APPRO-2024-29 : Fiscal 2025 Ambulance Enterprise Operating Budget in the amount of $1,021,682 (One Million, Twenty-One thousand, six hundred and eighty-two dollars).

Transcript (~10 min @ 2:08:08)

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▶ 2:08:06 Speaker 4: now quite a few years ago,

▶ 2:08:11 Mark Garipay: Just a point of information if you don't mind just introducing Oh, sorry.

▶ 2:08:13 Speaker 4: I'm sorry, me, sorry. Through the chair. Uh, I'm Bill Mergal. I'm from, uh, pro EMS solutions. Um, we were kind of here at the, at the start when the Melrose Ambulance was reinstated helping with Chief O'Brien and Patrick LaRusso. And, um, boy, that's going back a little ways now. Um, also, um, so we provide, uh, billing and, uh, some, uh, technology services, uh, to, uh, Melrose Fire and roughly 50 other departments in Massachusetts and somewhere around 80 departments in New York. Uh, as well, I also, uh, am the president of Pro EMS, the ambulance services 9 1 1 in Cambridge. Uh, so I, I actually am able to change hats and put my clinical and paramedic hat on and operational hat on at the same time as, uh, flip flopping to, uh, more on the ambulance and reimbursement. And also one of the other things that we have built out in Cambridge is the paramedic training program. Um, we have three cohorts of, uh, paramedics go through the nine month program, uh, predominantly in our place in Cambridge, at our training center Center for medics. And they spend split their time there in-house in the didactic portion of the program, and then go to local hospitals for the other half of the program. Uh, we've been able to get the program condensed down into nine months using different strategies, and we were able to add a third cohort We ran for years with only two cohorts, but now we actually have three cohorts of, of 40. And, and, you know, we're actually one of the few paramedic programs that are still successfully getting paramedics on the, on out there, uh, including paramedics for our own service. So, um, what the chief is talking about in terms of the training, the staffing shortages, these are all extreme problems that everyone is facing, not just Melrose.

▶ 2:10:31 Speaker 4: Kind of a long answer to who I am. Sorry. Thank you.

▶ 2:10:33 Maya Jamaleddine: Questions from my colleagues.

▶ 2:10:37 Mark Garipay: I just have one question. Uh, you, you handle all the billing and collections for the ambulances? We do. What, what percentage, um, are we collecting or what, what do, how much are we writing off? And

▶ 2:10:47 Speaker 4: Historically you've collected about 80% net. Net, right. We, when you talk about collection percentages, you can talk about the gross billing and then, which is often inflated just the same as hospitals, doctors', offices. It's really, it's, frankly, it's the American healthcare system and the way it's developed and the way that everyone bills, including EMS, the paradigm of the $30 aspirin as it were. Um, so then there's the net amount and net amount that what you could expect to collect against what you actually collect is usually around 80%. And, you know, the, the, a lot of that delta, that difference between 80 and a hundred goes to patients who have no insurance at all. If a patient has no insurance at all, chances are that transport is gonna be for free. Um, the city has always, uh, followed the model hardship policy that we developed many years ago. Um, that is absolutely, I would think, potentially even a more humane collection policy than even many of the hospitals follow, um, and has always had that in place. So there's not a lot of, of, of hoops that folks have to jump through to establish a financial hardship. And, um, and we've got it down to kind of a one page form and an attestation that they don't have insurance and, um, there're unable to pay. We use 500% of the federal poverty line to as a, as a benchmark. Um, and also other things, if they're already on, uh, been established on free care by the state or any other thing, uh, subsidized housing, there's any number of boxes that someone could check that would actually automatically qualify them for an abatement reduction, which is all done by policy. So that, that also the copayments for, uh, Melrose residents are, are waived. Uh, non-residents are billed their copay. Um, residents are, the copay is waived, which is allowed by, uh, Medicare, where the ambulance is actually funded by city tax dollars. So you're allowed to do that. Um, and Merose has always done that. Uh, so that's, that's a lot of where that other 20% lies. Um, but the Melrose is fortunate to have a remarkably low bill patient, two or 3%. It's really, it's really something, Albeit a little bit of a higher Medicare population. Right. Which, which certainly makes, um, collecting the revenue more challenging. Right. Because everything in healthcare, everything about EMS is unfortunately the way the system is set up, predicated on the cost shift, government payers and people with no insurance paying far less than what it costs to provide the service, which is made up by the commercially insured patients paying much more to cover that difference. EMS is the same healthcare paradigm problem that exists for all of healthcare in the, in the country.

▶ 2:14:22 Mark Garipay: Just one other question. Um, how much revenue do you have? Did you collect in the past year on that, that you,

▶ 2:14:27 Speaker 4: Uh, if You had that number, If we look at it, so looking at calendar year 2023 because fiscal year 24 would not be baked yet. Uh, was 1.109 million.

▶ 2:14:46 Speaker 6: Okay. Thank you.

▶ 2:14:48 Maya Jamaleddine: Um, vice Chair Williams. Thanks.

▶ 2:14:49 Ryan Williams: And as a point of order, what we are approving here is appropriation 20 24 29, right? Because it doesn't Mm-Hmm. The ambulance doesn't appear in the budget. Okay. Uh, I would like to make a motion to send appropriation 20 24 29 to the full board. Second council,

▶ 2:15:05 Maya Jamaleddine: We have a motion made by Vice Chair Williams to, um, recommend to the full council appropriation 2024 dash 29. Uh, seconded by Councilor Ro on discussion. Councilor Stewart,

▶ 2:15:20 Robb Stewart: Just point of clarification, was that a recommendation or was it, you just wanted to bring it without recommendation?

▶ 2:15:26 Speaker 4: What, say again. Sorry. I'm

▶ 2:15:28 Robb Stewart: Sorry, what? I threw the chair. I thought, um, I heard that you want to bring it to the full board, but I didn't hear the recommendation. Yeah, recommend, recommend to the full board. Okay. Thank you. Well, you think there's a, is there an ambulance line in the budget? I have A question. Councilor Smith? I I do not. No. I just wanted to have that Clarification. Um,

▶ 2:15:44 Maya Jamaleddine: any other, uh, question on discussion? Seeing none, counselors, um, um, Mr. Clerk,

▶ 2:15:52 Mark Garipay: We can, Can we just, um, yeah. Two minute recess for a second because I think there is, uh, there was an attachment at the bottom.

▶ 2:16:01 Speaker 4: Okay, well, hold on. Lemme just, oh, that's,

▶ 2:16:07 Mark Garipay: Yeah. Uh, IQM two, uh, there's a fiscal 2025 ambulance, uh, operating budget in there. That is an enterprise fund. It says on the top, I don't know if everyone sees it in there. Mm-Hmm.

▶ 2:16:19 Ryan Williams: What number? What number? Letter on the agenda. Letter. 2 31 last thing. Last thing.

▶ 2:16:21 Speaker 1: Last one. Right above departments.

▶ 2:16:27 Ryan Williams: Oh. So it's line 2 31. Motion. So, so I'll, I'll back the motion out because we need to motion to move the bottom line on 2 31. I was mistaken. I thought it because it was under an appropriation that it was an order of like a cash appropriation order. But if it's a, if it's an item that's maintained in the city's budget, then we would have to move to the bottom lineup. However, I will say that in the full Munis budget, um, the fiscal 2025 operating budget under agenda item seven A, this does not appear in muni,

▶ 2:17:00 Speaker 4: in the munis budget. Mm-Hmm.

▶ 2:17:02 Ryan Williams: Correct. So I'm unclear as to whether this is a, a budget.

▶ 2:17:04 Maya Jamaleddine: I would like to make a motion to recess for two minutes.

▶ 2:17:09 Speaker 2: Um,

▶ 2:17:10 Speaker 4: So moved. Second.

▶ 2:17:11 Maya Jamaleddine: Second. Thank you. We have a motion to recess for two minutes and we'll be back. Thank you

▶ 2:17:18 Speaker 2: About the getting transfer.

▶ 2:17:21 Maya Jamaleddine: We are back from recess. Uh, we still have a, uh, motion, um, to recommend appropriation 2024 dash 29, uh, to the full council. Um, the, um, recommendation was made by, uh, vice Chair Williams and seconded, uh,

▶ 2:17:45 Maya Jamaleddine: by Councilor Ro on discussion.

▶ 2:17:54 Maya Jamaleddine: Seeing none, Mr. Clerk.

▶ 2:18:01 Speaker 1: Go ahead. Vice Chair Williams? Yes.

▶ 2:18:05 Speaker 1: Um, council gpe? Yes. Councillor Stewart? Yes. Councillor Hamilton? Yes. Councillor Vandiver. Yes. Councillor Romanul. Yes. Mr. naca? Yes. Chair Jamaleddine? Yes. That motion passes unanimously.

▶ 2:18:19 Maya Jamaleddine: Thank you. I appreciate both of you, uh, for your patience.