Appropriations & Oversight Committee — 2016-05-23
Attendance
Robert A. Boisselle ; Donald L. Conn Jr. ; Scott M. Forbes ; Gail Infurna ; Jennifer L. Lemmerman ; Mary Beth McAteer-Margolis ; Monica C. Medeiros ; Peter D. Mortimer ; John N. Tramontozzi ; Francis X. Wright Jr. ; Michael P. Zwirko
Agenda
- Call to Order
- Public Participation
- Public Hearing - 8:00 P.M.
- Orders
- ORDER-2016-165 : Amend Melrose Revised Ordinances, Chapter 24, Article II - Fire Department, Sec. 24-32(E) - Emergency Rescue Vehicle, to set fees for FY 17
- ORDER-2016-161 : FY17 Ambulance Enterprise Fund Budget in the amount $904,565.70 (Nine Hundred Four Thousand, Five Hundred Sixty Five Dollars and Seventy Cents).
- ORDER-2016-158 : City of Melrose Operating Budget for Fiscal Year 2017 in the amount of 75,328,574.79 (Seventy-Five Million, Three Hundred Twenty-Eight Thousand, Five Hundred Seventy-Four Dollars and Seventy-Nine Cents)
- Adjournment
Minutes
CITY OF MELROSE APPROPRIATIONS COMMITTEE CALENDAR● MAY 23, 2016 Aldermanic Chamber Budget Hearing 7:30 PM The public should take notice that the Melrose Board of Aldermen may, on certain occasions, have a quorum in attendance due to standing committees of the Board of Aldermen consisting of both voting and non-voting members. Members attending this duly posted meeting are participating and deliberating only in conjunction with the business of the standing committee. Attendee Name Title Status Arrived Peter D. Mortimer Chairman Present Gail M. Infurna Vice Chairman Present Michael P. Zwirko Alderman at Large Present John N. Tramontozzi Ward 1 Alderman Present Monica C. Medeiros Alderman at Large Late Robert A. Boisselle Ward 4 Alderman Present Francis X. Wright Jr. Ward 3 Alderman Present Mary Beth McAteer-Margolis Alderman at Large Present Jennifer L. Lemmerman Ward 2 Alderman Present Scott M. Forbes Ward 7 Alderman Present Donald L. Conn Jr. President/Ex-officio Member Present In Attendance: Fire Chief Christopher Leary, Bill Mergendahl, CEO, Professional Ambulance, CFO/City Auditor Patrick Dello Russo
ORDER-2016-165 Amending Revised Ordinances Amend Melrose Revised Ordinances, Chapter 24, Article II - Fire Department, Sec. 24-32(E) - Emergency Rescue Vehicle, to set fees for FY 17 Recommend Passage Board of Aldermen
ORDER-2016-161 Enterprise Fund FY17 Ambulance Enterprise Fund Budget in the amount $904,565.70 (Nine Hundred Four Thousand, Five Hundred Sixty Five Dollars and Seventy Cents). Recommend Passage Board of Aldermen
ORDER-2016-158 Operating Budgets (City, School, Regional School) City of Melrose Operating Budget for Fiscal Year 2017 in the amount of 75,328,574.79 (Seventy-Five Million, Three Hundred Twenty-Eight Thousand, Five Hundred Seventy-Four Dollars and Seventy-Nine Cents) Board of Aldermen City of Melrose Page 1 Updated 7/7/2016 2:08 PM
Transcript
▶ 0:00 Peter D. Mortimer: Good evening, ladies and gentlemen. The hour being 7.30. In the evening on May 23rd, 2016, we will convene the Committee on Appropriations. The Committee on Appropriations is a committee of the whole. All members of the Board of Aldermen are members of the Committee on Appropriations. I am Chairman Peter Mortimer. We are joined this evening by Vice Chairman Alderman Gail Inferna, Alderman Michael Zwirko, Alderman John Tramontozzi, Alderman Robert Boisselle, Alderman Francis Wright, Alderman Mary Beth McAteer-Margolis, Alderman Jennifer Lemmerman, Alderman Scott Forbes, and President Donald Kahn, Jr. motion to open the floor for public so move mr chairman made by alderman forbes duly seconded
▶ 1:02 Peter D. Mortimer: by alderman inferno all in favor please say aye aye any opposed hearing none the floor is open for public participation any members of the public here this evening who'd like to ask questions or make comments about any order on tonight's agenda seeing none motion to close public participation alderman inferno has made a motion to close public participation duly seconded by alderman forbes All in favor, please say aye. Aye. Any opposed, hearing none. Public participation is hereby closed. This meeting is being recorded by MMTV, it is available for future viewing on the MMTV website, they can also give you a DVD and it's also available for viewing on the Melrose, Massachusetts website. The first order we have before us is to amend Melrose Revised Audiences,
▶ 1:59 Peter D. Mortimer: Chapter 24, Article 2, Fire Department Section 24-32E, Emergency Rescue Vehicle to Set Fees for Fiscal Year 17. President Kahn, please. Yeah, I'd move for concurrent action on this order with Order 2016-161, FY 2017 Ambulance Enterprise Fund Budget in the amount of $904,656. Second. President Carter has made a motion for concurrent action with order 2016-165, which I read a moment ago, and order 2016-161, which the President just read. Said motion was duly seconded by Alderman Inferno. All in favor, please say aye. Aye. Any opposed? Hearing none, these orders will be dealt with concurrently. Is there a motion to suspend the rules, please? So moved. Second. Alderman Zwirko has made a motion to suspend the rules, duly seconded by Alderman McIntyre-Mongolis.
▶ 3:08 All in favor, please say aye. Aye. Any opposed? Hearing none, the rules are suspended. Gentlemen, Mr. Mergendahl, Chief Larry, would you come forward and join us, please? Good evening. Good evening, sir. Good evening. We're before you tonight to request an adjustment in the ambulance rates. As we've indicated in the past, the rate should be reviewed and adjusted annually. Just a quick update on the service. We're on track to meet our projected number of transports for this fiscal year. As of today, we've had 1,424 transports. The projection for this year was 1,520. We started carrying a medicine used to treat someone with cyanide poisoning, which is associated with carbon monoxide poisoning.
▶ 4:11 All the medics have been trained in the administration of this drug. This is an optional drug that ALS ambulances can carry, but most services do not because of the expense. We've added a third Lucas device, a CPR machine, to our system, enabling our first on-scene crew to apply the unit so that medics can attend to other patient needs. Right now there's one on each engine and on the ambulance, and the goal is to have one on each piece. And several reasons for the adjustments, cost of supplies continue to increase for the items we use salary and wages line increased due to longevity and contractual step raises we've added a line for structural gear and the bond debt for the new ambulance so the 2014 ambulance has kicked
▶ 4:54 in thank you thank you sir are there any questions or comments from members of the board president khan please yeah um so i i did a re i was reviewing and looking back at this budget since we started chief and it looks like in fiscal 214 it was seven hundred and twelve thousand three hundred and fifty two dollars yeah went up twenty two thousand dollars in the second year to seven thirty four four thirty eight went up another fifty three thousand in 216 to 787 637 and now Now this year it's going like by $117,000 to $904,565. Seems like we're on a trend where the increases are getting larger and this seems like a fairly hefty increase. What is the reasoning here? The salary and wages increase was 15,000.
▶ 6:09 We added a gear line, which we never had, was an additional 10,000, and the bond debt, which initially, I believe the first year, we did not have to pay, increased to 35,000. So that's part of the problem, not so much of a problem that the ambulance is doing well. Yeah, and I saw that the salary and wage line last year was 542,087. So that's gone up this year to 557,290. And are you fully covering eight firefighters in this budget? Yes, eight and a half. Eight and a half. Yeah, that includes the EMS coordinator's position, half from fire and half from- And so it's all salary and all benefits are covered in this budget for eight firefighters? Correct. And how was that? I'm sorry, it also includes the overtime as well.
▶ 7:19 Okay, so you've got $120,000 in this budget for overtime. Correct. And you've got $120,000 in your fire budget. The fire budget is going to be up to $315,000. $315,000. So is that including this 120, or excluding? No, that's excluding. Okay, so you have a total of in excess of $425,000 available for open time in the upcoming year? Yep, 435. And we've been asking similar questions on enterprise accounts as we work through the process. How was the determination made to have eight people take it out of this budget, if you know? I do not know the answer to that. Would Mr. Delarusso be the appropriate person? Well, my guess would be there's two firefighters per shift that work the ambulance, so that would be the eight firefighters.
▶ 8:26 So two per group. What was the methodology to come up with the allocation of the eight firefighters to this budget? I believe originally through the chair that one was adopted was actually part of a grant for firefighters. And then over a period, I believe it was three years, the grant eventually went down. We turned around, brought in BLS, which is basic life support, and then ALS to complement the last portion of the grant that we were going to lose. So eight has been the number. In the prior year, I believe the chief indicated that they were looking to add another person, but half and half. You see, and I'm sure that's in his budget this year also, 8.5, but it was really predicated on a grant that the city had accepted years ago.
▶ 9:20 Okay, and so just in looking at this in the fire budget, approximately 20% of the fire budget is being paid out of this enterprise account. Is that not true? The employees that are in the fire budget are not in the enterprise fund budget. It's separate. Yeah, but I like to look at it with the, you know, the total picture. Overall. Yeah, overall number of firefighters and this portion. Our expenditure for the fire department looks to me like approximately $5 million and we're up to $907 out of this account. That's all I have for right now. I'll let other people speak. Thank you, President Kahn. Alderman Medeiros, please. Thank you. Good evening. Thank you. I was wondering if perhaps Mr. Mergendahl could go over the rate calculation for the ambulance.
▶ 10:22 And I know we have the projected revenue. Yeah, the activity summary? Oh, yeah, that's good, too. It's always nice to have you make sense out of it. So we went through the same exercise as we've done every year since the inception of the, or the re-inception of the ambulance here, which is doing everything we can to try to peg the rates to cover the cost of providing the service. So in doing that, we are now actually have four or five years of good historic data. So what you're seeing here is a pretty tight pin down of looking at historical past performance and the numbers and how they go. Melrose, as always, as we've talked about in the years past, has a very high percentage of Medicare patients,
▶ 11:23 which certainly makes it harder to raise additional revenue, your payer mix, as the term of art that would be used. And so naturally there's going to be a huge cost shift on those patients who have the third-party insurance because Medicare, Medicaid, and people with no insurance at all, unfortunately, do not nearly cover the cost of providing for ambulance service in Melrose or anywhere else in this nation. So consequently, there has to be this cost shift, and that's how we try to peg your rates, keeping the rates as low as we possibly can while at the same time trying to do a model to project what it is to cover the cost of providing the service and and that's what we've done now I every year I always give my same disclaimer in my
▶ 12:12 same caution which is this is not anything that we can use as a definitive thing if we we can certainly never know the exact number of transports we can never know the exact payer mix but all these numbers here this year are based on historical data over the last five years and that's how we how we got to them and this rate increase that you're seeing this year and and I have to actually compliment Melrose because you're one of the one of the few towns or cities municipalities that that actually does keep a good handle on tracking your costs and the rates and you do it every year and every year we here with this and you're one of the few that actually do this and again looking at last year this year a nominal small rate increase to cover the cost which is
▶ 13:06 always increasing and the other thing to think about that the chief also had Medicare actually went down last year so the reimbursement for Medicare for this year actually went down by half a percent if you can really imagine medic medic the Medicaid rate has not increased in I want to say 10 or 12 years but Medicare which you would normally expect would go up for the cost of living was driven by an inflation charge and the government calculated negative inflation this past year so the Medicare rate also went down half a percent relatively small but still it's down and not up and and there's no no one's costs are down and not up so that's part of the exercise that's what we've done and in using that data to peg the rate increase and and keep it as
▶ 14:01 Monica C. Medeiros: small as possible thank you and chief Leary I know you mentioned the number of transports that could you just repeat that number again that we had last year we're on target to the the projection was 1520 and and we're at 1424 right now and I see this is based the projection for the rates is based on 1600 so that is a little bit of an increase it is looking at the and I what I base these numbers on is I looked at me and again there's all there's always timing issues as well but I looked at the numbers from April 1 of 15 to March 31 of 16 trying to get the latest snapshot of numbers and the total number of transports for that time period was 1621 right which is why I kind of shaved it down a little
▶ 14:57 the 1600 we do we do try to make more conservative projections if we can is there a time of year where transports are up well it really is is really is dependent I mean emergency ambulance service can really go anywhere a lot of places you tend to see the the summers slow down a little bit but again usually that's marginal from people just getting out of town and you see the transports on the Cape and islands go through the roof so it really is dependent upon the just the locality and and the way that particular service area works well I wanted to point out that you know we have as you've included the past several years the data from the surveys from the department and you know it's consistent
▶ 15:50 Monica C. Medeiros: that we're receiving really high survey marks and so I just want to compliment you chief and in your department for that and it's in particular it's nice to see the comments that are in there from the people who've been transported and and you know and see that it was a difficult time and that you know they had such positive remarks so that's that's good we do appreciate that this is a service that you know we're providing to the residents I think it's very important that we go through this process and and look at the cost and make sure that we're doing our best to keep you know this tied into what you know keep it down as much as we can because no matter what there are people without insurance and there's people with you know high co-pays and and
▶ 16:34 Monica C. Medeiros: everything else so that in mind I I did want to one of the things that I've been trying to get a handle on is the indirect costs that we are that are sourced from the ambulance enterprise account into the general fund so if I I see mr. de la Rousseau back there he might be able to sort of explain what what's comprised in there I think it's about a hundred and thirty three thousand give or take that's through the chair just please the indirect cost number of 132 871 of life insurance cost I can provide you this document to write the health insurance so security pensions auditor treasurer department personal services cost information technology department EPW zero in that case legal services and city insurance costs so I'll provide this as I know
▶ 18:03 Monica C. Medeiros: what through the chair that I have to also provide the Mount Hood so I'll put them back to back that helps a lot I think they'll help you know keep the process as clear as possible I just and and on the discussion of staff and the that was the set the safer grants that we had received originally I believe that right sounds to save a great to save for grants and I know at the time we were we were hoping that they were going to allow us to because we had increased the staff at that time and we were going to possibly lose one staff member to attrition for retirement is did that work out the way that we had planned and that was going back some years I think that's before it's very I'm confused with the question yes sorry I president Khan's a question kind of
▶ 18:57 Monica C. Medeiros: sparked my memory originally I know we were bringing on I think eight eight new firefighters if my memory is correct and uh it was a little bit more than what we had had in the budget in our regular fire budget and we were going to be making the shift towards to doing the ambulance service at that time and i know that you know the idea was that we would keep the the firefighters on um obviously in paramedics and but that we didn't um we weren't sure how we were going to fund it moving forward and we had somebody that was a planned retirement coming in the future and we were hoping that we i don't we didn't have any layoffs and i don't recall that was prior to me becoming chief but uh we've sustained all the
▶ 19:48 staff um like i said we used the two two paramedics per shift which also in addition to being paramedics to train firefighters so it augments that staff as well you know should we have a fire thank you thank you thank you thank you alderman Medeiros if if i could double back on just one thing you said just to remind everybody it's something that but years when we first started this this body also adopted a very very humane collection policy to go along with the ambulance rates and what we do so that's another piece for for the for those who are uninsured with the rates everybody decided at that point and and that we would never want to deter anyone from calling 9-1-1 so that policy still remains in force that you guys said at
▶ 20:36 Monica C. Medeiros: the beginning of having the most humane collection policy possible honestly thank you yes and actually I did want to ask in terms of collection and I'm hearing from some other municipalities that they're having difficulty with some of the certain insurance providers that getting the money from the insurance company not necessarily from the individuals yeah it's an ongoing issue for ambulance service across the country what many of the health insurers are doing is trying to squeeze out of network providers by sending payments directly to the patient trying to get providers to enroll in contract with them that's a probably a good policy for hospitals and such but frankly for ambulance service it's it's one of those ones where ambulance service may be
▶ 21:24 getting swept in with the rest of health care because you know certainly ambulance service emergency ambulance service in particular you know there's really should not be a contracted entity I mean the health insurer cannot say oh we're gonna steer five heart attacks to you today and increase your volume by this much so contract with us so we can pay you less but that that's something that's across the board across the country and we're continually battling that issue thank you thank you again mr chairman thank you alderman Medeiros alderman forbes please thank you mr chairman i think you walked right into my question so um when i look at the activity summary and we spoke before the meeting uh it appears about 80 percent of our trips uh from
▶ 22:11 Scott M. Forbes: the ambulance are between medicare medicaid and what you have deemed here i think it's just uh bill patient which i would assume is no insurance correct so out of all the trips that we have there were 324 trips that were actually paid for by insurance can you just go over the the the columns for medicare medicaid because it looks at the gross charges that we actually charge for the service and how much we actually collect it's you know the the numbers are are disparate as far as the difference in what we're getting as far as what we're charging so if you could explain that to us and also for the people watching at home that would be much appreciated absolutely the the for Medicare and Medicaid patients in
▶ 22:56 particular those rates are set and fixed by the government Medicare fixed by the federal government Medicaid fixed by the state government Medicaid rates have not increased in over 12 years Medicare actually went down last year Medicare is decided on what's known as a fee schedule and it's pegged for all across the country Medicaid and adjusted by geography Medicaid is set by the state and there's just a flat number and frankly both of those rates are far far below what it costs to provide ambulance service so you got just as an example I I mean, your budget is now about $900, so it's costing almost $600 per transport. The total budget that you have divided by the total number of transports, every time you take someone to the hospital, it costs $600.
▶ 23:59 That's not out of line from anywhere. As a matter of fact, it's actually pretty good, very efficient. And if you take a look at the rate of what Medicare reimburses, they're reimbursing on average of about $430 for that trip. Medicaid is reimbursing on average of about $250 for that trip. So we know what it costs, and we know that 80% of your – and people with no insurance whatsoever are genuinely reimbursing you, generally reimbursing you nothing. They're not going to have insurance, and they're not able to cover it, and they're going to have a lot of other bills. so consequently what you're looking at is the the dramatic thing that exists in all of health care which is this cost shift on to the third party payers and
▶ 24:44 Scott M. Forbes: Melrose and ambulance service is actually no difference when you have a large portion that are reimbursing far less than what it costs you to provide the service that money has to be made up somewhere and that's why when your rates are set, that shift takes place onto the third-party payers. It's unavoidable and it's done all across health care. That's a long-winded response. No, no, I appreciate it, and I know that we never look at these things from a well, obviously, from a budget perspective, you look at it from a financial perspective, but when it comes to going out and making that call, you can throw all that out the window. I applaud the service that you do. I am a big supporter of the ambulance, and I don't
▶ 25:29 have any further questions at this time thank you mr. chairman Thank You alderman Forbes alderman boys L please I'm following up with mr. Forbes Alden Forbes question with the Affordable Care Act that's been in effect now and it's in full effect this year and so forth do you find any relief and not not getting any of this payment and so forth um honestly no and and the reason being is is that it's a double-edged sword you will see some patients move from uninsured to having insurance while at the same time you'll see other patients moving from a traditional third-party private insurance into a maybe even a Medicaid managed care third-party insurance so you see a tremendous swing sometimes in the amount that it reimburses just based on the coverage
▶ 26:18 type so it can cut both ways honestly it has definitely reduced the number of patients who are private pay patients by a couple of percentage points which is great but it's not it's not a windfall to the system overall for ambulance service also there's many patients that also ended up in what's known as health safety net it's free care so it's a type of insurance that covers you in the hospital and for inpatient stuff but health safety net does not cover emergency ambulance service or any ambulance service and so consequently even with that and even with universal coverage quote close quote it's not always universal thank you Thank You mr. chairman Thank You alderman voice out alderman Inferno please in my day job I work a lot with these insurances so I
▶ 27:14 Gail Infurna: understand exactly where you're coming from and the Medicare and Medicaid and you know it's it's amazing but certainly chief thank you in your department for doing such a great job I hear nothing but you know good things about the Melrose EMTs when they come to to service our people in their homes and you know what I don't think we like anything better than to have a Melrose fireman you know or EMT come to the house and they know exactly what they're coming into a question that we I get often as I'm down on Main Street or something and the fire engines go by and then the ambulance will go by or vice versa and I hope you'll give me just a little bit of lead way because this does kind of go into the budget I wonder if you allow it thanks I wonder if you
▶ 28:00 Gail Infurna: could just give me a little Reader's Digest and help educate the public why you send a fire engine and an ambulance because people will say no why why are they doing that you know and this is where we can be cost-effective and you know so if you can maybe help educate the public very readers digest version of why you do that the three tiered response so the police respond the fire engine the nearest piece of fire apparatus responds in the ambulance and every all those people the first responders so the closest person is going to initiate aid first and they'll assist whether it be the police with traffic or to help the patient while the paramedics are treating the injuries the The EMTs and firefighters that are on the fire trucks also assist in the patient care to expedite their transition to the hospital.
▶ 28:50 Gail Infurna: And at times we'll need a third rider because if it's, say, a cardiac arrest or something where all hands are needed, then that additional person will ride in the ambulance with them. All the fire trucks, everyone, we're all first responders trained in CPR, first aid, so that even if if there's a delay with the ambulance or unable to get there somebody's going to get there quick and administer aid I mean as a nurse I understand every second counts and all hands on board I certainly want that but it's just funny what you hear from people you know as they see you know the emergency vehicles go down we'll see now this is where we could cut back and blah you know and so I just thought it would be good to get the word out there as to
▶ 29:34 why you know all you want all hands on board no matter what so thank you for that quick one and once again thank you again for all your work if I could put my operational paramedic hat on for a second the the the last thing that any of you would want to do is go to an emergency and have to play catch up and have to wait for more help to come to execute something that you have to do in an emergency situation you would rather have more help there and that help is there in the station it is a very marginal marginal cause to have them also respond and the last thing you'd want to do is play catch-up in a situation that is a true life-and-death situation and and the idea that two people can manage a life-and-death situation and then have to wait for two
▶ 30:17 Mary Beth McAteer-Margolis: or three more folks to come you know in dire circumstances is not the time that you want to be waiting you would rather send the maximum response and and be able to handle the emergency or just even send send somebody home who hasn't had to do much rather than play catch-up in those times that you really need it thank you very much thank you mr. chairman for that little bit of lead way but it was budget related certainly Thank You alderman Inferno alderman Suarco please oh I'm sorry alderman MacMaster my goal thank you I just had a question on the the fee survey that you provided us with and it wasn't quite clear to me where we sort of stood in the grand scheme of things on the first page it lists Melrose ALS 1650 should that be the BLS 1650 because then the
▶ 31:12 Peter D. Mortimer: next the next two pages have us also with the ALS which I assume is one and two and maybe you could explain what the bundled rates are okay good could we hold that question right there the eight o'clock hour has arrived and it is time for the public hearing on this very same order second president Connors made a motion to hold the order for the present time discussion on the same order will We will continue in the purview of a public hearing. The motion to convene the public hearing, made by Alderman Wright. Second. Duly seconded by Alderman Boycelle. All in favor of convening the public hearing, please say aye. Aye. Any opposed? Hearing none, the public hearing is hereby convened. Are there any members of the public in the gallery who wish to come forward and speak on this order?
▶ 32:08 Peter D. Mortimer: Seeing none and none in the hallway. Seeing none, motion to close the public hearing. Second. Second. a motion to close the hearing from alderman inferno duly seconded by alderman boy cell all in favor please say aye aye aye the public hearing is hereby convened 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 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
▶ 32:53 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 terms of our reimbursement how we break out those charges historically we feel 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
▶ 33:42 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 this point three thousand dollars for ALS it's it's pretty wild well it sort 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 very deceptive and that's why sometimes when the rate surveys go around if folks
▶ 34:31 Mary Beth McAteer-Margolis: 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 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 eight and a half no I think that the services they do a tremendous job and I 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
▶ 35:25 Michael P. Zwirko: 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 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
▶ 36:09 Michael P. Zwirko: 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 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
▶ 37:00 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 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
▶ 37:40 Michael P. Zwirko: 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 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
▶ 38:30 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 ambulance bills sure sure and thank you for that as well I just had one of the 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
▶ 39:22 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 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 okay thank you for the update those are all the questions i had mr chairman thank you alderman Zwirko seeing no further alderman wishing to be heard is there a motion all of them for yourself
▶ 40:08 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 the patient condition determines where you take them as far as like a burn center or trauma center so that number may go up then uh on special cases well the if i may the the vast majority 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
▶ 41:04 Monica C. Medeiros: but we've always used to as the model for your for your financial projections okay good thank you very much thank you mr you're welcome alderman boy cell alderman Medeiros please thank you um i just wanted to follow up again on the ambulance fee survey and i know our 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 no i can tell you that for most of the other communities we bill for the the the percentage
▶ 41:56 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 can really have an effect on the rate that we have to yeah absolutely thank 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 again could just for um we work with right now 18 soon to be 22 thank you thank you Thank You alderman Medeiros motion to recommend orders to zero one
▶ 42:42 Peter D. Mortimer: six dash one six five and two zero one six dash one six one second Alderman Forbes has made a motion to recommend these two orders for passage to the full board they were joined so the motion applies to both orders it was duly seconded applicable to both orders by Alderman Boycelle all in favor please say aye aye any opposed hearing none these two orders will be recommended to the full board or passage the next order we have before us is a return to our city of Melrose operating budget for the fiscal year 2017 in the amount of $75,328,574.79. The first department that we will take up is department number 221. That is the fire department in the amount of $4,098,523.22. We are still under suspension, still joined by Chief Leary for the fire budget number 221.
▶ 43:53 Chief, would you like to make an opening statement or proceed directly to questions and answers? Yes. I'd like to thank Mr. De La Russa and his staff for their assistance in developing this year's budget. A couple of changes to the budget. The salary and wages line increased due to contractual step raises and longevity. We've increased the overtime line by $100,000. We've increased the vehicle repair line by $10,000. and we increased the structural gear line by 14,000. Thank you. President Kahn, please. So, Chief, can you tell us what your complement of your workforce is at this point in time with superior officers and firefighters, please? So there's seven captains, nine lieutenants, and 41 firefighters minus the eight firefighters that are in the ambulance budget.
▶ 44:52 But I mean, in the real world, the real department has 41 firefighters. Correct. Regardless of whence they're paid. And you have two vacancies at the present time? Three. Three. Three. Well, yeah. Well, actually, our budget said two vacancies and then EMS training vacancy. Correct. What's the plan in terms of dealing with those vacancies as we go forward? The EMS training position, I am currently in discussions with the union about, and the other two firefighters looking to next fiscal year in July to move forward with the hiring. Do you intend to have these people on for the full fiscal year? Yes, we're just finalizing. We've revamped our hiring packet and hope to be calling for the names within the next couple of weeks.
▶ 45:44 So hopefully we'll get it sometime in July. Okay. And so your overtime budget going forward is going to be $435,000. Is that correct? Combining ambulance and fire, yes. Right. And what have you spent so far this year on overtime? on on the fire budget is 443 219 and ambulance budget 81 320 do you anticipate that you're going to need any more transfers or appropriations of funds for uh over time before we get to the end of the fiscal no we should be also so you're just about 525 000 as we sit here correct and um What do you think is contributing to our overtime expenses right now, Chief? We had one member that's been deployed for over a year in the military and continues to be deployed, and we've had an exceptionally bad year for long-term sickness and illness.
▶ 47:06 We had a member that has since returned from a year about with cancer, and there's multiple other injuries and illnesses. Do you have any kind of a plan to try to address overtime or drive overtime down? Hopefully, I mean, all the members are back except for the member that's out on military, so our overtime numbers have decreased. So if we can sustain a healthy force, we should be in good shape. And do you think that these two vacancies, if you fill them, going to have any kind of a significant impact on your overtime expenditure it will definitely help yes do you think you can get the overtime down into the budgeted 435 000 going forward in this year i'm hoping to but the numbers a lot real more realistic than it has been um but i'm hoping that
▶ 48:01 um you know if the members can stay healthy i mean unfortunately i don't have a crystal ball that shows what's going to be down the road but it and then if the military that that member has orders until at least october yeah and i agree i mean i've often said that i'd like to see these budgets built with numbers that are realistic numbers but also um you know i don't like to see over a half a million dollars of overtime so hopefully we can make some strides to reduce that in the coming year it's all there for now thank you president khan alderman wright please good evening chief um no raise on the show i was raised when the um chief flyer was here um how long have you had the vacancies roughly one left in january and one just went to
▶ 49:01 Cambridge in last month have you considered a reserve list because if we last time we used it was in the 80s and I don't know that much about it but I'd be reluctant to use it because we have a very stringent hiring process and background checks and looking into people and if we were to hire someone to place them on the list it could be five years before we tapped into them I mean depending on the vacancies it could be sooner than that but the list is good for five years and the members that were on it in the 80s didn't get hired for almost five years so but if you put you just had one or two people on the reserve list and they and and every six months you could go back and read you know recheck click you know their credit that Corey and all that that was that
▶ 49:58 Francis X. Wright Jr.: would be my other point that it's it's we're duplicating our efforts rather than just have to do it one time when the time comes and get it done right and be done with it yeah but I think well I guess my experience is that when you communities do this they have people ready to go so when you have a vacancy you have the ability to get them into the next Academy and when you get them into the next Academy they come out they fill that vacancy now you've cut your overtime so I understand that in the 80s not unique to Melrose there were issues with reserve lists but I think with municipalities being run I think in a more professional manner than they were three decades ago that it can work and I
▶ 50:40 Francis X. Wright Jr.: would appreciate if the administration would would look at it it doesn't have to be a long list like I said one or two people on it like I said if you've got that ability to just having gone through that process made a selection have that person ready to go because you can't control your retirements obviously somebody can walk in and just leave you high and dry and if there's an Academy coming up and you've got somebody ready to go because otherwise you had a call for a list HRD has to produce a list you have to send out your postcards you have to do your interviews your pats you have to go through that whole process and I can take months and there's your overtime well at least a portion of it
▶ 51:22 Francis X. Wright Jr.: so I kind of beat this drum for a couple years to no avail but I think that I think this is it's worthy of looking so if that's one way we can look at potentially cutting over time I'd appreciate if they could be could be looked at thank you thank you mr. chairman thank you alderman right alderman force please $35,000 that's been budgeted for the vehicle repairs is just kind of give us a kind of brief overview of the the vehicles that we do have in the fleet and what the annual maintenance requirements are of those vehicles we have three engines a lot of truck the pickup truck that's a brush truck the ambulance is they're covered under the ambulance budget and those those repairs are under that sure so we do preventive maintenance twice a year
▶ 52:17 Scott M. Forbes: there's annual pump testing there's ladder testing and then the whatever breakdowns occurred during during the year more or less just routine maintenance to keep the upkeep of the vehicles we have in the fleet okay the other thing I just wanted to touch base and I didn't see anything for line item and in this budget for repairs and maintenance of the actual buildings can you talk about the houses and just talk about their current state and if there is going to be any kind of you know if there is any short-term needs right now as far as there's a desperate need to repair and the mayor and his staff are looking at it and he's convened or is working on a committee to address the public safety buildings police and fire and hopefully we'll get
▶ 53:13 plan together to see what just our needs are in in go from there currently the bathrooms at headquarters are in the process of being renovated one downstairs and the two upstairs and as far as general daily maintenance or repairs it all comes under facilities under mr. Shannon okay so that that's why it doesn't reflect in this budget and that committee wouldn't be all the firehouses not just one right here correct in the police station as well Okay. Thank you, Mr. Chairman. Thank you, Alderman Forbes. President Kahn, please. Yeah, I want to weigh in, too. I couldn't agree with Alderman Wright more that the city would save money if we had police and fire reserve lists. We would save money and time, and I think it is something that should be looked at.
▶ 54:04 Peter D. Mortimer: Thank you, President Kahn. Seeing no further, Alderman, wishing to be heard. Motion to move the bottom line. Second. We have a motion to move the bottom line. $4,098,523.22 for budget department number 221, the Melrose Fire Department. That motion was made by Alderman Boisselle and duly seconded by Alderman McAteer-Margolis. All in favor, please say aye. Aye. Any opposed? Hearing none, this budget will be recommended to the full board to be passed along with the order for the complete operating budget. The next budget we have before us is budget 291, the emergency management department in the amount of $4,900. What have you to say about that, Chief? So no changes to this year's budget. Some of the activities in the past year included the FEMA storm reimbursement.
▶ 55:00 We're waiting on final payment for the storms from 2015. Just want to note that Ann Waite from the DPW was instrumental in working with the rep from FEMA and getting our submission in. We developed the safety and emergency guidelines for all the city buildings. And this was given to all the department heads who in turn have delivered it to their staff. And we obtained a $6,400 EMPG grant from federal government. And we used that to upgrade the fire radios to fiber and adjust the frequencies for both fire and police radios. Thank you. Thank you, sir. President Kahn, please. where if anywhere does the compensation for the director appear now in the city budget that's in my salary so that's been folded into your salary yet last
▶ 55:46 Monica C. Medeiros: year that was then yes thank you President Kahn Alderman Medeiros please thank you so this was kind of a budget in flux last year is there any emerge are you doing any kind of emergency management work like is there a list of auxilary or anything that's we're looking at the needs of the community what with what type of a volunteer organization we want to have whether it be a cert team or something else Melrose does currently belong to the Medical Reserve Corps through the Health Department and they have a group of volunteers that are associated with them so it's still something that we're looking at nothing's been finalized yet I would have to say I'd like to see we had a strong group for a while back that had you know done a lot to help out the
▶ 56:53 Monica C. Medeiros: city especially during some of the flooding that we experienced and and I got to sit in in some of their training meetings and you know I'd like to I think that's a valuable asset especially in this time when we you know don't know when we could end up in an emergency of some sort where we may need more than just you know our very capable police and fire staff but sometimes there are times when we need more so I'd like to see this line utilized and the group return thank you thank you all the moment arrows motion move the bottom line Alderman boy cell has made a motion to move the bottom line of four thousand nine hundred dollars for the emergency management department said both of the duly seconded by alderman forbes all in favor please say aye aye any opposed hearing none
▶ 57:41 Peter D. Mortimer: this budget emergency management will be recommended to the full board for passage the next budget we have for this evening is budget thank you chief thank you for coming this evening the next budget we have before us is budget one one two it is the aldermanic budget in the amount amount of $145,301.30, President Kahn, please. Yeah, this budget is increased by 2.9% this year. Other than some small administrative items in the IQ M2 charge, it's virtually all salary lines. The Aldermanic total annual compensation is $5,000, Which it has been since I returned to the board in 2004 and even prior to that. So that's what we have in the Aldermanic budget. Thank you very much, President Kahn. Motion to move the bottom line.
▶ 58:40 Peter D. Mortimer: Second. Alderman Forbes has made a motion to move the bottom line for the Aldermanic budget number 112 in the amount of $145,301.30. That motion duly seconded by Alderman Boisselle. favor please say aye aye aye any opposed hearing none the aldermanic budget will be recommended to the full board for passage alderman Suarco has made a motion to adjourn second duly seconded by sorry personal privilege I just want to remind everybody that Sunday is the Memorial Day parade and beginning I believe at 1 30 so when the ceremonies to follow at the cemetery after the parade so we invite the public and thank our veterans and those who have served Thank you very much for that information, Alderman Medeiros.
▶ 59:28 Peter D. Mortimer: Alderman Zwirko has made a motion to adjourn. It was duly seconded by Alderman Lemmerman. Seeing no discussion, all in favor, please say aye. Aye. Aye. Any opposed, hearing none, the Committee on Appropriations is adjourned. Thank you, one and all.