1981 Miscellaneous •
EXECUTIVE SUMMARY
-- 'lERCENCY MEDICAL .SERVICES RATE STRUCTURE=ANALYSIS AND RECOI'41ENDATION
OBJECTIVES: To seek adoption of an Emergency Medical Services ' service
charge rate schedule which is responsive to the actual costs of services
-rendered and consistent with the County's adopted 1981-82 budget.
CONSIDERATIONS: The County Manager recommended during the budget develop
ment process for FY 81-82 that a general review be conducted of the Fee
-Policy for the County's Emergency Medical Services. As the adopted budget
for the County anticipates fee adjustments, an analysis of the existing
rate structure has been the first part of this general review.
The current rates charged for Emergency Medical Services are essentially
the same as they were in 1975. Meanwhile, it is a well known fact that
the costs for providing such services has skyrocketed. For FY 81-82,
. -the average cost per transport by Collier County EMS is $266. However,
under the present rates the "average" billed transport is only $75. Only
28% of the actual cost of the service is being borne by the individual user.
.:fin order to maintain a reasonable balance between user fee and property tax
support, an increase in revenue from fees has been included in the adopted
--.budget. $602,250 is the target fee revenue for FY 81-82. This compares
-with approximately $285,000 which would be produced by the existing rates.
The $602,250 figure represents 42% of the total budget.
In proposing an increase in rates, Collier County is in keeping with what
Wither jurisdictions have had to do. For those jurisdictions which target
.above 30% of their total revenues coming from user fee support, three
-(Lee County, Pensacola/Escambia, and SAS Pinellas County) have increased
--heir base rates to the $100 level.
There are two major reasons why the proposed rates are higher than- other
jurisdictions. First, the Collier County EMS budget anticipates a higher
-percentage of its revenue from fees than the other jurisdictions (42% as
,compared to 30-35%). Secondly, fewer runs per unit are made by Collier County
zs shown in Table #2. However, due to geographic size, dispersion of pop-
lation, and the location of the County's one hospital, all five ambulances
-end their crews are needed. Until:_such time as there is an increase in our
demand, the unit cost of emergency services for Collier County will remain high.
The proposed rate structure includes significant changes in the types of
-charges made. The most important of these include the discontinuance of the
Advanced Life Support (ALS), Transport-Emergency-Traffic, and night designations.
All of these have been incorporated into the Base Rate as they are a part of
the basic system. For example, ALS capability benefits all EMS patients;
--A Nether or not in a given emergency they actually use it.
It is vital that this proposed increase in rates be considered with all due
H:
RE: Executive Summary
EMS Rate Structure Analysis
November 2, 1981 •
Page 2
reflection, but as expeditiously as possible. The County is already one
month into the new fiscal year. The difference in the proposed rates
and the current rates could amount to approximately $27,000 per month in
revenues. In order to assist this expeditious review, copies of the report
have been distributed individually to the members of the ,Emergency Medical
Services Advisory Council .
RECOMMENDATIONS: That the Board of County Commissioners formally transmit'
the attached Emergency Medical Services Rate Structure Analysis to the EMSA
Council for their review and recommendations concerning a revised fee structure
for Collier County EMS; and that the EMSA Council be asked to provide their
report back to the Board before December 1 , or sooner, if at all possible.
PREPARED BY: ."sZ.Q
APPROVED BY: rid 1/69"td
DATE:
HH/db
cc: EMSAC Members •
William Reagan, Clerk
Harold Hall , Fiscal Officer
Douglas Greenfield, EMS Director
Thomas Hafner, Public Safety Administrator
Donald Pickworth, County Attorney
•
•
tr.
9 BY
COLLIER COUNTY, FLORIDA
EMERGENCY MEDICAL SERVICES
RATE STRUCTURE ANALYSIS
•
Prepared by:
Management Analysis Section
October 29, 1981
I IFS
EMERGENCY MEDICAL SERVICES
RATE STRUCTURE ANALYSIS
BACKGROUND
During the budget development process for FY 81-82, the County Manager
recommended that a general review be effected of the Fee Policy for the
County's Emergency Medical Services. The adopted County budget antici-
pates fee adjustments in order to provide for increasing operating
expenses and to maintain a balance between user fees and property taxes.
The existing EMS rates are the same as were charged by American Ambu-
lance, Inc. and have not beeen revised since January 31, 1978. Even at
that time the increases were minor, as shown in Attachment #1. Essen-
tially, the present rates are the same as they have been since July 29,
1975.1/
The Collier County EMS budget for FY 81-82 is $1,443,850. The budget as
adopted is to be funded by a planned $602,250 in Ambulance Service Fees
and $841,500 in transfer from the County's General Fund. The $602,250
from fee revenues represents approximately 42% of the total revenue
budget for Collier County EMS.
The analysis examines the present rate structure in light of several
factors:
• System demand.
- Costs.
• Billings/Collections/Revenues.
- Other Jurisdictions' Rates.
A management team comprised of Thomas Hafner, Public Safety Administra-
tor; Douglas Greenfield, EMS Director; and Henry Hill, Management
1/ July 29, 1975 is the date on which the rates listed as "current" on
Attachment #1 were set.
•
1
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Analyst, provided the research contained herein. This report was
authorized by the Management Analyst with the concurrence of the other
team members.
•
The following is a summary of their analysis and recommendations.
ANALYSIS
SYSTEM DEMAND
Demand factors are crucial to understanding the costs of EMS. Moreover,
system demand information aids in understanding the limitations Collier
County faces in the recovery of costs through the rate structure.
While sufficient data is now available to get an accurate picture of the
system, two constraints on that data must be kept in mind. First, the
operational information available prior to the County's take over of
this service in April of 1981 is generally incomplete or unavailable.
Further, the legal proceedings by the State Attorney against American
Ambulance allege that some of the revenue information which does exist
is inaccurate. Second, demand for EMS is cyclical in nature - higher
during the "season" and lower during the summer. Collier County's six
months of direct operational control do not include the peak demand
period of December through March.
A report of system demand for the period April 6, 1981 through October 4,
1981, ?/the first six months of the County's management, is included on
Table #1. Shown on Table #1 is a breakdown of runs by major zone. As
can be seen, the demand upon the system differs widely by zone with
Naples and Immokalee combining for more than one-half of the total
"runs" made. A "run" is a response to a reported
2/ Records from 10/4 to the date of this report are still being
tabluated.
2
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emergency or request for transporation requiring the use of a vehicle.
A run can have one of two results: "transport" or "non-transport". A
"transport is the physical transportation of a patient due to emergency
or other medical need. A "non-transport" is either a cancelled run, a
situation where transportation to a hospital is unnecessary or refused,
or a situation where other transportation is obtained. As Table #1
shows, transport and non-transport rates vary by zone. Particularly
significant is the fact that 32.4% of the total run demand is non-trans-
port. Presently, there is no charge to the patient for any services in
the instance of a "non-transport". Thus, nearly one-third of EMS's run
responsibility does not currently generate revenue of any amount.
For FY .81-82 the anticipated total number of runs is 8,030. This figure
assumes a 10% increase above the 7,300 total runs estimated for FY
80-81. 3/ By applying our knowledge of the systemwide transport rate as
shown on Table #1 (67.6%) we can estimate our total "billable" trans-
ports for FY 81-82:
8,030 (.676) = 5,428 transports 4/
This estimated number of transports will become the basis for the
revenue calculations below.
a
COSTS
The budgeted expenses for EMS during FY 81-82 are $1,443,850. Of this
figure, $1,280,355 -are operating costs, $123,630 are capital outlays,
and $39,865 are non-operating costs (allocated expenses and contingency) .
This budget allows for 39 full-time staff:
20 Paramedics 13 Emergency Medical Technicians
4 Paramedic Supervisors 1 Communicator/Secretary
3/ 7,300 "estimated" runs for FY 80-81 includes information from the
American Ambulance reports for the months of January, February, and
March. These figures are in dispute.
4/ This figure differs from that schown in the Tenative Budget Exhibit
G. At that time an 85% transport rate was assumed. The most cur-
rent information indicates the 67.6% figure.
•
3
1 L
Additionally there are four part-time ' paramedics who serve on an "as- •
needed" basis. This staffing level provides County-wide service through
five emergency vehicles with one back-up in Immokalee. Also, during the
peak season, a "day-car" will be added for the central city on a part-
time basis. As has been indicated, the system will make approximately
8,030 runs (5,428 transports) during FY 81-82.
•
For a sense of proportion, Collier County EMS's costs and demand level
can be compared with those other jurisdictions. Table #2 makes this
comparison. As may be seen, there is considerable variation in both
costs and demand levels. Collier County's $180 average cost per run
places it between Broward and Sarasota Counties in rank amongst the
surveyed jurisdictions. However, if the jurisdictions were ranked
according to average cost per ambulance, Collier County would rank below
Broward and Lee Counties.
Important factors in Collier County's costs are its geographic size and
dispersion of population centers; thus more units are required for fewer
responses than in jurisdictions where population is more clustered.
Table #2 also shows a comparison of the average number of runs per
ambulance. Sarasota Fire' which is by far the most expensive system on
a, cost per run basis, has less than 1,000 runs per ambulance. Collier
County, Charlotte County and Pensacola/Escambia have between 1,000 and
2,000 runs per ambulance. All other systems have more than 2,000 runs
per ambulance. Collier County's relatively low demand per ambulance
means that unit costs per run are high. Yet, all five of Collier
County's the present ambulances and their crews are necessary to cover
the County's dispersed population. The unit costs for an emergency run
will remain relatively high until such time as run demand increases;
thereby allowing a larger number of patients to spread costs among.
Consistent information regarding non-transport rates in other jurisdic-
tions was unavailable in the survey which provided the above information.
The various jurisdictions measure non-transport
• 4 •
differently. S/ However, while comparisons cannot be made across juris-
dictions, an important fact is highlighted by calculating Collier
County's average cost per transport. Assuming 5,428 transports and
dividing this into the total budget amount of $1,443,850, the average
cost per transport is $266. Under the present rate structure, the aver-
age charge per billed transport is approximately $75. This $75 of $266
represents 28% support of the actual cost of the service being borne by
the user. A critical element in setting a rate structure for emergency
services is the determination of what is to be the appropriate balance
between individual user support as reflected by the fees and community
support as reflected by the General Fund contribution.
BILLINGS/COLLECTIONS/REVENUE
No system in the State of Florida seeks to recover all its costs through
its rates. Many jurisdictions, as shown by their revenue sources, have
. made the philosophical decision that citizens should contribute a sub-
stantial portion of the costs of emergency medical services through
their taxes. Some jurisdictions (Miami Fire/ Rescue, Broward County
EMS, St. Petersburg Rescue, and Tampa Fire/ Rescue) provide emergency
Services at no charge to the individual patient. 6/ Also, as demon-
strated in Collier County's $266 average cost per transport figure,
actual costs for use of such services is high. Moreover, emergency
services must be provided to all regardless of ability to pay. Often
this means that the County would be unable to recover anything (or very
5/ Several jurisdictions (Jacksonville, Pensacola/Escambia, Charlotte
County EMS, Sarasota Fire, and SAS Pinellas) charge a $25. "cancel-
lation" or "first aid" fee in many of the instances which Collier
County currently writes off as non-transport. For example: Calls
which the patient or relative originate yet are cancelled, runs
where first aid is rendered, and runs where transport is refused.
This type of charge will be explained further in the section on
Proposed Rates below.
• 6/ Ambulance transportation is provided by private firms.
•
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little) from indigent patients. Finally, collections are a constant -
problem for emergency services systems.
Thus, for various reasons, the percentages of the budgets which the
jurisdictions attempt to recover from fees differs widely as is seen in
Table #3 below:
i •
TABLE #3: FEES AND CHARGES AS A PERCENTAGE OF TOTAL REVENUE
% OF TOTAL BUDGET REVENUES
SERVICE NAME FROM BILLABLE COLLECTIONS
Miami Fire/Rescue 0%
Broward County EMS 0%
St. Petersburg Rescue 0%
Tampa Fire/Rescue 0%
Sarasota Fire 11%
Herndon/Orlando 20%
Brevard County EMS 26%
Hillsborough EMS 33%
Lee County EMS 33%
Charlotte County EMS 34%
Pensacola/Escambia 55%
SAS Pinellas County 82%
Built into the FY 81-82 budget for Collier County EMS is a revenue
target of $602,250. This represents. approximately 42% of the total
budget. Compared with the jurisdictions listed in Table 3, Collier
County's 42% target is third highest.
The collection rate is significant in the effort to reach the revenue
•
target. As has been indicated, Collier County's EMS must provide
service without regard to ability to pay. Also, some people try to
avoid medical debts because they feel there will be no strenuous collec-
tion effort. Additionally, there are problems with the lag times in
insurance payments which patients wait for before sending in any money
on their bills. These factors are important in realising that, even
with the most rigorous effort possible, a 100% collection rate on billed
transports is unattainable. This has been acknowledged by other juris-
dictions as is shown in their reported collection rates here in Table
• #4:
6
•
I L
Attachment 2
•
•
Collier County Ambulance
Summary of Billings, Receipts and Accounts Receivable
Month of 4-6-81 thru
Sept. 1981 Sept. 30, 1981
Ambulance Billings $ 31,949.72 $ 199,260.60
Less: Payments Received 22,766.77 , 69,404. 10
Less: Medicare Contractual Adjustment 18.01 500.31
Less: Nedicaid Contractual Adjustment 1,695.45 1,963.65
Addition to Accts. Rec. Sept 1981 $ 7,469.49
Balance Accts. Rec. 9-30-81 $ 127,392.54
Detail Summary
•
Billings Accounts Receivable
Month of 4-6-81 thru as of
Sept. 1981 9-30-1981 9-30-81
Individual and
Private Insurance $ 31,044.12 $ 154,273.76 $ 117,496.77 (1)
Medicare 37,561.88 5,554.06
Medicaid 905.60 7,418.96 4,341.71
Total $ 31,949.72 $ 199,260.60 $ 127,392.54
(1) Includes 225 accounts ($24,882.86) billed but undeliverable by Postal
Service; we have not been successful in determining a deliverable
address. These should be turned over to an outside collection agency
immediately in order to increase the probability of collection.
•
•
Source: Finance Office
f
L
complete billing system becoming fully operational indicates that the •
original projection of 75% may be too optimistic. At this time a re-
vision of this percentage downward to 70% is a more appropirate expecta-
tion. A 70% rate will be assumed in all subsequent projections involving
the collection rate in this report.
r ,
•
Applying the 70% collection rate to our billable transport estimate
gives the following:
• 5,428 (.70) = 3,800 "collected" transport bills.
Assuming the existing rate structure generates an "average" bill of
approximately $75 10/, a multiplication by the 3,800 collected transport
bills yields $285,000 in expected revenue given a retention of the
existing rate structure. Therefore, in order to achieve the revenue
target of $602, 250 an increase in rates of at least $83.49 per average
bill to produce the $317,250 in additional revenue is necessary.
RATES IN OTHER JURISDICTIONS
Part of the analysis which has been performed was a study of the rate
structures of the other jurisdictions. A survey conducted by Collier
County EMS reported a diversity of types and levels of charges. 11/ The
two most common and directly comparable charges among these are the Base
10/ The composition of an "average" bill is as follows:
$45.00 Base Rate
24.12 Milage
5.72 Other Medical Supplies
$74.84
The average bill was derived by a random sample of 150 bills from
the period 4/6 through 10/4.
11/ The survey results have been incorporated throughout this analysis.
For a listing of the jurisdictions and the complete results, see
the memorandum to the Board of County Commissioners from Douglas
Greenfield, EMS Director which is an Appendix to this report. Also
an update of the survey information obtained by telephone checks
during 10/81 has been noted on the original survey report.
8
•
.J L.
Rate for transportation and mileage. These items also comprise the bulk
of charges on the "average" bill. As such, a specific look at these in
the other jurisdictions will be made here.
Of the jurisdictions which seek above 30% of their total revenues from
fees, all except one are showing major increases in their Base Rates as
shown in Table #5: 12/
TABLE #5: BASE RATE CHANGES
SERVICE NAME FORMER RATE FY 81-82 RATE
Charlotte County EMS $45 $ 60
Lee County EMS $65 $100 ,
• SAS Pinellas County $40 Non-Emerg. $ 75 Non-Emerg.
$50 Emergency $100 Emergency
Pensacola/Escambia $40 Non-Emerg. $ 75 Non-Emerg.
$50 Emergency $100 Emergency
Hillsborough EMS $55 $ 55
Lee County EMS, a neighboring jurisdiction, has gone to a $100 Base
Rate. SAS Pinellas County and Pensacola/Escambia, with former Base
Rates most similar to Collier County's, have both had to double their
charges. •
12/ Collier County is more directly comparable with this group as it
seeks 42% of its total revenue from fees. See Table #3 above.
9
1 i..
ATTACHMENT #3
PROPOSED RATE STRUCTURE FY 81-82
COLLIER COUNTY EMS
FEE CURRENT RATE PROPOSED RATE
First Aid/Cancellation 0 $25.00
Base Rate $40.00 Transfer
45.00 Emergency
$50.00 Traffic $120.00
Night Charge $5.00 . 0
Mileage $1.80/Mile $2.50/Mile In-County
$4.00/Mile Out-of-
• County
Wait Time $25.00/15 Min. $25.00/15 Min.
Special Handling $10.00 $15.00
Oxygen $10.00 $15.00
IV Start 0 $5.00
Medical Procedures/Supplies:
Minor Trauma $3 to $10 $10.00
Major Trauma $10 to $30 $25.00
Advanced Life Support:
Medium $50.00 0
Major $80.00 0
Drugs/Ampules/Solutions $10.00 Each $10.00 Each
Special Events Standby 0 $250.00 First 6 Hrs.
of 12 Hr.
Period.
$ 50.00 Each Addition-
al Hour.
Accompanied Prisoner
Transport Base Plus Mileage $35.00 Regular
$65.00 Immokalee
Body Removal 0 $35.00
Helicopter:
In-County 0 $350.00
Out-of-County 0 Ambulance Base Rate
plus regular
Helicopter . Allo-
cated Rate.
The specific mileage rates for the various jurisdictions surveyed are -
shown here as Table #6:
TABLE #6: MILEAGE RATES
SERVICE NAME FY 81-82 RATE
Charlotte EMS $2.00/mile ($15 minimum)
Lee County EMS No Charge in-County ;
$4.00/mile out of County
SAS Pinellas County $1.50/mile Non-Emergency
$2.00/mile Emergency
Pensacola/Escambia $1.50/mile Non-Emergency
$2.00/mile Emergency
Hillsborough EMS $2.00/mile
Generally, the jurisdictions surveyed are at a $2.00/mile rate. Lee
County has a $4.00/mile rate to apply to out-of-County transportation.
The cost of providing emergency medical and ambulance services has
increased for all jurisdictions surveyed. These increases have been
• shown in the growth in their budgets and have been reflected in the
rate increases noted above. 13/ Should Collier County implement a new
rate structure, it will be comparable with what other jurisdictions have
had to do.
PROPOSED RATE STRUCTURE
As has been noted, a revision of existing rates is necessary for Collier.
' County to meet its revenue target of $602,250 from fees. The rate
structure proposed in Attachment #3 should result in an average bill of
approximately $161 14/. This amount plus the First Aid/Cancellation fee
is necessary to accomplish the budgeted revenue target given the con-
straints of a 67.6% transport factor and a 70% collection rate.
13/ Compare the FY 80-81 budgets for the various jurisdictions in the
survey included as the Appendix.
14/ This "average" bill was computed from the sample discused in foot-
note 10 and is as follows:
$120.00 Base Rate
33.65 Mileage
•
7.50 Drugs/Other
$161.15
10 •
In general, the recommended rates reflect the increased cost of provid-
ing emergency medical and ambulance transport services. The following
synopsis of each charge details the changes which are proposed in the
specific fees.
FIRST AID/CANCELLATION $25.00
This fee is proposed as a new charge for Collier County EMS. A First
AO/Cancellation charge is recommended because of the large number of
non-transports (cancellations, refusals, first aid) which currently do
not produce any revenue for the system. Presently, a patient is charged
only if transported - even if that person has received first aid treat-
' ment. A flat fee of $25.00 is proposed in the attempt to recover
revenue from this portion of our response liability. Approximately
$17,000 could be generated from this charge. 15/ The cancellation fee
would be charged only when the patient or an immediate relative
initiates the run call and then cancels it after a vehicle has been
dispatched to the scene. The first aid fee would be charged if the
patient receives any medical attention by the ambulance crew but is not
transported. The $25.00 amount is the same as is charged by Pensacola/
Escambia, Jacksonville, Sarasota Fire and Charlotte County EMS. SAS
Pinellas County charges $35.00 as a cancellation charge.
BASE RATE $120.00
This fee is the basic charge for ambulance transport. As such it is the
backbone of the rate structure and the attempt to recover the costs of
15/ Assuming one-half of 32.4% no-transports were cancellations for
first aid and applying a 50% collection factor (as most of these
non-transports occur in the Immokalee zone where a greater problem
with collections currently exists) .
11
1 L
providing emergency services. An increase is proposed to more accurate-
ly reflect those higher costs and to gain greater financial support of
the system by the individual users. As had been indicated at the outset
of this report, the present rates are essentially the same as were
charged in 1975 (except with the addition of the Advanced Life Support
(ALS) charges and the reduction of the Traffic Base charge), while costs
have increased greatly. Moreover, of the jurisdictions surveyed which
reported seeking over 30% of their total revenues from fees, all but one
had an increase in their Base Rate. Of those increased, all were in the
$100 range.
The $120.00 Base Rate would also mean the discontinuance of the "traffic-
emergency-transfer" and "night" designations, and the incorporation of
the ALS charges as the basic cost for providing all of these situations
is the same. Currently, ALS charges are $50 for minor to medium life
support measures, and $80 for a major life support measures. These
charges were in addition to the Base Rate charges ($45 emergency and $50
traffic). As such the actual basic charge for ambulance use under these
circumstances could range from $95 to $130. Essentially, the benefit of
ALS capability is one shared by all EMS patients whether or not, in any
given emergency situation, they actually use it. It is more appropriate
therefore to include it as a part of the Base Rate.
The fact that the proposed rate is somewhat higher than the other in-
creased jurisdictions is predominantly due to two reasons. First, the
Collier County budget proposes a higher percentage of revenue from fees
than the other jurisdictions (42% as opposed to 30-35%) . Secondly,
fewer number of runs are made by the Collier County ambulances as was
shown in Table #2. Yet, due to the geographic size, dispersion of
population, and the location of the County's one hospital, all five (5)
'ambulances and crews are needed. Until such time as there is an in-
crease in run demand, the unit cost of emergency services runs will
remain high.
12 • .
w
NIGHT CHARGE Discontinued
Under the current rates an additional $5 charge is made if the run was
made at night. It is recommended that this charge be incorporated into
the Base Rate as the basic "cost" of a night run is the same as at any
other time.
MILEAGE $2.50/Mile In-County $4.00/Mile Out-of-County
The Mileage Rate is a variable charge determined by the number of miles
the patient is transported. As shown in Table #6, $2.00 per mile is the
most common rate charged among the surveyed jurisdictions. The recom-
mended rate of $2.50 per mile is higher than the others surveyed juris-
dictions. It reflects the fact that Collier County has fewer runs to
spread its operating cost over; as was the reason the Base Rate was
somewhat higher then other jurisdictions. A higher fee for out-of-
' County transport is recommended due to the longer committment of
personnel time (often requiring overtime) necessary. The $4.00 per mile
recommended rate is the same as Lee County is charging.
WAIT TIME $25.00 Per 15 Minutes After First 15 Minutes
Wait Time is the charge for the vehicle and crew to stand-by during a
transport of a non-emergency nature. No increase in this fee is recom-
mended as Collier County's rate is in line with other jurisdictions ($15
to $30 per 15 Minutes) and the charge covers the cost of the personnel
and equipment involved.
SPECIAL HANDLING $15.00
This charge is for providing service of an unusual or complicated nature.
For example, Special Handling includes complicated extraction (Jaws of
. Life) , aircraft on/off, stairwell removal, or a patient requiring re-
straint. An increase is proposed to cover the costs of the new Jaws of
Life equipment being purchased.
13 • .
I ON
MEDICAL PROCEDURES/SUPPLIES $10.00 Minor $25.00 Major Trauma
In the current rate structure, a variety of charges exist for specific
procedures and supplies. These range in price from $3 to $30. In order
to simplify billing, it is proposed that these be combined into two
charges: Major and Minor Trauma. A flat charge of $25 would be made
r
for those formerly in the $10 to $30 range, while a flat charge of $10
would apply to those formerly in the $3 to $10 range. Oxygen and IV
start have been separated with Oxygen going to $15 and an IV start (new
charge) costing $5.
ADVANCED LIFE SUPPORT Discontinued
Charges for this service would no longer be billed separately. Rather,
they will be incorporated into the Base Rate as the costs they represent
are a part of the basic system responsibility. Most of the additional
expenses needed to provide ALS services are fixed costs (personnel and
equipment) . The fact that the services are available to all, whether or
not they are actually required in a given emergency, is of major benefit
to all EMS patients. Further, the ALS separate charges caused delays in
patents being reimbursed by third party payers. Several jurisdictions
(Sarasota Fire, Hillsborough EMS, SAS Pinellas County, and Pensacola/
Escambia) have found that the specific ALS charges were not appropriate
and therefore have incorporated them into their Base Rates.
DRUGS/AMPULES/SOLUTIONS $10.00 Each
Certain situations require administration of various drugs, ampules, or
solutions. No change is recommended in this charge as the current rate
adequately covers the expenses for these items.
SPECIAL EVENTS STANDBY $250.00 First 6 Hours of 12 Hour Period
$ 50.00 Each Additional Hour Thereafter.
This is a new charge proposed to cover the costs of the ever-increasing
• demand for specially dedicated units for public events; r•or example,
14
0
1L
should a promoter desire to have a unit standby at the site of a -
concert, or a sporting event at which the sponsor feels a specially
dedicated unit is necessary. This charge would not apply to situations
where a vehicle is merely stationed at ,an event site which was relative-
ly close to the normal station location with the proviso that it may be
moved to respond to an emergency elsewhere.
ACCOMPANIED PRISONER TRANSPORT $35.00 Regular, $65.00 Immokalee
This is a new special charge to the Sheriff or other law enforcement
agencies for situations in which an ill prisoner must be transported in
a secure vehicle.
BODY REMOVAL $35.00
This is a new fee proposed to cover the growing number of instances
where Collier County EMS is requested to handle transport of a deceased
person to a funeral home. From a sanitary or a psychological perspec-
tive, it is not considered good medical practice to transport deceased
people in ambulances. However, sometimes funeral homes cannot respond
in a timely manner. The delay means that the Sheriff's Office or
Collier County EMS must handle the removal. Until such time that a
formal plan to handle these removals is developed, this fee is proposed
to reimburse a part of EMS's costs in handling body removals.
HELICOPTER $350.00 per Run In-County; Helicopter Allocated Rate
Plus Ambulance Base Rate for Opt-of-County
The helicopter charge is a new fee recommended to cover the costs of
helicopter utilization in emergency or other transport situations (where
distance or time is crucial) . For in-county emergencies requiring the
helicopter a $350.00 flat charge is recommended. This allows for
approximately one hour of helicopter use and covers the cost of addi-
15 •
1 L
tional personnel and special crew training. Out-of-County transport
would be charged the existing Helicopter Allocated Rates to cover the
cost of operating the helicopter. In addition to the Helicopter
Allocated Rates, the Ambulance Base Rate would also be charged to cover
the cost of the EMS crew involved.
HH/sgg/cm/113-A
10/29/81
16 •
•
APPENDIX
•
•
•
•
•
tiEMORA:NDUM
•
•
To: Board of County Commissioners
Thomas Hafner, Public Safety
• Bill Norman, County Manager
From: Douglas Greenfield, Director of EMS
Date: August 19, 1981
•
•
•
This is a recent budget and operational phone survey take h of
several prominent EMS Districts around this state.
my concerned emphasis was on operational cos': vs. recovered
• revenues through collections and actual cost to`the individual
user of the service. What I found in each system was a some-
what different -philosophy toward revenue recovery. Some
recover nothing while others vigorously strive to obtain 100%
plus profit and growth margins through the use of computer
automation and well developed billing centers within their
organization.
*es ••ctf lly u mitted,
ul as ie
. sir. ..:or i E M.S.
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tt.05
I 3Ze DIRECTOR WILL:
x. officer for basic and advanced life
Act as the training 4
zupport.
available for continued aonitoringoquality of
care performed by EMT and paramedic personnel.
available for periodic retraining of EMT and
paramedic personnel. '-,
100.06
OPERATIONS SUPERVISOR: `
Collier EMS will employ one operations super visor who
• - will work directly under the EMS •
-.. wishing to apply for this position (in the event of a
vacancy) must have an endorsement from the Meal
Director, and observe normal County hiring procedures.
In, addition, the applicant must be Florida State
Certified Paramedic for at least two (2) years and
Collier County Certified Paramedic for at least one (1)
years. The responsibilities of the Operations
Supervisor will be to assist the Director in organizing
• and administering-ho the maintenance ency opcareion and
County-wide pre-hospital
system.
$. Specific duties include, but are not limited to the
following:
1. Handling any special events.
2 „ Handling complaints coming in the EMS office by
phone or walk-ins.
3. Field supervision and medical back-up as needed.
4. Coordinating training as requested by the EMS .
Director or Medical Director.
5. Promoting Collier EMS system through public
relation campaigns, appearances and special
events.
6. Oversees all office personnel.
_ 7. In view of responsibility of #3 - shall be
responsible for remaining in touch with the
Medical Director' s protocol, i.e. , attendance of
`„
7 t
. - PARaMEO iC ,S P is
meetings and testing as deemed necessary by the
•
Medical Director.
M _► crpF VISORS:
;here are three paramedic supervisors, one for each
0,.:ft. The Paramedic Supervisor provides advanced
-hospital care support and supervision for i lshft
Lacs the guidelines set by Collier County EMS. Employees
+u=s=ing to apply for the position (in the event of a
vacancy) must be Florida State and Collier County Certified
taraziedics with at least two years as a Florida licensed
practicing paramedic and one year as a Collier County
Certified Paramedic. The responsibilities of the Paramedic
frvisor include, but are not limited to:
A. Supervisors will be responsible for the performance of
general supervisory duties in addition to having the
technical skills and , knowledge necessary for the
performance of the duties peculiar to their specific
assignment.
t . Supervisors will initiate, or receive and consider,
proposals for changes in department policy, rules or
procedures and forward them to the next level of
ad inistration (Director of EMS) .
C. Supervisors will familiarize themselves with EMS
manuals, directives and objectives and will disseminate
pertinent information to subordinates.
^. . Supervisors will organize their own work and that of
subordinates to insure the adoption and practice of the
bent principles and procedures , to meet current,
unusual, and changing conditions.
V. Supervisors will take a personal interest in the
welfare and problems of subordinates and will be
available to employees seeking guidance and counseling.
F. Supervisors will adopt an attitude of guiding employees •
by sound logic and clear thinking, rather than by
arbitrary orders and commands, and will strive for
willing response and cooperation from subordinates.
G. Supervisors will be aware that recognition of good work
is an indispensable need in the employees continuing
relationship with EMS and will make certain that
meritorious acts and accomplishments are rewarded,
either by personal encouragement and praise or by
formal commendation.
8
}
"
#, - rv1Gors will make oral and written reports to the
tnif Director whenever disciplinary action is warranted
or isx required 'by the EMS rules and regulations. The
Sv. rvisor in concert with the Personnel Director will
t permit any employee to begin or continue on duty if
tSe employee is physically or mentally unfit to perform
a.ezigned duties.
'.o Supervisors will assist employees in becoming more
affective to gain effectiveness in their assignments
trough the development of appropriate habits of
tl`e 9ht, action, skill, knowledge and attitude.
Erpnas:is will be placed on respect for the. personality
and dignity of each employee in order to allow maximum
4evelopclent of his natural capacity.
J. su rvisors will avoid disciplining subordinates in the
presence of others.
• t! Supervisors will be responsible for ordering supplies
and equipment, maintenance of vehicles and proper
operation and function of radio and telemetry
equipment. Will maintain cleanliness and assure proper
inventory and disposition of equipment.
100.0
1 .5 PARAMEDIC AND EMT/DRIVER:
X. The ALS crew consists of one paramedic and one
emergency medical technician/driver or one paramedic
and a paramedic driver. The crew performs as a team to
assure care and custody of all patients presented in an
emergency situation. The duties are performed in •
accordance with Chapter 401 , Florida Statutes and the
Florida Administrative Code 10D-66 as amended. While
personnel in any crew may arrange to perform duties as
best suits their capabilities and enhances their
teamwork, accountability for specific duties is
outlined as follows in Sections 100. 09 - Paramedic and' .
100.10 - Emergency Medical Technician/Driver.
100.09
TV? PARAMEDIC:
A. The paramedic is strictly accountable for the
following:
1. Supplies and equipment for the vehicle and the
station, including but not limited to Section
200.03, part A, Daily Routine (check supplies) ;
9
EMERGENCY MEDICAL SERVICES DIRECTOR
This is a supervisory position over subordinate employees engaged in render-
ing emergency medical service. Work is evaluated by the Public Safety Ad-
ministrator through analysis of the effectiveness of the program and review of
regular reports.
DUTIES AND RESPONSIBILITIES
Formulates program and provides resources, policies, procedures and admin-
istration to perform the administrative function of the department.
•
Plans, coordinates and organizes the personnel staff.`
•
Establishes and maintains such records, statistics, reports and controls as
necessary to ensure compliance with all applicable laws, policies, ordinances,
resolutions, directives and regulations.
Prepares and reports to the Public Safety Administrator an annual estimated
budget for implementation and maintains management controls over the estab-
lished budget to insure a balancing of expenditures and receipts of funds.
Investigates federal and state resources of financial assistance and grants and
prepares necessary applications.
Maintains good working relationship and coordination between the department
and other divisions of County Government members of the general public,
federal, state, and local agencies, offices and officials.
Recommends changes, to the Public Safety Administrator, needed to increase
' the efficiency and effectiveness of the department.
Performs related work as required
FACTOR 1 - KNOWLEDGE REQUIRED BY THE POSITION
Knowledge of modern office practices, procedures, and current adminis-
trative practices.
Knowledge of departmental operations and their relationship to the over-
all County objectives and goals.
Knowledge of techniques used to perform a work force analysis for
comparison with County wide population and labor force
characteristics.
Knowledge of Local, State and Federal directives, guidelines and appli-
cable laws and regulations, covering the departmental operations.
Knowledge of leadership and small group communications techniques.
Knowledge of supervisory training methods.
Knowledge of public relations methods and media practices.
FES:
OT: D
59.1.b-A-4
F-4
Ability to establish and maintain effective working relationships with
subordinates, other employees at all levels and the general public.
Ability to effectively communicate orally or in writing.
Ability to work under pressure.
Ability to communicate with people of varied social, economic and educa-
tional backgrounds to obtain pertinent data.
Ability to read and interpret County, State and Federal regulations and
laws in outlining programs and the technical operational procedures
necessary for those programs.
Ability to plan, delegate and supervise the work of assigned employees
•
and to coordinate departmental programs and activities.
Ability to develop, write, compile, analyze, compose and edit correspon-
dence, speeches and reports as required.
FACTOR 2 - SUPERVISORY CONTROLS
Incumbent is responsible for planning and carrying out assignments,
resolving most of the problems which arise. Coordinates the work of staff
personnel and interprets policy. Contacts supervisor only to advise on
progress or potential controversial matters. Completed work is reviewed in
terms of effectiveness in meeting requirements or expected results.
•
•
FACTOR 3 - GUIDELINES
Incumbent is provided a number of written guidelines, both regulatory
and procedural. The employee uses judgment in interpreting and adapting
guidelines such as departmental policies for use in specific cases and many
recommend changes or modifications in standard operating procedures or
departmental regulations.
FACTOR 4 - COMPLEXITY
'There is a substantial amount of problem analysis involved in determining
what needs to be done or how best to approach a problem. Employee is re-
quired to identify and analyze conditions and elements to discuss interrela-
tionships. The chosen course of action may have to be selected from many
alternatives.
FACTOR 5 - SCOPE AND EFFECT
The purpose of the work is to establish criteria used in the ambulance
service operation. The effectiveness has a major impact of community
concern.
FACTOR 6 - PERSONAL CONTACTS
Personal contacts are with co-workers, employees of other agencies, and
-the general public. Contacts at this level are usually those with news media,
family members of clients concerning emergency situations requiring ambulance
service.
E-5
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•
FACTOR 7 - PURPOSE OF CONTACTS
Contacts are primarily to influence, motivate, or control persons or
groups. The employee must demonstrate skill in dealing with these persons
to obtain the desired effect.
FACTOR 8 - PHYSICAL DEMANDS
The work requires little physical exertion. There may be occasional
field work requiring standing, walking, and lifting objects over 50 lbs.
FACTOR 9 - WORK ENVIRONMENT
•
The work is typically performed in an office -setting with infrequent
exposure to moderate risk and exposure.
FACTOR 10 - SUPERVISORY ACCOUNTABILITY
Position is responsible for the direction of a staff of sub-professional,
clerical and technical employees relating to ambulance services, assigns work,
initiates disciplinary action and makes all hiring and promotional decisions.
MINIMUM REQUIREMENTS
•
•
E-6
•
PARAMEDIC
This is responsible and advanced medical aid work in providing emergency
care to the sick and injured. Work is performed under the direction of the
shift supervisor.
DUTIES AND RESPONSIBILITIES
Incumbent is responsible for the functioning of the ambulance unit and the
actions of the attendant and/or EMT assigned to the unit. Coordinates all
• activities of the unit.
Provides responsible and advanced emergency care to sick and injured by
administering medications and providing life support measures.
Assures that the unit, and all equipment in it, will be accounted for and kept
clean and in good working condition at all times.
Assures that each vehicle is serviced when needed, including tires, lights,
tune-ups, etc. Reports damaged or lost equipment to duty supervisor.
Maintains reports and record-keeping including trip sheets, information
sheets, check lists, medical examiner reports, collections and receipts.
Oversees and is directly responsible for the patient care entrusted.
Uses proficient terminology and professionalism in communicating with the
physicians and/or other medically oriented individuals.
Assumes responsibility for paramedical equipment and medications assigned to
the unit.
Continues patient care until relieved by an equally or more highly qualified
individual.
Performs related work as required.
FACTOR 1 . Knowledge Required By The Position
Knowledge of sophisticated electronic equipment.
Knowledge of advanced first aid and the use of life sustaining practices
and procedures.
Ability to communicate with people calmly and efficiently.
Ability to work as part of a team and carry out duties in a professional
manner.
Ability to understand and carry out oral and written instructions.
Ability to operate and maintain ambulance equipment and telemetry
systems.
FES:
OT:
60.1-C-3
P-3
TCY
Ability to comply with the EMS standard operating procedures. Mkt
participate in American Red Cross Standard First Aid and Personal.
Safety Class, CPR instruction and initial Gaining given 637- the
Division.
FACTOR 2. Supervisory Controls
The supervisor provides assignments by defining objectives, priorities
and deadlines. Once assignment is made, the supervisor provides assistance
only when unusually difficult situations arise or no clear precedent has been
set.
FACTOR 3. Guidelines
Employee is provided a number of written guidelines, both regulatory
and procedural. The employee must use independent judgment in locating and
selecting the most appropriate guideline to use and in making minor deviations
to adopt to specific situations.
FACTOR 4. Complexity
Employee is required to perform several duties involving different pro-
cesses or methods to provide the full range of ambulance service. Employee
determines what needs to be done or how best to approach a problem.
FACTOR 5. Scope and Effect
The purpose of the work is to provide efficient emergency medical care
within the scope of ambulance service. The service has a major impact of
community concern.
FACTOR 6. Personal Contact
Personal contacts are with co-workers, employers of other agencies, and
professional personnel, as well as with members of the public.
FACTOR 7. Purpose of Contacts
Contacts are primarily for exchanging of information in order to provide
competent emergency medical service.
FACTOR 8. Physical Demands
Position at this level requires regular performance of strenuous activities
such as lifting of the sick and injured, standing, walking and carrying of
objects.
FACTOR 9. Work Environment •
The work involves a moderate level of risk and discomfort, or, in un-
usual situations exposure to potentially dangerous situations.
P-4
FACTOR 10. Supervisory Accountability
The Paramedic is responsible for the functioning of the unit and the
actions of the attendant and/or EMT's assigned to the unit.
MINIMUM REQUIREMENTS
State of Florida Paramedic Certificate.
Valid Florida Chauffeur's License and good driving certificate.
•
{
P-5
EMERGENCY MEDICAL TECHNICIAN
This is advanced medical aid work in rendering assistance to persons re-
quiring ambulance service. The EMT is in charge of the back of the am-
bulance and patient care when on call.
RESPONSIBILITIES AND DUTIES
Render first aid in emergencies such as bandaging, splinting, resuscitation,
administering oxygen, shock treatment.
Secure patient for movement during ambulance trip so as not to aggravate
injury.
Insure that all first aid supplies and life sustaining equipment are sufficient
and operational at all times.
Handle bills and presentations; operate radio enroute to emergency scene;
assist attendant in lifting patient into and out of ambulance, wheelchair or
stretcher.
Performs maintenance on station, substation and surrounding grounds. Oper-
ate all equipment on the ambulance and perform all duties assigned to the
ambulance attendant classification.
Perform related work as required.
FACTOR 1 . Knowledge Required By The Position
Knowledge of advanced first aid and the uses of life sustaining practices
and procedures.
Ability to communicate with people calmly and efficiently.
Ability to work as part of a team.
Have excellent motor coordination of eyes, hands and fingers in treating
patients.
Ability to carry out duties in a professional manner.
Ability to understand and carry out written and oral instructions.
Ability to operate and maintain ambulance equipment and telemetry
systems.
Physical strength and ability sufficient to handle medical service treat-
ment.
Ability to understand orders given by doctor over the radio and in
person.
Must be EMT Registered with the State of Florida and employed by
C.C.A.S. for not less than six (6) months.
Skill in defensive driving and completion of defensive driving course,
and possess Florida Chauffeur's license.
FES: •
OT:
59.1.b-A-7
E-7
•
FACTOR 2. Supervisory Controls
The employee plans and carries out the successive steps in the assign-
ment and handles problems and deviations in accordance with policies, pre-
vious experience or accepted practices in the public safety field.
Supervisory assistance is provided through radio contact in unusually
difficult situations or when the assignment has no clear precedent.
FACTOR 3. Guidelines
•
• Considerable judgement, following standard operating procedures and
departmental policies are applied when not applicable, more reliance is placed
on previous experience in similar situations.
FACTOR 4. Complexity
Positions at this level require performance of several duties or methods
used to provide the full range of services. There is a substantial amount of
problem analysis involved in determining what needs to be done or how best
to handle the problem. The chosen course of action may have to be selected
from many alternatives.
FACTOR 5. Scope And Effect
The purpose of the work is to handle emergency medical situations in
conformance with established criteria.
FACTOR 6. Personal Contacts
Personal contacts are with co-workers, employees of other public safety
agencies, and the public. Typical of these contacts are people involved in an
accident or illness situation and are usually characterized by the employee
responding to requests or emergency situations involving public safety
services.
FACTOR 7. Purpose Of Contacts
Contacts are primarily to perform advanced medical aid in an emergency
situation. The employee must demonstrate skill in dealing with these persons
to obtain the desired effect.
FACTOR 8. Physical Demands
Position requires some physical exertion and performance of moderately
strenuous activities.
•
FACTOR 9. Work Environment
The work involves regular and recurring exposures to potentially dan-
gerous situations. These situations are characterized by conditions over
•
•
E-8
which the employee has little control, therefore, must have specialized train-
ing to work as effectively as possible under unusual • environmental stress.
MINIMUM REQUIREMENTS
•
•
•
E-9
COLLIER COUNTY E.M.S. AMBULANCE CHARGES
ITEM: CHARGE: DESCRIPTION/INFORMATION:
BASE RATE $75.00
MILEAGE $ 2.50 Per mile - In county
$ 4.00 Per mile - Out of county
WAITING TIME $25.00 Per 15 minutes (Example: Dr.'s office
SPECIAL HANDLING $15.00 Above and beyond the normal procedure:
Example: Five flights of stairs,
restraints for Signal 20)
EKG - QUICK LOOK NO CHARGE No charge to patient if "quick look"
only is used to assess your patient.
OXYGEN $15.00 Anytime patient receives oxygen.
DRUGS $10.00 All drugs are charged out to the
patient at $10 per drug. Example:
Nitrous-$10, IV solution-$10,
Nitro-$10, Atropine-$10. This is $10
per ampule or solution.
IV CHARGE - START $ 5.00 One time charge for starting an IV,
irregardless of how many IV's started
However, you do charge for each IV
solution set you hang.
MAJOR ITEMS $25.00 Major items consist of: Burn sheets,
ET's, E0A's, Foley Catheters, O.B.
Kits, Poison kits, Snake Bite Kits,
Trauma dressings. Any combination of
these items equal the $25 charge --
not per item.
MINOR ITEMS $10.00 Minor items consist of: ABD Pads,
Ammonia Inhalants, Constricting Bands
Elastic bandages, Eye pads, Kling,
Kravats, Oralpharangeal Airways,
Padded south gag, Sterile Gauze Pads,
Unsterile Gauze pads. Again, any
combination of these items total the
$10 charge -- not per item.
2/22/82 mcg
DEFINITIONS OF E.M.S. TERMS
ITEM: DEFINITION:
ALS ALS means when the services of a Paramedic are needed and
used on the run ($85). Includes lead monitor of a patient.
BLS BLS means when you provide basic life support, ie., oxygen
splinting, bandages, etc. ($25).
TRANSPORT Transport means when all you do is provide the patient
with transportation to a nursing home, hospital, doctor's
office, home, etc. without the need for ALS/BLS.
PRISONER TRANSPORT Prisoner transport is when you are transporting a prisoner
accompanied by a Police Officer. Collier/Naples charge
is $35. Immokalee is $65.00. No other charges even if
you have a cardiac arrest, as long as you have a police
office ride in with you. If he doesn't ride in, then you
charge according to the treatment given the patient.
BODY REMOVAL i Body removal is a base fee of $35 plus the base rate of $75
plus mileage.
HELICOPTER Helicopter charge In County is $350 plus other pertinent
surcharges and supplies (exclude base rate of $75 - but all
other pertinent charges prevail). Out of county charge is
$300 per hour both ways.
RESPONSE CHARGE There is a $35 charge when you respond to a scene by request
patient or the patient's family and they then refuse to let
you transport. You would also charge $35 for the chronic
abuser of the service.
FIRST AID CHARGE WITH A $35 charge is utilized on a "no transport" situation where
NO TRANSPORT you physically did something for the patient such as:
bandaged head, splinted, used 4x4's. There is no charge if
you just take vitals and assess the patient.
Example of an ALS call:
Situation: You respond your ALS Unit to a man with chest pain - possibly an AMI.
Fee: Base Rate: $75.00
Mileage: (2 @ $2.50) $5.00
ALS (use of Paramedic) $85.00
Oxygen $15.00
Nitrous $10.00
IV (D5W TKO) $15.00 ($5-Start, $10-Solution)
IV (D5W with Lidocaine) $20.00 ($10-Solution, $10-Lidocaine)
Morphine (1) $10.00
$235.00 Total charge
Of course, if your patient would code, there could be additional charges:
Example: ET Tube $25.00 (Major item)
Removal from
31st floor $15.00 (special handling)
DEFINITIONS OF E.M.S. TERMS
ITEM: DEFINITION:
ALS ALS means when the services of a Paramedic are needed an,
used on the run ($85). Includes lead monitor of a patient_
BLS BLS means when you provide basic life support, ie., oxygen
splinting, bandages, etc. ($25)_
TRANSPORT Transport means when all you do is provide the patient
with transportation to a nursing home, hospital, doctor's
office, home, etc. without the need for ALS/BLS.
PRISONER TRANSPORT Prisoner transport is when you are transporting a prisoner
accompanied by a Police Officer. Collier/Naples charge
is $35. Immokalee is $65.00_ No other charges even if
you have a cardiac arrest, as long as you have a police
} office ride in with you. If he doesn't ride in, then you
charge according to the treatment given the patient.
BODY REMOVAL is Body removal is a base fee of $35 plus the base rate of $75
plus mileage.
HELICOPTER Helicopter charge In County is $350 plus other pertinent
surcharges and supplies (exclude base rate of $75 - but all
other pertinent charges prevail). Out of county charge is
$300 per hour both ways.
.RESPONSE CHARGE There is a $35 charge when you respond to a scene by request
patient or the patient's family and they then refuse to let
you transport. You would also charge $35 for the chronic
abuser of the service.
FIRST AID CHARGE WITH A $35 charge is utilized on a "no transport" situation where
NO TRANSPORT you physically did something for the patient such as:
bandaged head, splinted, used 4x4's_ There is no charge if
you just take vitals and assess the patient.
Example of an ALS call:
•
Situation: You respond your ALS Unit to a man with chest pain - possibly an AMI.
Fee: Base Rate: $75.00
Mileage: (2 @ $2.50) $5.00
ALS (use of Paramedic) $85.00
Oxygen $15.00
Nitrous $10.00
IV (D5W TKO) $15.00 ($5-Start, $10-Solution)
IV (D5W with Lidocaine) $20.00 ($10-Solution, $10-Lidocaine)
Morphine (1) $10.00
$235.00_ Total charge
Of course, if your patient would code, there could be additional charges:
Example: ET Tube $25.00 (Major item)
Removal from
31st floor $15.00 (special handling)
",� - COLLIER COUNTY E.M.S. AMBULANCE CHARGES
ITEM: CHARGE: DESCRIPTION/INFORMATION:
BASE RATE $75.00
MILEAGE $ 2.50 Per mile - In county
$ 4.00 Per mile - Out of county
WAITING TIME $25.00 Per 15 minutes (Example: Dr. 's office
SPECIAL HANDLING $15.00 Above and beyond the normal procedure:
Example: Five flights of stairs,
restraints for Signal 20)
EKG - QUICK LOOK NO CHARGE No charge to patient if "quick look"
only is used to assess your patient.
OXYGEN $15.00 Anytime patient receives oxygen.
DRUGS $10.00 All drugs are charged out to the
patient at $10 per drug_ Example:
Nitrous-$10, IV solution-$10,
Nitro-$10, Atropine-$10. This is $10
per ampule or solution_
IV CHARGE - START $ 5.00 One time charge for starting an IV,
irregardless of how many IV's started
However, you do charge for each IV
solution set you hang.
MAJOR ITEMS $25.00 Major items consist of: Burn sheets,
ET's, EOA's, Foley Catheters, O.B_
Kits, Poison kits, Snake Bite Kits,
Trauma dressings. Any combination of
these items equal the $25 charge --
not per item.
MINOR ITEMS $10.00 Minor items consist of: ABD Pads,
Ammonia Inhalants, Constricting Bands
Elastic bandages, Eye pads, Kling,
Kravats, Oraipharangeal Airways,
Padded nouth gag, Sterile Gauze Pads,
Unsterile Gauze pads. Again, any
combination of these items total the
$10 charge -- not per item.
2/22/82 mcg
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