HomeMy WebLinkAbout37-Fire Department
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Prepared for
MAYOR
W.R. Holcomb
COUNCIL
Esther Estrada
Jack Reilly
Jess Flores
Michael Maudsley
Tom Minor
Valerie Pope- Ludlam
Norine Miller
First Ward
Second Ward
Third Ward
Fourth Ward
Fifth Ward
Sixth Ward
Seventh Ward
By The San Bernardino City Fire Department
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October 1, 1990
#37
/0-1-90
CITY OF SAN BlCARDINO . REQUEST FoFOouNCIL ACTION
Orom:
Chief William L. Wright
Subject:
Establishment of Emergency Medical
Services! Paramedic User Fees and
voluntary Membership Program
Oept:
Fire
Date: Oct. 1, 1990
Synopsis of Previous Council Action
Sept. 10, 1990-
April 16, 1990-
April 2, 1990-
Ways and Means Committee, approved in concept
Council Meeting, agenda item 45 failed by 3- 3 vote.
Set public hearing date on proposed ordinance
authorizing collection of Emergency Medical Servicel
Paramedic Fees.
March 22, 1990-
Legislative Review Committee recommended
approval of proposed ordinance.
Recommended motion:
That the establishment of Emergency Medical Servicesl Paramedic User
Fees and Voluntary Paramedic Membership Program be approved in
concept, with an effective date of '" And that the City
Attorney be directed to prepare necessary resolution{s).
Sig1aIure
Contact person: Chief William L. Wright
Phone: 384-5286
Supporting data attached: Yes
Ward:
FUNDING REQUIREMENTS:
Amount:
Source: IAt:rl Nol
IAt:rl DescriDlionl
Finance:
Council Notas:
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7S-02U
AgeOOa ttem No: 37
/tJ-/- C)O
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EMEQNCY MEDICAL SERVICES/ PARA~IC 'USER FEES'
AND
VOLUNTARY
'MEMBERSHIP' PROGRAM
October 1, 1990
CONTENTS
1. Staff Report
Proposal... ....... ... ..... ...... ... ...... .... ... ....... ....... .... ..... ....... ... ..... ... ....... ...... ..... ......2
Background.................................................................................................. 2
Fiscal impact.................................................................................................3
Implementation............................................................................................3
2. Detailed Analysis
Proposal.........................................................................................................6
Application Process......................................................................................8
Low Income Reduction................................................................................9
Billing...............................................................................................................9
Collections.....................................................................................................9
Phase-In proposal...............................................................................:....... 11
Marketing......., .... .....,.. ...... ........ ......................... I.:........... ........ .......... ......... .12
3. Questions and Answers..............................................................................................14
4. Glossary.......................................................................................................................21 .
5. References... .... ..... ... .... ... ....... ... ... ...... ..... ... ....... ....... ................. ..... ... ..... .............. ....... .25
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S.B. CIty 10/ 90
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CITY OF SAN BERNARDINO. REQUEST FOR COUNCIL ACTION
o
ST AFF REPORT
EMERGENCY MEDICAL SERVICES/ PARAMEDIC 'USER FEES'
AND
VOLUNTARY
'MEMBERSHIP' PROGRAM
October 1.1990
The C' establish fees for providing emergency medical services (EMS). A fee of
$1 00 ~ r basic life support (BLS). provided by all11 fire engines. and a fee of $200 for
advanced life support (ALS). provided by 3 medic-engines and 1 medic-squad.
These costs would be referred to as "User Fees". The user fee is charged for fire
department EMS services rendered. independent of the need for ambulance
transportation.
If residents want to avoid the 'out of pocket' expense of an ALS or BLS user fee they
would have the opportunity to become "members" of the Voluntary Paramedic
Membership Program by paying a "membership fee" of $24. User fee would then
be charged to the member's insurance company and will be accepted as
payment in full. A 'Low Income' membership fee of $12 would also be available for
those who qualify.
The net revenue for "User Fee" charges alone, based on a flat rate of $100 for BLS
. and $200 for ALS or paramedic level service, is projected to
be approximately $374,640. "User fees" plus a modest membership of 10% of the
59,000 dwelling units in the city could generate $610,764 annually.
Under NO circumstances will fire department services be delayed or denied to
anyone. Verification of membership and ability to pay will NOT occur at the scene
of any emergency.
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BACKGROU~~:
"User fees" and "membership programs" are becoming increasingly popular to
augment city revenues. City Rre Department staff surveyed the departments of like
S.B. City 101 90
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size in Southem cQmia. Model programs exist in H9tington Beach and Fullerton
where 6O-7r:t'1o of municipal water customers are members. Anaheim, Orange,
Hawthome, Monterey Park, and Westminster also have successful programs that
recover all or a major portion of their EMS budgets.
FISCAL IMPACT:
Minimal initiallv. 'User Fee' billing services will be contracted to Courtesy Services.
They will send all users, or their designated health insurance provider, a separate bill
for fire department emergency medical services. Courtesy Services has proposed
a fee of 9.5% of gross collections. The gross revenue projected for 'non-resident
user fees' alone is $109,068. Courtesy Services fee of 9.5% would amount to
approximately $10.361 annually. Initially the program's revenue will be directed
into an 'Trust Account'. These funds will be used for marketing. public education,
advertising. mailings. consultation costs. and to evaluate the management needs
to ensure maximum success of the program.
The Rnance and Data Processing Departments are putting together a proposal for
'membership fee' collections and membership verification.
Temporary help will be needed during the enrollment period for data entry and
other related tasks.
IMPLEMENTATION:
A phase-in process is recommended:
Phase One - 'Non- Resident User Fees'
The first four to six months only non-residents will be billed for 'User Fees' until
the Membership program becomes effective. This phase will allow us to
evaluate our methods and needs for record keeping. documentation, and
billing procedures with a relatively small sample group (24% of the patients
tranSDorted are non-residents) and begin generating revenue. Any changes
that need to be made will be less costly and time consuming.
,,0
From the statistics provided. we can fairly accurately. determine the number
of BlS and ALS responses that involve non-residents. After applying the fees
to these numbers fora gross revenue of $109,068, we can then subtract the
collection fee of 9.5% ($10.361) and show a net revenue for 'user fees'
5.B. CIty 10/90
3
generated Q non-residents alone of S98.7oQnnUaIlY.
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During this phase the program's revenue will be directed into a 'Trust
Account'. These funds will be used for marketing. public education.
advertising. mailings. and consultation costs. Consultants will be used to
evaluate the coordination and management needs to maximize the success
of the program.
This 'non-resident phase' can be implemented 90 days after approval. Funds
will be set aside for printing costs and establishing a marketing plan.
Phase Two - 'Membership Enrollment'
A two month open enrollment period for voluntary membership. following a
month of intensive marketing is recommended. Multi-media publiC
information programs will be developed along with brochures and
applications mailed in the water bills. In addition a mass mailing to every
dwelling unit in the city. would start in March. April, May. or June.
Phase Two - open enrollment for VOluntary membership will repeat annually.
Phase Three - Full Implementation
After the voluntary membership open enrollment period ends, memberships
become effective. and at that time the "User Fee" will be applicable to AIJ.
"non-member" users (residents and non-residents) from that time on.
Again, under NO circumstances will fire department services be delayed or denied.
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S.B. City 101 90
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EMERGENCY MEDICAL SERVICES/ PARAMEDIC 'USER FEES'
AND
VOLUNTARY
'MEMBERSHIP' PROGRAM
October 1. 1990
DETAILED ANAL VSIS
INTRODUCTION:
The paramedic program began in the City of San Bernardino in 1976 with one
paramedic squad and no additional funding. Since that time THE program has
become much more sophisticated and has grown to include four paramedic
units and all fire suppression personnel trained to at least the level of Emergency
Medical Technician-1 (EMT-l).
Due to increased public awareness, health education, the 911 system. population
growth. and other factors. the paramedic program has dramatically expanded in
volume, calls, technology, and expense.
FACTS:
. In 1990 the San Bernardino City Fire Department is projected to respond to
over 16.000 emergency calls. Medical aid and rescue calls alone will total
about 13,000 or about 81 % of these calls. This is almost twice the call load of
28 California cities of like population.
. Of the 28 cities with populations befween 100 and 200 thousand. 16 provide
paramedic service through their fire departments. Of these, 10 have
implemented alternative funding programs, and several of the others are in the
process.
. 9 of the 16 cities that are using the alternative funding programs are using either
the User Fee and/ or voluntary paramedic membership/ subscription programs.
Others are using special assessment districts and taxation.
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. Of 7 nearby cities in San Bernardino county that provide fire department
S.B. City 10/ 90
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paramedic sera. 5 have implemented altemaQ funding programs. and the
other 2 are in the process of implementation.
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. Since 1980. the fire department's share of the city's budget has steadily
decreased from 19 to 13%. During this time frame fire and medical aid calls
have more than doubled.
. 1 in every 4.5 households will call for Emergency medical care In 1990.
Approximately 1 in every 17 residents will be transported to the hospital.
1. PROPOSAL
It is proposed that the San Bernardino City Fire Department administer an emer-
gency medical services (EMS)! Paramedic fee program that would receive reve-
nues from two sources:
. First. an Emergency Medical Services! Paramedic "User Fee" Program to re-
cover the City's direct cost of responding to and providing emergency care
within the city limits. A $100 fee would be charged for basic life support (BLS)
provided by all 11 Engine Companies. These personnel are trained to the level
of EMT-1. Advanced life support (ALS) procedures provided by Paramedic
units (3 medic engines and 1 medic squad) would have a direct fee of $200 to
the user. The user fee 1S incurred for fire department EMS services rendered,
independent of the need for ambulance transportation. Courtesy Ambulance
will handle the" User Fee" billing and collections for a proposed 9.5 % fee on
revenues collected. The bill for Fire Dept.! EMS user fees would be separate
from ambulance bills.
Many health insurance plans will cover a large portion of the user fee. Medi-
Care has some provisions to pay the user fees, although Medi-Cal does not
pay for Fire EMS service.
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. Second, residents of the city will have the opportunity to become a "member"
of the EMS! Paramedic Program for a fee of $24 dollars per year per house-
hold. If any permanent resident of a member's household requires fire depart-
ment Emergency Medical Care during the year. the member's insurance
S.B. cuy 101 90
6
company wouQe billed instead of the membeQe membership fee 'pre-
pays' any uninsured portion of the bill (eg; no out of pocket expense for fire
department paramedic services).
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Under NO circumstances will fire department services be delayed or denied to
anyone. Verification of membership and ability to pay will NOT occur at the
scene of any emergency.
The senior citizens in our community have a very strong incentive to become
members. Both the MediCare and "MediCare Plus. plans pay only a fraction of
pre-hospital emergency medical fees. As "members.. these seniors will have pre-
paid the portion of the user fee that these plans do not cover. Many seniors are
reluctant to call911 because of the expenses involved. In Oregon, where a
state- wide membership program has been popular for several years, 70% of the
members are people over 65 years of age. Once "user fees. are implemented.
offering a membership to the residents most at risk of suffering a catastrophic
medical emergency will make them ~ reluctant to call 911 when they or a
loved one is experiencing a medical emergency.
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Our department staff
has researched several
Southern California Fire
Departments that have -
a successful member-
ship and user fee pro-
gram. Membership fees
range from $17 to $56
per year. Fees for serv-
ice range from $75 to
$258 per person (see
Figure 1). The proposed
fees for membership
and BLS Service for the
. City of San Bernardino
are below average.
The ALS Fee is slightly
S.B. CIty 101 90
FIgure I
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PA.ILUoIEIlIIlC ......". ....
FEE COMPARISONS
of Soothem California Cities
250
.. 200
:I
..
:J 150
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1251
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fill
BLS Avo.
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lEI ALS u_ F..
II BLS USer F..
. Membership F..
CompllC<lDY San BcrnarCl1no City Fire [)CPt 8/90
7
In San Bernardino County,
maximum rates for ambu-
lance service is established
each year by a formula
developed by the County
Health Officer. Currently, the
base rate for a BLS Ambu-
lance is $191.19 plus mileage
and additional charges. The
maximum allowable rate for
ALS Service (Paramedic Am-
bulance) is $431.46 plus
mileage. In this city there is
an agreement with Courtesy
Services for a 10% reduction
in those rates. Therefore,
current rates charged in the
city are $172.07 and $388.31
respectively. The average mileage for emer-
gency transportation in the city of San Bernardino
is 5 miles. Therefore, the average ambulance bill in the city can range from $220
to $436 for emergency service (see Figure 2).
above the averaQ
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OFfguro 2
J'.'//"'''''''//'''''''''''''''''''''''''''''///''''''''''''/''''''''''"""""''''''''''''/..
_Ic<i__
RAlE COMPARISONS
S.B. COunty Ambulo_ Provlel... YO SOn _"'100 City F1rellepL
~/////////f///////////////"/////////////.///'/////////'//////////////////L.a
Type Ambulo_ S.B. City
service Prowlclon FIre COpt
BlS Ba.. Rata $172.07 $100.00
AOOlTIONAl CHARGES
Emergency 86.81 0
Nigh! 55.75 0
Oxygen 23.90 0
. Mileage Averaga Charge 47.75 0
ALS Ba. Rate $261.60 $2Oll.00
ADDITIONAl. CHARGES
EKG 39.80 0
NighI 55.75 0
Oxygen 23.90 0
Maximum ALS Charge 388.31 200
(notlnduding~
. Mileage Averaga Chalge 47.75 0
PK90
Soirees: D!pt. of Public Health, COlXtesy Strvlces 1)/90
. 1n8.B.CityNMdonS.B.Co.
tIIIIIbhtled,.. d SUSfmh and CantMy s.w...,.,.
--
. AmWanc:e '*inc:tucMa 10'J1. e.. A.te Nducfon tor S.B. City.
2. APPLICATION PROCESS
If given a chance to put off making a decision, many people will. With this in
mind, an open or on going enrollment for the membership program alone will not
provide the incentive for most people to join. Consequently, a two month open
enrollment period following a month of intensive marketing is recommended. A
publiC information multi-media blitz with brochures and applications mailed in
the water bills and secondly a mass mailing to every 'dwelling unit' in the city,
. should start in March, April, May, or June.
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Applications and membership fees will be accepted by Finance Department
S.B. CIty 10/ 90
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and entered into Qomputerized membership dat~se. Central Cashiering
should be able to accommodate walk-in membership sales. It is expected that
some people will want to join after the enrollment period. New residents into the
city should of course be given the opportunity to join. The fee will still be $24. with
no penalty or prorations. This membership shall also be very clearly described as
non-refundable. Residents wishing to enroll after the deadline shall either be not
allowed. or charged a $12 late processing fee. Concessions will not be made. as
this could undermine the program. The long term success of a membership
program depends on residents renewing year after year.
3. LOW INCOME MEMBERSHIP FEE REDUCTION:
A fee of $24 per year should be affordable to all households. However. 3.5% of
the residents file a low income utility tax exemption. A 50% reduction for low
income is acceptable, providing the percentage filing is not drastically altered.
4. BILLING:
"User Fee" billing services will be contracted to Courtesy Services. When fire
department Emergency Medical Service is provided. the Engine Company Captain
will be responsible to collect patient information to facilitate billing. This information
will be forwarded to Courtesy Services, whether the patient was transported or not.
They will send all users. or their designated health insurance provider. a separate bill
for fire department emergency medical services. Courtesy Services has proposed
a fee of 9.5% of gross collections. The gross revenue projected for non-resident user
~ alone is $109.068. Courtesy Services fee would amount to approximately
$10.361 annually.
Hidden in the explanation of benefits in many insurance programs are items that
may define "Medical Emergency". Some people find that their insurance com-
pany is unwilling to pay benefits not perceived as "Emergency in Nature". Some
impose limitations on pre-hospital emergency care that are more restrictive than
hospital services. It is clear that some people will not benefit by a membership
program if they truly have 100% coverage with no deductible. Many more will
. receive the advantages of not having to worry about the deductible for the Fire
C Department bill at a time when they have ambulance. hospital. and physician
expenses as well.
S.B. City 10/90
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5. COLLECTIONS 0
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Once fees for Rre! EMS service are imposed, it is anticipated that some people
will not pay the bill. Since this program is untested in San Bemardino, a projection
of the percentage of delinquent accounts is unknown. Courtesy Services has
accurate records of their statistics however, and they have calculated a collec-
tion rate of 38.74%. All projections have been calculated with this figure.
The Springfield! Eugene, Oregon Rre Department has also maintained accurate
statistics on insurance reimbursement and member utilization rates. They have
developed a formula they maintain is very accurate to predict annual revenues
from user fees and membership, as well as how often members tend to use the
FIgure 3
EMERGENCY SERVICES REVENUE CALCULATOR
CITY OF SAN BERNARDINO
Non- 10%
1990 Members lIemb....
PopuIoIIon 156,000 140.400 15.600
- 59,000 53.100 5,900
Penlons per 2.5 2.5 2.5
Foe per Household 0 $24
PMienta Transported 8,920 8005 1,872
llllzallcn Rate 6% 12%
pp. +plI. hMpOftId)
Average Billng per pl. $120 $120
Sl%BLSO,100
2O%ALS. S200
InsurwlCe Reimbursement $29 $78
.....6"'1
CoIIeded from pis. $17 $0
(ouIclpoc:Ul:ct.cIudiM)
Gross Receivables (per patlent) $46 $78
Courtesy Services Collection Fee -9.5% -9.5%
Net __ (per paliertl $42 $71
Fee for Service vs FireMed Program (_Ip + Foe for_I
Fee for Service only F1reMed
Non-Member Trenspof1s Non-Member Tronsporta $336,252
(8,920 x $42) (8,006 x $42)
.3741.~
Membership Revenues
(5.900 x $24)
$141,600
,0
1872 rnerri>. transp. x $71
(1IlOll'b. .......... _.1
$132.912
"'90
.
$610.764
S.B. CIty 101 90
SOI.I"ce$: FlreMed Con$\lltant$ Inc., Eugene, OR.
S.D. City Fire Oep.-tnent
10
-~--
emergency servicOand the gross revenue receiveQom insurance companies.
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In the calculator chart(see Figure 4) pertinent statistics have been entered for
the City of San Bemardino. The number of patients transported is a portion of the
total number of those receiving fire department EMS service. We believe that a
10% membership is a fairly conservative goal for these projections. The member-
ship fee along with the user fees would net the department approximately
$610,764 annually. This is $236,124 more revenue generated than if we had only
user fees and no membership program. The membership program can also save
our residents as much as $79,000 in insurance deductibles annually.
6. IMPLEMENTATION:
A phase-in process is recommended:
Phase One - 'Non- Resident User Fees'
To provide for these start-up costs, It is recommend that the city initially implement
non-resident onlv 'User Fees. for services rendered. The first four to six months only
non-residents will be billed for 'User Fees. until the Membership program becomes
effective. This phase will allow us to evaluate our methods and needs for record
keeping. documentation, and billing procedures with a relatively small sample
-.
COURTESY AMBULANCE SERVICES
DlI~CY~". ~
WITHIN CITY UMI'lS
lS,DOCI TOTAL MEDICAL RESPONSES
8,900 TOTAl TRANSPORTS
13
(6779)
IMident Tranaportl
31"
(4080)
No TlUntpOd RItqUIred
20"
(214))
Non..........
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SO...c:e;COOI:C:ly'er'l'l<<!:l
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group (24% of the patients transDorted are non-residents) and begin generating
revenue (see Figure 4). Any changes that need to be made will be less costly and
. time consuming.
From the statistics provided, we can fairly accurately, determine the number of BLS
and ALS responses that involve non-residents. After applying the fees to these
S.B. CIty 10190
11
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numbers for a groQvenue of $109.D68, we can th~ubtract the collection fee of
9.5% ($10,361) and show a net revenue for "user fees" generated from non-
residents alone of $98,707 annually.
During this phase the program's revenue will be directed into a 'Trust Account'.
These funds will be used for marketing, public education, advertising, mailings, and
consultation costs. Consultants will be used to evaluate the coordination and
management needs to maximize the success of the program.
This 'non-resident phase' can be implemented 90 days after approval.
Phase Two - 'Membership Enrollment'
A two month open enrollment period for voluntary membership, following a month
of intensive marketing is recommended. Multi-media publiC information programs
will be developed along with brochures and applications mailed in the water bills.
In addition a mass mailing to every dwelling unit in the city, would start in March,
April, May, or June.
Phase Two - open enrollment for VOluntary membership will repeat annually.
Phase Three - Full Implementation
After the voluntary membership open enrollment period ends, memberships
become effective, and at that time the "User Fee" will be applicable to AU "non-
member" users (residents and non-residents) from that time on.
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7. MARKETING
The success of the membership program depends on annual membership
renewals. All of the successful membership programs surveyed offered annual
improvement in the level of service. This aspect of the marketing is essential os a
major selling point to the public. Once these programs were in full operation, all
cities directed a percentage of the membership revenue into a budget or 'Trust
Account' earmarked specifically for EMS improvement and equipment. The
. publiC benefit of improvements to the program would be emphasized during the
annual marketing period in our brochures and media. This is considered to be a
very significant factor in increasing 'membership' revenue, publiC support, while
S.B. City 10/90
12
continuing to proC), a low membership fee for a nQinal yet popular
investment.
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It is recommended that the the city Implement the -FIREMED" membership pro-
gram. This Is the largest EMS membership program in the nation. It is popular in
the state of Oregon and is gaining popularity in Southem Califomia. ApproxI-
mately 70% of the water customers In Huntington Beach are members. adding
$36 per dwelling unit to the fire department budget. Monterey Park and Sonoma
have also implemented the program. and Oceanside and L.A. City have ex-
pressed interest as well. We would benefit from the synergistic effect of their
marketing campaigns. Our residents would benefit by the reciprocity agree-
ments that participating cities must honor. The only obligation is to purchase our
brochures from the FireMed Consultants in Eugene. Oregon for one year. Their
fees are very competitive and they will handle all of the bulk mailing.
Again. under NO circumstances wiUfire department services be de-
layed or denied.
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S.B. CIty 10/ 90
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EMEQNCY MEDICAL SERVICES/ PARA~IC 'USER FEES'
AND
VOLUNTARY
'MEMBERSHIP' PROGRAM
October 1.1990
COMMON
QUESTIONS AND ANSWERS
1. Q Who Is eligible to enroll?
A. -Any resident of the City of San Bernardino may become a member.
-All permanent residents of a household are covered for any medical
emergency that occurs in the City.
-All members of a residence are covered for any medical emergency
that occurs in the City of San Bernardino.
-Apartments. mobile homes and retirement suites are considered single
family residences and require a separate membership for each unit.
2. Q: How do I enroll in the Voluntary Membership Program?
A. RII out the attached enrollment form and return it with your payment to the
City Finance Department.
3. Q: Can I Join If I do DQt live In or operate a business In the City of San Bernar-
dino?
A. No. the Paramedic Membership applies only to residents of the ~ of San
Bernardino.
4. Q: Can renters become members?
A. Yes. the program is available to all residents of the City of San Bernardino.
5. Q: If I need Paramedics and I am DQt a member, can I stili call 911 and have
paramedics respond?
A. Yes. the San Bernardino City Fire Department will respond to Qml medical
emergency in the City. 911 operators will determine the level of response
needed.
lie
6. Q: What does the $24 membership cover?
A. Your membership fee pre-pays any insurance deductible for all San Bernar-
dino City Fire Department paramedic service for one year no matter how
many times you need them. In other words. Q!l members will have no out of
pocket expenses for fire department paramedic service.
S.B. City 10/ 90
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7. Q: What Is the QamediC service charge If I decQ not to become a member?
A. Basic life support is $100 and advanced life support or paramedic level as-
sessment or treatment, or accompaniment to the hospital is $200.
8. Q: If I share a rented house! apartment with other people, does each person
have to become a member?
A. No. the annual membership is based on households and will cover everyone
who is a permanent resident there.
9. Q: If I am a senior citizen on a fixed Income and cannot afford either the mem-
bership fee of $24 or the 'user fees', can I stili use the paramedics In an emer-
gency?
A. Yes, anyone experiencing a medical emergency should call for the para-
medics regardless of their ability to pay. The City offers a special reduced
rate program for persons claiming a financial hardship.
10. Q: If I am retired and only have Medi-Care coverage, should I become a mem-
ber?
A. Yes, you should enroll. Medicare will not cover all of the costs of emergency
care.
11. Q: Can I make monthly payments?
A. No, this would increase the cost of running the program and prohibit the
City from offering the low $24 membership.
12. Q: What If I don't join during the enrollment period, but decide to become a
member later?
A. You may become a member later, but there is a $12 service charge for late
enrollment, in addition to the $24 membership.
13. Q: Will non-members receive the same quality service as members?
A. Yes, absolutely, because verification of membership will NOT take place
until after the emergency. All non-members will then be billed for a service
fee of $100 to $200 depending on the level of treatment.
14. Q: What If I join and then move out of the city during that year. Do I get a re-
fund?
A. No, the membership fee cannot be refundable.
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15. Q: Can I use Fire Department paramedics for 'DQIl-emergency' or routine am-
bulance transport to the hospital?
A. No, this membership covers only medical emergencies. The fire department
paramedics accompany patients in an ambulance only in medical emer-
gencies.
S.B. CIty 10/ 90
15
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16. Q: Why does tAre department bill my InsurancQompany If I paid to become
a member?
A. To make the membership fee affordable for everyone, the fire deportment
reserves the right to bill your insurance carrier. Without the ability to charge
your insurance. your membership would be much higher. Your membership
fee pre-pays any deductibles you may owe for fire department paramedic
services needed during the membership year.
17. Q: If my Insurance covers 100% of emergency medical expenses, do I need a
membership?
A. We strongly recommend that you review your policy or contact your insur-
ance company. Many have higher deductibles for emergency medical
services than it may appear.
18. Q: How do I become a member If I Just moved Into the city?
A. If you sign up within 30 days of establishing residency. there will be no late
service charge.
19. Q: If I become a member, am I covered for emergency services while I am
away from home?
A. You are covered any time and anywhere within the City of San Bernardino. If
you require the services of another RreMed provider they will honor your
membership with us (If the City chooses to utilize the FireMed Consultant's
program). Other cities using this program have reciprocal agreements.
20. Q: Do you offer a low Income reduction for the membership?
A. Yes. The City offers a special reduced rate program for persons claiming a
financial hardship. Contact the City Finance Department.
21. Q: Will Medl-Cal or Indigent Medical Services (IMS) cover the user fees If I do
not become a member?
A. No. neither Medi-Cal nor IMS will cover the user fees. We encourage you to
become a member.
22. Q: Do I need an 1.0. Card to show the paramedics that I am a member?
A. No. membership will be verified after the emergency by the City Finance
Department.
o
23. Q; How long willi be covered by the membership?
A. Paramedic coverage runs one full year. You must renew your membership
each year during the enrollment period to ensure continuous coverage. If
you enroll after the enrollment date. you will be assessed a late fee of $12, in
addition to the $24 membership fee, and will be covered for the remainder
of the year. .
S.B. CIty 10/ 00
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24. Q: If I become9member and move to another ~ of the city during the year,
willi have to pay again for my membership?
A. No. but you must call the City Rnance Department and request a change
of address form. Reminders will be published periodically in the City Newslet-
ter and on cable lV.
25. Q: Isn't the membership program just another form of taxation?
A. No. it is strictly a voluntary membership program.
26. Q: What Is the difference between Basic Life Support (BLS) and Advanced Life
Support (ALS) services?
A. BLS is that service given by the firefighter EMT. ALS service is that service that
requires the skills and expertise of a professionally trained paramedic.
27. Q: Who determines that a callis either a BLS or an ALS charge?
A. The Fire Captain. who is the Incident Commander on scene. will make the
decision. in collaboration with the fire paramedics. according to the services
rendered.
28. Q: Can I become a member gfku using the fire department paramedic service,
and then get the user fee waived?
A. No. You must pay the user fee. However you may then enroll in the mem-
bership program for the remainder of the year. (Note special exceptions to
this rule may apply to senior citizens over 65 and persons covered by Medi-
care and Medi-Cal. Call the City Finance Department).
29. Q: Can I become a member if I do not have health insurance?
A. Yes. We encourage you to enroll. As a member Y9u will not have to payor
be liable for any emergency medical services provided by the San Bemar-
dino City Fire Department.
30. Q: If I need paramedics for visitors in my home, are they covered by my mem-
bership?
A. No. the annual membership is based on households and will cover everyone
who is a permanent resident there.
o
31. Q: Why is the fire department charging fees for paramedic service?
A. The City Fire Department has been providing paramedic services free of
charge since 1976. Since that time paramedic training. equipment. and
operating expenses have all increased dramatically with no provisions to
directly fund the program. Most cities that offer paramedic service have
Implemented or are seeking similar funding programs.
S.B. CIty 10/90
17
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32. Q: As a buslneOhow do I enroll In the program?O
A. There are no provisions for business memberships at this time. However,
businesses may have the opportunity to enroll on behalf of their employees
during the next enrollment period.
33. Q: If someone calls 911 because they believe I am experiencing a medical
emergency, willi be liable for the bill?
A. No, only people receiving treatment can be charged for services. You can
refuse treatment. However, if you are experiencing a medical emergency
you should be examined immediately by the paramedics.
34. Q: Willi be charged for paramedic service even if I do not go to the hospital by
ambulance?
A. Only people receiving paramedic assessment or treatment can be charged
for services. You can refuse treatment. However, if you are experiencing a
medical emergency you should be examined immediately by the paramed-
ics.
35. Q: What hospitals do the San Bernardino City fire paramedics accompany pa-
tients to?
A. All major hospitals (not including health clinics, etc.) in the Cities of San Ber-
nardino, Redlands and Loma Undo. The fire dept. paramedics accompany
patients to Kaiser Fontana occasionally. Kaiser patients with life threatening
problems are normally routed by doctor order to the closest hospital.
36. Q: What if I am a member and the City Fire Department paramedics are on
another cali?
A. If the closest paramedic unit is on another call, the next closest paramedic
unit will be dispatched, and so on. If all City units are on calls, the closest
paramedic ambulance will be dispatched.
37. Q: If more than one person must be treated, such as at a traffic accident, will
each person be charged?
A. Yes, each person who receives treatment will be charged $100 or $200 de-
pending on the level of treatment rendered. Members will be verified after
the emergency, and will have no out of pocket expense for San Bernardino
City Fire Department paramedic services.
38. Q: If my children have different last names, or an in-law lives with me, will they
be covered?
A. All permanent residents of a membership household will be covered.
o
39. Q: What should I do if I am a member and I receive a bill for paramedic serv-
Ice? 0
S.B. City 10/ 90
18
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A. Simply call QFinance Department and be pQared to provide your insur-
ance carrier name and policy number. If you receive a bill from the city.
and have no medical Insurance. call the Rnance Department to verify your
membership status and you will have no further obligation.
40. Q: Wont the city lose money if we allow residents that have no medicallnsur-
ance to become members?
A. Medical insurance is difficult to obtain for many people. If an uninsured
resident requires hospitalization. the $200 fire department charge will be the
least of their financial worries. It may be better to receive the annual mem-
bership amount from many of these people than to try to collect on the
relative few that will need our service. They have incentive to become
members. we should let them.
41. Q: Will the city collect service fees from users that are on Medl-Cal or public
assistance programs?
A. If a recipient of Medi-Cal is a non-member and uses the fire department
paramedic service. there is no provision for reimbursement to the city. The
user is personally responsible for the $100 to $200 bill. These users should have
the option to come to the city with the bill. pay the $24 membership fee plus
the $12 late fee. and have the user fee waived. This would generate funds
instead of trying to collect on no-win cases and cover the member for the
remainder of the year.
42. Q: If I call the paramedics for someone else, willi be charged?
A. No. only people receiving paramedic assessment or treatment can be
charged for services.
43. Q: When can Courtesy ambulance begin billing non-resident users for fees?
A. They require 60 to 90 days lead time to get the system on line and to de-
velop and print forms. The computer system. program. and clerk are ready
now.
44. Q: What Is the charge for delinquent 'non-member' user fees?
A. Courtesy Services uses a collection agency that obtains a 15% fee for delin-
quent accounts.
o
45. Q What special equipment, training, or procedures are required for the fire
department to implement the first phase of the program; billing for non-
resident user fees?
A. In service traininQ will be provided. free of charge to the city. by the Courtesy
services Accounts Receivable Manager. This training will orientate all fire-
fighters on obtaining billing information. and require engine companies to fill
in the appropriate sections of an I.C.E.M.A. (Inland Counties Emergency
S.B. CIty 10/90
19
.~~~
Medical AAy) run form on each medical cOcal!. Heavy increase in
usage of the copy machine will result.
o
46. Q: What provisions have been made for the possibility of the program failing
short of projected revenues?
A. Since the overhead costs for the first phase are so low. it is difficult to foresee
falling short of the break-even point. However the program should be evalu-
ated for improvement after the first year and a report submitted to council.
The implementation resolution should include a program failure plan to de-
activate.
47. Q: What Is the cost of the paramedic program and how will fees offset the op-
erational cost?
A. This requires a very complex and multi-faceted answer since the fire and EMS
services are so interwoven. However. fees can be used to improve the para-
medic program and equipment.
48. Q: What will be the month of open enrollment for the majority of group medical
plans? c;Ne should try to have our enrollment period after this time).
A. Group medical enrollments run all year. Although if there are truly any
months that have more activity than the rest they would be January and
June.
However. these months are probably not the most conducive to maximizing
memberships
49. Q Is It legal to charge a Medl-Cal recipient a membership fee?
A. Other cities in California do pursue the Medi-Cal patients for membership.
with the philosophy that they are often users. yet there is no state reimburse-
ment for the fire department response. It is therefore considered better to
collect the membership fee once a year. rather than nothing. This should be
reviewed by the City Attorney.
SO. Q What will we do If we receive membership applications from outside our
service area?
A. Their check should be returned along with a form letter detailing the fact
that only residents of the City of San Bernardino are eligible to enroll in the
program.
51. Q What resistance, If any, can we expect from the Insurance companies?
A. There is no record of insurance companies refusing to pay fire departments
in California.
o
52. Q: Why is the fire department asking for higher fees now than those proposed In
the April R.C.A.? .
S.B. City 10/90
20
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ALS:
BLS:
Alternative
Funding
Program:
Captain!
Fire:
Defibrillation:
Dwelling unit:
Trust
Account:
o
EMS:
S.B. CIty 10/ 90
EMER~CY MEDICAL SERVICES! PARA~C 'USER FEES'
AND
VOLUNTARY
'MEMBERSHIP' PROGRAM
GLOSSARY
advanced life support. Medical care provided by a State
and ICEMA certified paramedic.
basic life support. The emergency medical service provided
by a Rrefighter! Emergency Medical Technician - 1 (EMT-l).
the standard public utility model of tax subsidized programs
are augmented or replaced by fees for service. subscriptions!
memberships. grants. or special assessments.
supervisor of a fire ladder truck or engine company (crew).
to sfop the heart from fibrillating and restore the normal
cardiac rhythm. This is accomplished with the use of electrical
energy.
each single residence (eg; a fourplex consists of 4 dwelling
units).
an account in which a portion of the user fees are set aside
for marketing and consultation costs to maximize the success
of the program.
emergency medical services
21
EMT-l:
o
Engine
Company:
FireMed:
Household:
Low Income
residents
Medic
Engine:
Medic
Squad:
Medical
Emergency:
o
S.B. City 10/ 90
. .
o emergency medical techniciaQ (100 hrs. training)
three man fire engine including a Captain, Engineer and a
firefighter.
a trade name for the largest paramedic membership
program in the country with consulting! marketing services
offered by 'FireMed Consultants Group'.
all permanent residents of a dwelling unit.
individuals or families who have qualified for the low income
utility tax exemption through the Rnance Department.
four man fire engine including a Captain, Engineer, and two
Firefighter! Paramedics
two man utility type pick-up truck including two Firefighter!
Paramedics.
including, but not limited to, a serious, sudden, and life
threatening illness or injury, or any interference with a persons
airway, breathing, or circulation (such as severe
uncontrollable bleeding), or any sudden alteration in a
persons mental state that is perceived to be serious or life
threatening to that person.
22
Paramedic 0 0
Membership
0 Program: a voluntary program which provides for no out-of Docket
expenses to members. For those with health insurance
coverage it pre-pays a 'member's health insurance
deductible.
Open
Enrollment
Period: two months strategically chosen to accept membership
applications.
Paramedic: State and ICEMA certified for advanced life support
measures. (1200 hrs. formal training).
Paramedic,
Firefighter: firefighter who is fully trained in firefighting, rescue, and is also
State certified as a paramedic.
Paramedic,
Clvillan-
Ambulance: State certified as a paramedic and are not qualified to
perform rescue! extrication procedures. etc.
Reciprocity
Agreement: this applies to those public agencies utilizing the FireMed
Program. A FireMed member's membership is recognized by
all cities utilizing the 'FireMed Program' as offered by the
RreMed Consultants Group.
Residents: In this conteXt, residents of the incorporated areas of the City
of San Bemardino.
0 Resuscitation: to revive a victim of pulmonary and or cardiac failure.
S.B. City 10/ 90
23
Unincorporated
Areas:
o
User Fees:
Walk-In
Membership
Sales:
Ventricular
Fibrillation:
o
S.B. CIty 10/ 90
o
o
county islands within the San Bernardino City perimeter.
charges incurred for the use of the fire department
emergency medical services. The BLS fee is $100 and the ALS
fee is $200.
sales to individuals who choose to enroll in person with Central
Cashiering.
a condition in which the heart stops beating. One of the most
common causes of sudden death that paramedics are
trained and equipped to treat.
24
o
EMEQNCY MEDICAL SERVICES! PARAQDIC 'USER FEES'
AND
VOLUNTARY
'MEMBERSHIP' PROGRAM
REFERENCES
Dusseault. John Paul: Marketing Consultant. FireMed Consultants. 785 Grant St.
Eugene. OR 97402.
EmerQencv Medical and Rescue Services: Ron Coleman. Managing Fire Services
2nd Edition. International City Management Assoc. pp. 367 -370.
RreMed Paramedic Membership Proposal; James O. Page. Rre Chief. City of
Monterey Park. Sept. 4. 1986.320 W. Newmark Ave.. Monterey Park. CA 91754.
Griffin. Pat: Revenue Manager. City of Orange. 300 E. Chapman Ave.. Orange. CA
92666-1591 P.O. Box 449.
Hendricks. Garv: EMS Division Coordinator. Anaheim Fire Dept.. 500 E. Broadway.
Anaheim. CA 92805.
Kaumo. Richard; FireMed Director. Huntington Beach Fire Dept.. 2000 Main St..
Huntington Beach. CA 92648.
Murohv. Dennis: Fire Division Chief and FireMed Director. Dept. of Fire and Ufe
Safety. 225 Fifth St.. Springfield. OR 97477.
Ooeration H.E.A.R.T.: City of Hawthorne Rre Dept.. 4455 W. 126th St.. Hawthorne. CA
90250.
Paramedic Fee Feasibility Study; Orange Co. Fire Dept..180 S. Water St. Orange. CA
92666. January 20. 1988.
o
Paul. Ed: Revenue Manager. City of Fullerton. 312 East Commonwealth Ave..
Fullerton. CA 92632.
S.B. CUy 10/90
25
Procedures and RAmmendations: Paramedic ReaQess Program, Orange Are
Dept. July 26, 1983.
c
Public Sector Ambulance Memberstlip; Dennis Murphy, Journal of Emergency
Medical Services, Sept. 1987, pp. 76 -83.
Reauest for Council Action: Raymond Picard, Are Chief, City of Huntington Beach.
Resolution No. 6066. Sept. 6, 1989.
Reauest for Council Action: City of Fullerton, May 10, 1983, paramedic fee proposal
for May 17, 1983 council agenda.
Reauest for Council Action: City of Fullerton, March 14, 1984, paramedic
Subscription Program March 20, 1984 council agenda.
Reauest for Council Action- Proposal for paramedic fees; Bob D. Simpson, Fire
Chief, Anaheim Fire Dept., April 29, 1985.
Resolution 7657: City of Fullerton, a resolution establishing revised fees for the
Paramedic Subscription and fee for Service Program, May 19, 1987.
Resolutions 7086. 7087. 7088:, City of Fullerton, resolutions establishing administrative.
regulations governing the paramedic service program, June 16, 1983.
LI.~1.E. ProQram orooosal; Dwayne Scott, Fire Chief, Westminster Fire Dept., April 2,
1990.
Whv Subscription ProQrams?: Jack Stout, Journal of Emergency Medical Services,
October 1986, pp. 71 - 75.
,0
S.B. CIty 10/ 90
26