Orders

Transcript (~10 min @ 32:28)

Speakers identified by voice; unnamed voices are numbered within this recording. Auto-caption text — verify against the video.

▶ 32:26 Peter D. Mortimer: we are now back to our regularly scheduled deliberations on these conjoined orders at this time and alderman McAteer-Margolis has the floor please continue alderman McAteer-Margolis

▶ 32:37 Speaker 3: thank you thank you so this this is the fee survey from uh surrounding communities the first page is bls on underneath where it says service it says bls and als that's just the type of service that that community provides so the top page is bls okay the second page is als1 and the second page is als2 oh i see i see now yeah the second part of your question is the uh bundled the bundle rates are some systems like ours it's a it's all all in one service so for the 1650 you have the oxygen you get bandaging with whatever service equipment is required right some do it ala carte where they have a base fee and then they'll charge for the monitor in IV and oxygen does it make any difference in

▶ 33:20 Mary Beth McAteer-Margolis: terms of our reimbursement how we break out those charges historically we feel

▶ 33:27 Speaker 4: that the best way to do it is all wrapped in one base rate which is what we've always done since the beginning and that's what we do with all of our clients and the reason is is because those those codes for extras are actually outdated at this point they went out about 14 or 15 years ago but changes like kryptonite for some people and they just normally haven't caught up so usually those many times those rates that are broken out actually don't end getting paid sometimes they just get bundled into the base rate as a function of the computer software you know and well you you you would not believe there there are some some places that are lower there are some places that are at

▶ 34:13 Speaker 7: this point three thousand dollars for ALS it's it's pretty wild well it sort

▶ 34:17 Mary Beth McAteer-Margolis: of looks like that we're a little bit high but then when you do look at the communities that don't bundle it it appears as though we're not it can be

▶ 34:26 Speaker 4: very deceptive and that's why sometimes when the rate surveys go around if folks don't aren't looking at in a very sophisticated way they will leave out not not intentionally you know but it's just just they just don't understand what they're doing they're not considering the fact that once you add in those ancillary charges that other people that their base rate in essence will far exceed whatever pretty else in the chart is and chief I guess my kind

▶ 34:55 Mary Beth McAteer-Margolis: big picture question would be do you feel that the services that we're providing are adequate for the community and and do we need any more than the

▶ 35:09 Speaker 3: eight and a half no I think that the services they do a tremendous job and I

▶ 35:18 Mary Beth McAteer-Margolis: think that it's the numbers are right and I was there right and and I just do I do remember a story I from a neighbor who always used to say why do they send the fire truck and one time in the neighborhood they couldn't get in to the front door and the fire truck had to go up into the window and you wouldn't want them to be waiting outside for that so thank you very much and thank your crew for all they do keep us healthy and safe thank you

▶ 35:47 Michael P. Zwirko: alderman mcintyre margolis alderman's work oh please thank you mr chairman and thank you for being here tonight gentlemen i also wanted to follow up on that ambulance fee survey that Alderman McAteer-Margolis pointed out I am I'm just curious if we have so I'm not as well versed in this as others are so please just a little bit of latitude but the I guess my question is is do we have any competition in town with ambulatory services or do we essentially have a monopoly I mean how exactly does does it work and I asked that because I'm looking at these three sheets in the the fee survey and it does seem that we're towards the top uh in our in our fees and i'm just wondering if um uh you know private markets or others you know can undercut that explain to me how it works and and if we are towards the top end of these why that is if you can yeah so so um

▶ 36:44 Speaker 4: really where milrose fire department really provides emergency ambulance service you really actually don't have competition um the there's a service zone plan and melrose fire department is the primary service zone provider so competition for emergency ambulance service really honestly doesn't exist and as a matter of fact we'd be remiss to say that i you know and i may be speaking out of term but cataldo ambulance has always done a pretty good job i think in supporting from the private side with mass casualty incidents and big fires and such where they come in and backfill and also pick up the calls that melrose can't so they're not as much competition i don't think as they are a partner and i think if you looked at their rates and the rates of action ambulance which are the other which is the other provider up here i think

▶ 37:33 Michael P. Zwirko: you're going to find that they're right in line with theirs yeah and i only ask because in generally with the market i mean if you have a monopoly you don't have anywhere else to go and i can understand from emergency services standpoint there aren't any competitors i guess i was just bringing it up and in the fear that you know sometimes if your costs get too high there's diminishing returns on those profits or you know realized gains potentially realized gains so I just wanted to be cautious about that I guess the first time that I'm looking at that so I appreciate your answer I also wanted to you had mentioned with respect to the reimbursement rates that we get from Medicare and Medicaid them being lower than from a third party our ambulatory services eligible for like uncompensated care pool funds at all or

▶ 38:19 Speaker 4: is that no they're not ambulance ambulance service so today the uncompensated care pool the free care pool is referred to as health safety net yeah and ambulance service is not reimbursed at all at all out of self sometimes you see emergency ambulance service being reimbursed by certain Medicaid coverage types that don't cover non emergency but even for emergency the free care pool health safety net does not cover it those are honestly pursuant to your financial hardship policy those are actually automatically written off they've already been vetted by the state and by Medicaid as having no money and no ability to pay it doesn't make sense to build them and hammer them with

▶ 39:02 Michael P. Zwirko: ambulance bills sure sure and thank you for that as well I just had one of the

▶ 39:09 Michael P. Zwirko: questions is probably applicable to the chief and this really has to do with well we've combined the order so she's curious did you came before us back I believe in February with respect to the turnout gear and the extractor have those been installed and has the gear been purchased since found a suitable

▶ 39:34 Speaker 3: location at engine 3 and the vendor supposed to be out this week to finalize the preparation so that we can go forward with it all right hopefully within the next month we'll be ready to go and as far as the gear I think most of the members that are getting the additional gear have been measured there's just a couple more stragglers but that's in the process and some of it's being manufactured as we speak

▶ 39:59 Speaker 8: okay thank you for the update those are all the questions i had mr chairman thank you alderman

▶ 40:02 Peter D. Mortimer: zwerko seeing no further alderman wishing to be heard is there a motion all of them for yourself

▶ 40:10 Robert A. Boisselle: no commentary very good go ahead sir uh in your listing of projected revenue you have average miles or dollars per mile and average miles is two uh is there any necessity for the unit to go into boston with a uh individual on an emergency basis some of its patient requests others

▶ 40:28 Speaker 3: the patient condition determines where you take them as far as like a burn center or trauma center

▶ 40:37 Robert A. Boisselle: so that number may go up then uh on special cases well the if i may the the vast majority

▶ 40:41 Speaker 4: of your trips go to malwaq okay um and and those usually tend to be under two miles right so the the the few trips that go out of town to winchester or to in town to mass general kind of bump your average up to two but again in the spirit of trying to keep projections conservative but we've always used to as the model for your for your financial projections okay good thank

▶ 41:10 Peter D. Mortimer: you very much thank you mr you're welcome alderman boy cell alderman Medeiros please

▶ 41:13 Monica C. Medeiros: thank you um i just wanted to follow up again on the ambulance fee survey and i know our

▶ 41:24 Monica C. Medeiros: payer mix if you will is approximately 80 percent medicare medicaid or bill patient um where those folks are not paying the full amount and you know either or the full amount isn't being paid and somebody else in some way has to subsidize the cost um is that pay or makeup similar in these other communities or do we know what these other communities

▶ 41:51 Speaker 4: no i can tell you that for most of the other communities we bill for the the the percentage of Medicare is actually lower and the percentage of insurance is it is a bit higher and that number that number can swing your numbers dramatically so that

▶ 42:05 Monica C. Medeiros: can really have an effect on the rate that we have to yeah absolutely thank

▶ 42:11 Speaker 4: you thank you but I but you know we've always been able to maintain that rate at a reasonable level especially when you compare it to everyone else I mean if it started going up into like that three thousand range you'd start going well then now we're talking maybe it's good your rates are are very much in line with surrounding providers in and how many communities do you work with

▶ 42:31 Speaker 4: again could just for um we work with right now 18 soon to be 22 thank you

▶ 42:40 Scott M. Forbes: thank you Thank You alderman Medeiros motion to recommend orders to zero one six dash one six five and two zero one six dash one six one second Alderman