Fee Schedule for Nursing Staffing Company - PowerPoint

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					      Louisville Fire Department
       Ambulance Fee Proposal

______________________________________________________

 Presented by: Tim Parker
               Chief of Department
 Date: 8-8-07
     Briefing Objective

 Provide a comparative analysis of
  metro-wide ambulance fees.


 Provide background information
  about the need for ambulance fees.


 Establish a path forward or District
  policy on ambulance fees.
                    Background
In May of 2006 LFPD voters approved a property tax
increase to bring the ambulance service back into the
Fire Department.
Due to:
           Extended response times by current provider
                       (17 minutes by contract)

           No dedicated ambulance from 7 PM – 7 AM

           Service by 4 different providers in a 5-year period
             (Private ambulance services can’t make a
              profit in a small market.)

           Received 30-day notice of service cancellation
    Funding Distribution
 Of Approved Tax Increase

                      Replace aging fire apparatus,
 .5 mill = ($200k)   buy new ambulances and
                      provide for operating expenses


 1 mill = ($400k)    Fire Station modifications,
                      construction and infrastructure


                      Paramedic staff salary and
 2 mills = ($800k)   benefits program
          Purpose for
     Cost Recovery Program
   #1 Reduce Frequency of Future Tax Requests

 Compensate for lost revenue from Urban Renewal
           ($3.2 million impact in 25 years)

 Minimize impact of fluctuating property values
          (Includes exclusions)

 Cover fuel, insurance & energy (heat) cost increases

 Help keep LFD competitive with larger departments

 Provide additional funding for future EMS personnel

 Support EMS innovations, training and equipment
  Six-Year Operational Cost Forecast
                    Without Ambulance Fees
          Assumes an Annual 12% Merit and Benefit Increase
                                                                   Year-to-Date
               Approved                           Projected          Projected
   Operating   Program         Projected           Annual           Cumulative
     Year       Funding       Expenditures         Reserve            Reserve

      1        $800,000   $         615,861   $      184,139   $         184,139
      2        $800,000   $         689,764   $      110,236   $         294,375
      3        $800,000   $         772,536 $         27,464   $         321,839
      4        $800,000   $         865,240 $        (65,240) $          256,599
      5        $800,000   $         969,068 $       (169,068) $           87,531
      6        $800,000   $       1,085,356 $       (285,356) $         (197,825)
Estimated 6-Year Program: Approved Program Funding - $4,800,000
                          Expenditures - $4,997,825
Six-Year Operational Cost Forecast
                  Without Ambulance Fees
   Assumes an Annual 12% Merit and Benefit Increase

1200000

1000000
                                       Approved
 800000                                Program
                                       Funding
 600000
                                       Projected
                                       Expenditures
 400000

 200000                                Projected Annual Reserve


      0
          1   2      3   4   5   6     Projected Accumulative
-200000                                Reserve

-400000
What other options are available to
 help sustain Emergency Medical
       Services Programs?_______


 Reduce funding of other programs
    Fire Stations    Apparatus Replacement    Equipment


 Request additional funding

 Reduce staffing in other program areas

 Implement an ambulance recovery fee program
        Cost Recovery Option 1
          Fixed Rate ($720-BLS/$1170-ALS)

 Average                Average Average Projected      Projected
Transports                 Bill   Collection Monthly    Annual
Per Month               ALS/BLS &   Rate     Revenue   Revenue
(Best Data Available)   Payor Mix




        20               $850       50%     $ 8,500    $102,000


        30               $850       50%     $12,750    $153,000
        Cost Recovery Option 2
Itemized Charges ($600-BLS/ $700 ALS)

 Average                Average Average Projected      Projected
Transports                 Bill   Collection Monthly    Annual
Per Month               ALS/BLS &   Rate     Revenue   Revenue
(Best Data Available)   Payor Mix




        20              $1,100      50%     $11,000    $132,000


        30              $1,100      50%     $16,500    $198,000
  Seven-Year Operational Cost Forecast
                          With Ambulance Fees
          Assumes an Annual 12% Merit and Benefit Increase
                                                                 Year-To-Date
          Approved     Projected                   Projected       Projected
Operating Program     Ambulance      Projected      Annual        Cumulative
  Year     Funding     Revenue      Expenditures    Reserve         Reserve

   1      $   800,000 $   102,000   $    615,861 $     286,139 $       286,139

   2      $   800,000 $   102,000   $    689,764 $     212,236 $       498,375
   3      $   800,000 $   102,000   $    772,536 $     129,464 $       627,839
   4      $   800,000 $   102,000   $    865,240 $      36,760 $       664,599

   5      $   800,000 $   102,000   $    969,068   $    (67,068) $     597,531

   6      $   800,000 $   102,000   $   1,085,356 $    (183,356) $     414,175
   7      $   800,000 $   102,000   $   1,215,598 $    (313,598) $     100,577
Estimated 7-Year Program: Approved Program Funding - $5,600,000
                          Ambulance Revenue - $714,000
                          Expenditures - $6,213,423
Seven-Year Operational Cost Forecast
                     With Ambulance Fees
          Assumes an Annual 12% Merit and Benefit Increase

1400000                                     Approved
                                            Program
1200000
                                            Funding
1000000                                     Projected
                                            Ambulance
 800000                                     Revenue
 600000                                     Projected
                                            Expenditures
 400000

 200000                                     Projected Annual Reserve

      0
           1   2    3   4    5    6   7     Year-to-Date Projected
-200000                                     Cumulative Reserve
-400000
How common is ambulance billing?

 Nationally, nearly 85% of transport agencies bill for
  services.

 All of the 15 departments we surveyed in the Front
 Range bill for their services. All but two were county
 or local government agencies.
 Will my insurance premium increase
  as a result of ambulance billing?

 There is no evidence that EMS specifically increases
  health insurance premiums. Ambulance fees
  account for less than 1% of healthcare
  expenditures.
How much will come out of my pocket?

  The overwhelming percentage of revenue will come
   from Medicare, Medicaid & other insurance
   company payments.

  Payments from individuals depend on their insurance
    policy; however, we estimate 5% ($5,100) will
    come from copays or out-of-pocket.


 Ambulance service will always be provided regardless of
 one’s ability to pay.
         What if I’m unable to pay?

 If you can demonstrate financial hardship in accordance
  with the District’s policy, a substantial reduction is
  available (based on income ranges).

 If at any time during the billing process a claim for
  financial hardship is made, we will send a Hardship
  Certification Form.

 We can also set up a billing payment plan for anyone
  who is unable to pay in one payment.
         Subscription Program
The District will offer a subscription program at a nominal
fee to cover all of your deductibles and/or copays. This
means no out-of-pocket expense to you for an ambulance
bill after your insurance provider has paid.
Annual Membership Fees:
   (Example)
                Individual   -     $25
                Couple       -     $45
                Family       -     $60
                Senior Couple - $35

                Resident of skilled nursing      - $50
                 facility or senior living center
Recommended Fee Schedule
                     Fixed Rates


  Service Type           Resident   Non-resident


Basic Life Support       $   720      $   820
    Transport

  Advanced Life          $ 1,170      $ 1,270
Support Transport
                  Billing Comparison
                    Traumatic Cardiac Arrest

                       Basic Life   Advanced Life Advanced Life
    Department          Support       Support       Support
                                                     (Average)

Federal Heights          $550           $650         $1,325

Mountain View            $625           $700         $1,194

North Metro              $575           $750         $1,040

Lafayette                $600           $900         $1,218

Pridemark                $350           $723         $1,400

Northglenn Ambulance     $396           $850         $1,799

Louisville              $720          $1,170        $1,170
Questions?

     Comments?

             Concerns?

				
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