventions which are cardiac monitoring, IV, or prescription medications A4033 ALS 2 Emergency 3 or more different medications, manual defibrillation/cardioversion, intubation, surgical airway, etc. A4026 ALS 1 Non-Emergency ALS 1 requires 1 or more ALS interventions

13 ASOTIN, ASOTIN COUNTY, CLARKSTON, LEWISTON, NEZ PERCE COUNTY, OTHER EMS INFORMATION FY 2009 Location Number of Billable Calls Charges Payments Adjustments ALS BLS Asotin Medicare , , , Medicaid 3 4 4, , , Private Ins 4 6 7, , Self pay 0 2 1, , TOTAL (Billable calls 52) 37, , , (Non billable calls 14) Asotin County Medicare , , , Medicaid , , , Private Ins , , , Self pay , , , TOTAL (Billable calls 446) 303, , , (Non billable calls 237) Clarkston Medicare , , , Medicaid , , , Private Ins , , , Self pay , , , TOTAL (Billable calls 1088) 701, , , (Non billable calls 309) Lewiston Medicare ,274, , , Medicaid , , , Private Ins , , , Self pay , , , TOTAL (Billable calls 3240) 1,884, ,124, , (Non billable calls 1081) revised 4/28/10

14 Location Number of Billable Calls Charges Payments Adjustments ALS BLS Nez Perce County Medicare , , , Medicaid , , , Private Ins , , , Self pay , , , TOTAL (Billable calls 305) 244, , , (Non billable calls 193) Other (all pickup locations other than areas listed above) Medicare , , , Medicaid 3 3 7, , , Private Ins , , , Self pay 6 1 6, , , TOTAL (Billable calls 69) 76, , , (Non billable calls 42) TOTAL BILLABLE CALLS 5200 (Total Non billable calls 1876) 3,249, ,880, ,300, TOTAL ALL CALLS 7076 Medicare is an entitlement program funded entirely at the federal level. Medicare is a health insurance program for people age 65 or older, people under age 65 with certain disabilities, and people of all ages with end stage renal disease. The Medicare program provides Medicare Part A which covers hospital bills, Medicare Part B which covers medical insurance coverage, and Medicare Part D which covers prescription drugs. Medicare Part B is what ambulance charges are covered under. Medicare allows secondary health insurance providers to be billed as well. If any balance remains, the individual is billed accordingly. Medicaid is not an entitlement program, and it is not solely funded at the federal level. Eligibility is determined by income. States provide up to half of the funding for the Medicaid program. The main criterion for Medicaid eligibility is limited income and financial resources, a criterion which plays no role in determining Medicare coverage. Medicaid covers a wider range of health care services than Medicare. Private pay is defined as individuals who have health insurance of some sort or another. Ambulance billing has in excess of 500 different health insurance companies they have billed for services. The individual is still responsible for the balance of the account. Self pay is defined as individuals with no health insurance and are 100% responsible for the services rendered by the Lewiston Fire Department revised 04/28/10

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