ORDER-2015-156 : FY16 Ambulance Enterprise Fund Budget in the amount $847,478.09 (Eight Hundred Forty Seven Thousand, Four Hundred Seventy Eight Dollars and Nine Cents).

Transcript (~14 min @ 10:55)

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▶ 10:28 Peter D. Mortimer: We have a motion for concurrent action. seconded by President Kahn, seconded by Alderman McAteer-Margolis. All in favor, please say aye. Aye. Any opposed? Hearing none, these orders will be joined and dealt with simultaneously. And before we proceed any further, I was remiss in not mentioning that this meeting is being filmed, recorded by MMTV, and it is available on the city website and the MMTV website for any members of the public who would wish to view it at a future time. Aye. We have the conjoined orders, I'll read the second one. Order 2015-156, FY16, Ambulance Enterprise Fund Budget in the amount of $847,478.09. The two orders are before us, and I would welcome a motion to suspend the rules to hear from the appropriate city officials. Such said motion is made by Alderman Forbes, duly seconded by Alderman Boycelle. All in favor of suspension, please say aye. Aye. Any opposed, hearing none, we're under suspension. Gentlemen, would you please come forward.

▶ 11:39 Peter D. Mortimer: Please state your names and positions for the record.

▶ 11:43 Speaker 7: Chief Chris Leary, Melrose Fire.

▶ 11:45 Speaker 8: Thank you, Chief.

▶ 11:48 Speaker 8: Bill Mergendahl, Pro-MS Solutions.

▶ 11:51 Peter D. Mortimer: Thank you, Mr. Mergendahl.

▶ 11:53 Speaker 9: Patrick Delarusso, CFO, City Auditor.

▶ 11:55 Peter D. Mortimer: Thank you, Mr. Delarusso. Would you like to start with an opening statement? Please.

▶ 12:00 Speaker 8: Proceed.

▶ 12:02 Speaker 7: I'm here for you tonight to request an adjustment in the ambulance rates. indicated the rate should be reviewed annually and adjusted as needed just a quick note on the service the transition to full als went off without any problems we are on track to meet our projected number of transports for this fiscal year as of the end of april i had 1284 transports with projected 1515. every medic has received their pal certification of pediatric advanced life support this is not a requirement of the state but just another example of the the highest standards that we have for our staff we continue to provide the highest level of care and receive excellent reviews for the patients we serve as noted in the most recent survey this is a testament to the hard work and dedication of each and every member of the department there are several reasons for the adjustment the cost of our supplies continue to increase for the items we use our salary and wages line has increased due to contractual step raises and we've added an ems training position that will be half funded through ems budget and half funded through the fire budget we have new debt for the ambulance bond that will kick in this year and we continue to have more medicaid medicare than projected which affects the payer mix which in turn affects the revenues as i've stated before we're not in the ambulance business to make a profit but to maintain a high quality ems system with the added benefit of placing two additional firefighters on the fire ground each day which results in increased protection for every citizen

▶ 13:33 Peter D. Mortimer: and firefighter in melrose thank you thank you chief i'm mr mergendahl i'm mr delarusso would you like to say anything before we proceed president khan please thank you gentlemen

▶ 13:42 Speaker 6: yeah i just have a couple of questions relative to this budget chief how many how many uh firefighters salaries do we have uh contained within this budget it'll be eight and a half and are they fully or partially funded through this budget fully so we have eight eight and a half positions fully the new position will half will be through

▶ 14:05 Speaker 6: here and half will be on the player side and what percentage of you of your department now are paramedics chief we have 21 medics total out of 57 and i have a couple of questions for mr

▶ 14:22 Speaker 6: del russo mr del russo does this budget enterprise fund continue to be fully funded through the

▶ 14:32 Speaker 9: enterprise system yes sir the chair it certainly does in fact um we now have a reserve balance of fifty seven thousand nine hundred and twenty eight dollars currently and no general fund or

▶ 14:46 Speaker 6: other city revenue has been pumped into this budget during this fiscal year is that correct

▶ 14:52 Speaker 9: That is correct.

▶ 14:54 Peter D. Mortimer: That's all I have. Thank you, President Kahn. Alderman Boisselle, please.

▶ 14:58 Robert A. Boisselle: In the documentation that came to us, there's an evaluation of the ambulance service and so forth that you sort of put together. One of them that sort of stood out was the dispatching aspects of it. That there's been a 2% decrease in two of these categories. And one of them actually went below the benchmark that you see here. And one of those categories is the professionalism of person on the phone. And then the decrease for ability of person on phone to meet your needs. What's, is something going on that we should be aware of?

▶ 15:41 Speaker 7: There was a state mandated program of the 911 dispatch and EMD. And so how we currently do it, police is the PSAP for 911, they get a call. If it's medical in nature, they transfer it to Cataldo who currently does our EMD, Emergency Medical Dispatch. So they screen the call, get what information they can. At the same time, the police notify us of an emergency and we go. So it's difficult to say where the problems arise from because there's three different potential people that are talking to this person.

▶ 16:26 Robert A. Boisselle: Well, I mean, it's interesting, all the other categories, you must have about 30 of them, all show your guys are doing a great job, and this one just sort of stood out in the communications aspects of it, is probably the most important part in the beginning of this process of the 911 calls and so forth so I just want to make sure we're having we're not having problems with languages with people in in the neighborhoods and so for interpreters

▶ 16:55 Speaker 8: that may be needed yes I think I think one of the things that could possibly be done is is also attached with the scores there are comments so maybe we could you know work together with the chief and look at look into some of those comments and try to drill down and see if we can find through the comments piece not just the scoring piece if there are some outliers there that your response rate on these patient satisfaction surveys is is fantastic actually over 18% of the patients respond back in which is fantastic when you look at any measure of any survey that goes out and every single patient gets a survey and even patients who ultimately aren't transported patients who refuse service are sent a survey also so to have that high rate of return is is is great and then as you also said your your score is across all the categories and the overall satisfaction rate is between 94 and 95 percent which is you know exceptional so but when but looking at trends like that it's it's sometimes it's good we can look at the comments part and see if we can drill down and and find those couple outliers very good you mentioned the cost and when you

▶ 18:16 Robert A. Boisselle: opened your statement and so forth the Affordable Care Act was pretty well went into full effect this past this past year and it's getting more stringent as we go through the coming years from what I'm understanding now there was an article that came out of the Florida news and so forth concerning hospitals on notice with Florida settlements over ambulance rides are you aware of the situation that's going on there in the court settlement that came

▶ 18:46 Speaker 8: out of that I am there's more and more activity going on with the Center for Medicare and Medicaid Services CMS and the federal government the Office of inspector general enforcing the laws related to all Medicare payments and all providers ambulance services one of them and in that case that case there actually applies to all non-emergency services what is a non-emergency service a non-emergency service where this case applies to are what would that case the essence of that case is that the hospitals called and booked ambulance rides for patients on a non-emergent basis so take them from the hospital to a nursing home hospital to home hospital to a rehab and that's not a lights and siren kind of a thing that's what you guys do or lights and sirens emergencies the calls that are applicable in this case are the non emergency calls where it's in a facility stuff and so it's a unique approach in this one because it was always the ambulance provider that got blamed solely and this is a different tactic now they're also roping in the hospitals who actually ordered the ambulances and authorized and said they were medically necessary and so this is a it's actually a very big case when it comes to ambulance service but it doesn't really apply to the to the Melrose Fire Department because it really is applicable to only to non emergency service very good thank you

▶ 20:18 Peter D. Mortimer: very much Thank You mr. chairman Thank You alderman for self any other alderman wishing to be heard Alderman Medeiros thank you I just want to thank you for

▶ 20:24 Monica C. Medeiros: all the detail and information we appreciate it and it's great to see those scores and I just wanted to ask how much you know now that we've made the transition how much are we relying on Cataldo do we find ourselves maxed out often or is it infrequent we on average miss about 20 to 25 calls a

▶ 20:46 Speaker 7: month based on whether we're on a another run or two runs at the same time and Cataldo comes in and they've been a great asset and they can pick up

▶ 21:05 Monica C. Medeiros: whatever we can't handle and then as far as moving forward is there anything you know that on the horizon that we should be aware of good or bad well we're

▶ 21:13 Speaker 7: looking at one of the reasons for the CMS training position is to look into other avenues of potential revenue and services one is community paramedicine where you don't go out and actually do a transport but you could do a well-being visit it's kind of like VNA these other like a hot safe community different different things we want to get into maybe down the road ALS engine companies so that the we can utilize the other medics that we have put the equipment so so that they can start working on you at the house prior to the second ambulance getting there.

▶ 21:53 Monica C. Medeiros: Thank you. Thank you very much.

▶ 21:55 Peter D. Mortimer: Thank you. Alderman Medeiros. Alderman McAteer-Margolis, please.

▶ 21:58 Mary Beth McAteer-Margolis: Thank you, Mr. Chairman. Thank you, gentlemen, for coming. Chief, you said something about part of the increase was due to the debt for the ALS ambulance. Was that what it was? In your opening remarks?

▶ 22:16 Speaker 7: The bond, starting to have to pay back to bond.

▶ 22:18 Mary Beth McAteer-Margolis: to start to pay back the bond so um i i just wondered if maybe this would be better for mr de la rousseau the um reserves that we have mr de la rousseau the 57 000 um does that just stay in the ambulance account or do we use any of that to pay back that that bond or what are we doing

▶ 22:41 Speaker 9: with the reserve funds for the chair we're retaining as much as we can each year on the reserve the um first line of defense has been to have a minimum of fifty thousand dollars set aside in the fund um as we go forward in this uh early stages of the development of the enterprise and it still is early you know three plus is um still a young venture in its own way and so we met our target of fifty thousand my expectation is that over time they'll probably probably go up to probably 10% of the budget, but we're going to maintain the 50,000 plus threshold at this time. But we would not use that to pay debt. Obviously, that's an, as an operating expense, we would rely on the regular budget to do that.

▶ 23:28 Mary Beth McAteer-Margolis: Okay, so we're just going to leave it as it is for this coming year, the 57 at the moment. Yes. We're not taking anything out of it. We're just going to build up, let the reserve continue to build up?

▶ 23:38 Speaker 9: correct and again as other enterprise funds it can only be spent on the ambulance services right and god forbid the chief would need it for some particular reason that is unforeseen then he has would have to come before this board and ask for an appropriation no different than water or so on

▶ 23:56 Peter D. Mortimer: thank you very much thank you thank you alderman mcintyre margolis seeing no further alderman wishing to be heard at this time is there a motion to we can place

▶ 24:06 Peter D. Mortimer: place it on hold until after the public hearing.

▶ 24:10 Speaker 8: One second, please.

▶ 24:10 Speaker 5: So moved. That was my-

▶ 24:12 Peter D. Mortimer: That was going to be your motion? Second. Very good, all right. So we'll place this on hold until after the public hearing, which is scheduled for ten minutes. Hope you won't mind sticking around. So we'll see how we're going to do with that. Right now, we have a motion to put this order on hold. Second by Alderman Boisselle, made by Alderman Medeiros. All in favor, please say aye. Aye. Any opposed? Hearing none. And we'll keep these two conjoined orders, conjoined by the President's motion on hold until public hearing happens at 8 o'clock.

▶ 24:44 Peter D. Mortimer: So we'll see you back up at the table briefly. Thank you, gentlemen.

▶ 24:54 Peter D. Mortimer: The next order we have before us is order 2015-159. It's reauthorization of account number 2665, police fire alarm for fiscal year 2016. We're under suspension. So Chief Lyle, I would invite you to come to the table, and please join us here in the horseshoe.