Minutes 08/06/1997 EMERGENCY MEDICAL SERVICE ADVISORY COUNCIL
(EMSAC)
INFORMAL MINUTES
August 6, 1997
2:00 P.M.
EMERGENCY MEDICAL SERVICES HEADQUARTERS
3301 East Tamiami Trail
Council Bob Laird Excused Members: Sheldon Reed
Members: Sharon Hanlon Paul Gunther-Mohr
Gary Young Roger Evans
Bob Schank Rhona Saunders
Fay Biles Palma Fuson
Mike Davis
Others: Leo Ochs
Diane B. Flagg
John Yonkosky
Barbara Brown
Joan Young
George Leamon
The regular monthly meeting of the Collier County EMSAC committee was called
to order at 2:00 P.M. on Wednesday August 6, 1997 by Bob Laird Chairman.
Due to the absence of six members, no action would be taken at this meeting.
Bob Laird introduced George Leamon, a visitor who was interested in joining the
EMSAC group.
Chairman Laird stated several years ago while on the Productivity Committee,
several complaints were received in regards to the price of the ambulance bills,
being to high. He had heard the ambulance bills were going to increase, and he
was concerned.
John Yonkosky handed out a weekly report sheet, it is the first time in 2 1/2 years
that DOR has been to -0- for status report. At this time DOR is completely caught
up with the run reports. All bills through the 19th of July have been processed.
Trip Tickets have been received through the 27th of July and have been billed
through 19th. On the status report under receipts last month $335,000 was
collected, compared to monthly budget of $287,500. The annual budget divided
by twelve months is how they derive at the monthly budget figure. That is just a
figure to work towards. Billing and cash flow is higher in certain months, cash
flow is always higher in the last three months of the year.
Fay Biles wanted to know how successful collection agencies were with
collections. John stated that 25 to 30% is collected. Bills in collection are from
October, 1994 to present. Leo stated DOR staff will be working harder to collect
fees before being turned over to collection. The collection agency that DOR
works with gets 20% of collections.
Leo stated the EMS budget is funded through fees and ad valorem taxes. That
split has been an average of 50 -50% over the past several years. When the
DOR was formed, the board liked the idea of the flat rate, but they wanted to
continued to keep pace with medical inflation, especially Medicare increases that
may be past along from year to year. Staff recommended that be monitored and
make recommendations accordingly.
Diane B. Flagg, handed out a brochure entitled "Current Billing Methodology".
She stated 43% of the total ambulance runs are Medicare runs. Medicare
currently pays based upon $250.00 They will only pay 80% of $250. Regardless
of what you charge. Patient pays $50.00 out of pocket. The total amount
received for 43% of the bills is $250. DOR has to write off $52.00 as un-
collectable, because the patient cannot pay.
In the A0326 ALS specialized service, Medicare pays 80% of $282.00 which is
$225.00. The patient pays out of pocket $57.00. DOR has to write off $57. As
un-collectable.
•
Under John Yonkosky and Jeff Page's proposed option, mileage is a reimbursed
expense, but it also creates several hundred dollars to the bill. They are
proposing to have a charge of $4.00 per mile with a 7 mile cap. This is what
Medicare reimburses. Actual mileage will be paid up to 7 miles. Base rate of
$264.00 plus mileage. Medicare (per John's projection) is expected to increase
their base rate reimbursement January 1, 1998, from the current $250. to $292.
Based upon that Medicare will pay $233. The patient would pay 20% of the $292,
which would be $59.00.
Mileage was not charged before as it made the bill too expensive for some areas
of the county. There was no mileage cap previously.
John stated he has an approved mileage rate from Medicare of $4.11. We can
mix the revenue stream somewhat by reducing base rate and charging mileage
and come out with more money realized.
Since September, 1994 our reimbursement rate from Medicare is still only
$250.00. John stated that is due to the 18 month window. June 1, 1995 our rate
was $250.00. July 1, 1996'we increased our rate to $302. The rate has to be in
place for a twelve month period ending June 30. Before they will give us an
increase.
More information will be available at the Medifest conference held in Orlando, Fl.,
next month.
Bob Laird excused himself as he had to leave early, but he wanted to thank
Sharon Hanlon for all her efforts on the board, as this will be her last meeting as
her term will expire on August 31, 1997.
Sharon Hanlon said she would not support the increase based on the possibility
that Medicaid will not pay the mileage and she felt we recently increased to $302
to take advantage of what Medicaid pays, and if we are now going to reduce to
$264 does that mean we have to wait the twelve months again if we need to
increase again? Also, she feels there are some agencies that do not pay mileage.
Diane stated that historically from 1994 to June, 1995 our rate was $250.
Medicare pays $250. Twelve months later July 1, 1995 to June 30, 1996 our rate
was $302. Medicare still only paid $250. Our rate has been $302, Medicare is
still only paying $250. The next time frame they will look at will be July 1, 1996
through June 30, 1997. Once again our rate has been $302, we won't know until
November, 1997 what are rate will increase to. Even though our rate was
increased and has been over the time frame they look at, Medicare has not
increased our reimbursement.
Leo Ochs wanted to know since we did not adjust our current rate on July 1, 1997
what kind of impact will that have on January, 1999. John Yonkosky said it only
has an impact if we wait a long time. Again, there is the possibility Medicare will
pay only a flat rate.
Leo Ochs said the budget figure for FY98 is $3,465,000.
Fay Biles inquired if more information would be available after the Medifest
Conference.
Leo Ochs stated he would'like a recommendation from the Advisory Board, to
take back to the County Administrator. The committee agreed to wait until the
September meeting to make a recommendation.
Meeting Adjourned
EMERGENCY MEDICAL SERVICE ADVISORY COUNCIL