ORDER-2018-180 : Amend Melrose Revised Ordinances, Chapter 24, Article II - Fire Department, Sec. 24-32(E) - Emergency Rescue Vehicle, to set fees for FY 19.

Transcript (~10 min @ 31:40)

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▶ 31:46 Jennifer L. Lemmerman: chief Lena thank you for being here everybody would you like to make an opening statement on this particular item or move directly to questions from the committee move right to questions okay I see Alderman Trem and Cozy first

▶ 32:00 John N. Tramontozzi: So this is, what we're doing is we're going to increase the billing on the ALS-1, ALS-2, and the basic life support ambulance service.

▶ 32:14 Speaker 7: Correct. In the mileage. Sorry? In the mileage. In the mileage, correct, right.

▶ 32:27 John N. Tramontozzi: The increases that you have, is that what the general state of the ambulance rates are in this neighborhood?

▶ 32:34 Speaker 7: That is correct. Our rate increases are in line with other communities at this time.

▶ 32:44 John N. Tramontozzi: But just so, I just want to go over it a little bit. Despite the fact of the increase in the rate, doesn't necessarily mean that you're going to get that particular rate received. And you presented to us, and I appreciate this, is the projected revenue sheet. The bottom line is, depending on what the transportation is for, for example, if it's an automobile accident, the billing would go to the automobile insurer, which more likely than not, at a higher percentage of recovery through an insurance company, an automobile insurer, and a vehicle collision.

▶ 33:22 John N. Tramontozzi: I'm here to say, as opposed to comparing it to the Medicare rate of recovery.

▶ 33:27 Speaker 7: Right, I believe all these, the billing goes through health insurance, or Medicare, Medicaid.

▶ 33:33 John N. Tramontozzi: So if the bill, say you want to bill as a basic life support at 1835, but it's billed to Medicaid, you're not going to get the full 1835. get a reduced amount whatever the contract basis is for Medicare, same thing with Medicaid. Health insurers will pay whatever they contractually agreed to pay on ambulance rates.

▶ 33:56 Speaker 7: That's my understanding.

▶ 33:57 John N. Tramontozzi: The other thing, too, is if by chance a patient is without insurance, and we know Massachusetts is supposed to have insurance, but assuming there's no insurance or it doesn't whatever reason it's not covered what is what is the process in billing a patient without

▶ 34:16 Speaker 7: insurance a direct bill but most likely we eat it right so it's kind of a balance so yeah you

▶ 34:20 John N. Tramontozzi: get the higher rate that you collect from insurance companies you don't push on the billing as much so in the long run it balances out yeah professional ambulance does all our

▶ 34:32 Speaker 7: billing so we're kind of hands off on the fire department part of it right which still produces

▶ 34:41 John N. Tramontozzi: a significant revenue so um oh yes we appreciate that that it's great it's a great service that the city provides um and um we look forward to the continued uh improvements and projection of revenue in the city so thank you so much thank you i know you're a supporter of the

▶ 35:02 Speaker 1: inbound service so that's great very much so all right thank you thank you thank you thank you

▶ 35:05 Monica C. Medeiros: chief kalina uh the first time i get to really uh officially call you that so i'm glad to see

▶ 35:17 Monica C. Medeiros: you here today uh first i wanted to say that you had provided us this afternoon with the melrose EMS projected revenue document for FY 2019 and I just wanted to just officially move that we have that added to this order this is this is the document that's really used to determine the rates is that correct that's correct and that's through our consultant correct they annually they look at our

▶ 35:46 Speaker 7: our transports these are real conservative numbers and we pretty much hit our marks every year on

▶ 36:01 Speaker 7: their projections um and we're looking for the rate increase um to there's been some contractual increases over the last couple years we didn't have a rate increase last year so this would keep

▶ 36:17 Monica C. Medeiros: is in line with um the rates uh cost for operation so it's right there and uh so what we're looking at proposed before us is a 200 increase for the advanced life support one the advanced life support two and the basic life support rates as well as a three dollar per mile increase yes and i know you said this is conservative numbers so this is being estimated on 1550 transport transports and i know i had read your budget questionnaire and it said

▶ 36:57 Monica C. Medeiros: uh 1958 medical aid calls are those the same or is that what we did last year um

▶ 37:04 Speaker 7: no that's about what we do medical aid calls directly request for ambulance um so they don't

▶ 37:12 Speaker 7: always leave in an ambulance uh well we do more than that but those are what we call patient refusals there's a lot of uh ambulance calls we can't collect because our ambulance is tied up either on another call in transit transport to uh maybe a boston hospital and sometimes we might lose one or two uh other calls that are going on at the city at the same time and cantalo

▶ 37:38 Monica C. Medeiros: ambulance is our backup so you know this is important because it's uh you know this is obviously a service that we provide a medical service that we provide to people and obviously we want to make sure that we it is something that we're charging a fee for that's outside of the tax base and we want to make sure that we're you know accurately tying it to the cost so it's important that we you know we we do have a self-funding enterprise yeah and so we obviously have to make sure that we're not overcharging but at the same time make sure that we're not losing money so that we're able to to operate and and be there for everyone so it's it's sort of a a balancing act and so we see that the projected revenue on the conservative side is um

▶ 38:23 Monica C. Medeiros: one million sixty five thousand one hundred fifty seven dollars but yet our the budget that we have proposed is about a hundred thousand dollars less and that's part of just making sure that we're being conservative and well there's

▶ 38:44 Speaker 7: other costs that we we receive fifty five dollar contribution fifty five thousand dollar contribution from that was Wakeville Hospital annually that

▶ 39:07 Monica C. Medeiros: usually happens in the fall and my notes tell me I had hoped to have some questions prepared if we had this a little bit sooner but as we can see there's usually a certainly a collection rate that we don't as I think all of tramitosi mentioned we don't always get what we that's correct what we fill out for and do you

▶ 39:29 Monica C. Medeiros: know like is the increase per mile is that based on equipment is that based on just gas costs or

▶ 39:36 Speaker 7: it's it's fuel costs it's equipment we have to purchase these are diesel engines we have to purchase additives to keep the engine running yeah I don't know the exact terminology for it but we have to run it like half an hour and highlight I don't while this product is in the gas tanks and it kind of cleans the diesel engines and I don't have the cost to that but there is other costs to keep the vehicles other than just mile for mile and you know per gallon and so we feel

▶ 40:08 Monica C. Medeiros: confident that these numbers will will it's very confident okay thank you very much thank you

▶ 40:20 Jennifer L. Lemmerman: medeiros did you make a motion during that time to add this uh yes let's consider this a motion to

▶ 40:24 Monica C. Medeiros: add the melrose ems system projected revenue document received this afternoon second we have

▶ 40:33 Jennifer L. Lemmerman: a motion made by alderman medeiros and seconded by alderman mortimer to add the morrow's ems system projected revenue document to iqm2 and attach it to this order all in favor aye aye

▶ 40:43 Peter D. Mortimer: motion to recommend the order as amended to the full board for passage second we have a motion

▶ 40:49 Jennifer L. Lemmerman: made by alderman mortimer and seconded by alderman moisel to recommend order 2018-180 as amended

▶ 41:02 Speaker 1: any further discussion all in favor aye aye any opposed that motion will be recommended to the

▶ 41:05 Jennifer L. Lemmerman: full board thank you chief kalina i'm just looking at our next okay we have a few more department