* This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting. [00:00:01] ALRIGHT. THE CITY COUNCIL OF THE CITY OF LEAGUE CITY TEXAS WILL NOW COME TO ORDER ON IN A WORK SESSION ON NOVEMBER 14TH, 2023 AT 5:00 PM ROLL CALL. UH, ANDY MANN, I THINK YOU'LL BE HERE IN A MINUTE. TOMMY COES HERE. TOM CRUISE HERE. UH, I THINK JUSTIN'S RUNNING A LITTLE BEHIND. CHAD TRESSLER HERE. AND SEAN SAUNDERS HERE. ALRIGHT. AND THEN WE'LL OPEN WITH PUBLIC COMMENTS. 50% OF THE PUBLIC IS TALKING RIGHT NOW, BUT AND THEY DIDN'T HEAR WHAT YOU SAID. ANYBODY, ANYBODY WANTED? OKAY. MOVING ON. UH, PRESENTATION. DISCUSSION REGARDING EMS FOLKS. FOR EXAMPLE, LOOKS LIKE WE'RE WAITING FOR CHIEF LUGO AND NICOLE, SO, ALRIGHT. CONTINUE TO TALK AMONGST YOURSELVES. , I HIS TRUCK. LOST TRACK OF, OF TIME OR, OKAY. I'VE BEEN HERE. ARE Y ALL HERE? ALRIGHT. I JUST HANG OUTSIDE SYDNEY. THIS IS RIGHT UP HERE. YES. SO IS THE CHARGES, WHY AREN'T THERE SUCH A BIG DIFFERENCE BETWEEN THE CHARGES AND THE PAY? BECAUSE A LOT OF PEOPLE, IF THEY DON'T HAVE INSURANCE, THEY HAVE TO PAY MEDICARE. AND THEN IF YOU MEDICARE. YEAH. AND THEN MEDICARE IS CAP. AND THEN INSURANCE COMPANIES ALWAYS NEGOTIATING BILLS. SO US RAISING THE FEES, ALL IT DOES IS MAKE SURE THAT IF THERE IS SOMETHING THAT CAPITAL CAPTURE MOST OF IT. SO IT, IT PROBABLY WILL NOT NECESSARILY INCREASE THE AMOUNT WE COLLECT. BUT THEN THEY'RE ALSO GONNA GO INTO SIDE, THEY WENT TO BAYTOWN FEES. THERE'S NOW A LAW THAT WE CAN'T, THAT WE'LL GO INTO EFFECT LATER THAT WE CAN'T CONTINUE TO RAISE IT. SO WE MIGHT AS WELL RAISE IT UP NOW AND THEN WE CAN, THEN WE'LL BE IN A BETTER PLACE LATER ON. BUT NICK, THESE SHOULD BE BASED OFF OF THE MEDICARE RATES NOW. NO, THAT'S WHAT A LOT OF 'EM HAVE DONE. NOBODY DOES IT. YOU NEVER DO IT AT A BASE ON MEDICARE. YOU ALWAYS DO IT ABOVE AND THEN MEDICARE WRITES IT ALL AND THEN YOU JUST COLLECT UNDER MEDICARE. NO, THAT'S REALLY, THAT'S WHERE THEY START THEIR SCHEDULES WITH MEDICARE RATES. NO, WE MAKE THE, WE MAKE THE ARGUMENT FOR REASONABLE AND CUSTOMARY. SO MEDICARE RAISES THEIR WELL, REASONABLE AND CUSTOMARY ISN'T BUILT BASED ON MEDICARE EITHER, RIGHT? SO. CORRECT. IT'S BASED ON THE PREVAILING WAGE OF, OF THE OTHER, UH, OF THE PAYERS. HMM. YEAH. SO MEDICARE ALWAYS IS GONNA PAY UNDER THE PAYERS LIKE BLUE CROSS OR ANYBODY ELSE. SO YOU WANNA TRY TO RAISE IT UP AND BILL FOR AS MUCH AS YOU CAN AND COLLECT UNDERNEATH IT JUST IN CASE. CAN WE JUST, HE'S LIKE, HANG OUT THERE IF SOMEBODY JUST DON'T DRINK MY HAY. DID THEY HANG AGAINST THAT CITIZEN AT SOME POINT? WE JUST DRIED IT OFF. THEY SEND AN INITIAL ATTEMPT TO COLLECT IT THING OVER HERE WE NEED AND THEN THEY EVENTUALLY NO TEQUILA, TEQUILA, TEQUILA, TEQUILA THOUGH. GOOD EVENING. APOLOGIZE FOR BEING A LITTLE LATE. OUR, UH, BILLING COMPANY WE WERE TALKING TO, THEY'RE GONNA BE ABLE TO BE HERE FOR EVERYBODY. ASK ANY QUESTIONS THAT YOU MAY HAVE IN REGARDS TO THE EMS FEE SCHEDULE THAT WE'RE PROPOSING TO Y'ALL THIS EVENING. AND CHIEF UH, SMITH IS ALSO, UH, GONNA DO A DEEPER DIVE INTO THIS. SO FOR OUR EMS BILLING FOR OUR CITY AND OUR FIRE DEPARTMENT, THE LAST TIME WE'VE DONE A FEE INCREASE WAS FIVE YEARS AGO, 2016. AND MOST RECENTLY THE STATE HAS PASSED A NEW BILL, UM, THAT GOES INTO EFFECT IN JANUARY THAT STATES, UH, ANY EMS AGENCIES CANNOT DO ANY PROPOSED FEE INCREASES WITHOUT POSTING ON THE TDI WEBSITE BY ADOPTING IT THROUGH COUNSEL. AND IF IT'S DONE AFTER JANUARY, UM, YOU ONLY LIMIT IT TO A 10% INCREASE ON YOUR EMS FEES THAT YOU CAN DO. SO ONE OF THE BIGGEST IMPORTANCE RIGHT NOW FOR US IS TO INCREASE OUR EMS RATES, UM, TO WHERE THEY SHOULD BE AGAIN, SINCE WE'RE ABOUT FIVE YEARS BEHIND ON OUR EMS BILLING. AND THEN AFTER THAT, EACH YEAR WE CAN DO A 10% INCREASE AND WE CAN STAY AHEAD OF THE CURVE INSTEAD OF BEHIND, UM, WHICH WE DON'T WANT TO BE. SO THE PURPOSE OF THIS IS WE'RE GONNA REVIEW OUR CURRENT EMS BILLING RATES. WE'RE GONNA COMPARE IT TO REGIONAL AND STATE PROVIDERS AND THEN CONSIDER INCREASING OUR EMS BILLING RATES ON BASED OFF THE PROPOSAL. [00:05:01] SO FOR THE SB 2 24 76, THIS IS THE NEW STATE LAW THAT GOES INTO EFFECT AGAIN JANUARY ONE OF 24. IT AMENDS THE CURRENT MEDICAL COSTS, UH, FOR SURPRISE BILLING, UH, LAW TO INCLUDE GROUND AMBULANCE SERVICES, WHICH MEANS, UM, WE WILL NO LONGER BE ABLE TO BALANCE BILL PATIENTS. 'CAUSE CURRENTLY WHATEVER OUR PRIVATE INSURANCE COVERS ONLY THAT PERCENTAGE, THE REST IS GIVEN TO THE PATIENT TO PAY OFF THE REST OF THE MEDICAL BILL. MEDICAL EXPENSES THAT WE DO FOR TRANSPORTS. NOW OUR HIGHEST PERCENTAGE OF COLLECTIONS IS THROUGH MEDICARE. AND MEDICARE HAS A SET RATE THAT THAT'S THE MAX THAT WE COULD EVER, UH, BILL, UM, THOSE TYPES OF PATIENTS. AND SO WHAT DOES IT MEAN FOR LAKE CITY FIRE DEPARTMENT? WE CAN REGISTER AND SUBMIT RATES FOR TDI FOR PUBLICATION. UH, FUTURE RATE INCREASES LIMIT TO A MAX OF 10% FOR THE PRIOR YEARS, LIKE I'VE STATED. AND WHAT CHIEF SMITH IS PASSING OUT FOR EACH OF Y'ALL IS A LARGER VERSION. SO YOU CAN SEE WHAT OUR EXPENSES ARE COMPARED TO THE REVENUE AND THEN WHAT WE'RE PROPOSING FOR OUR COLLECTIONS. THANK YOU. YOU WANNA START ON THIS LINE AGAIN? AN UPDATE ON THE STATE LAW AND STUFF ALREADY. OKAY. UM, I APOLOGIZE FOR TRYING TO SHUTTLE, SHUTTLE AROUND. UM, IF YOU'LL GO BACK ON SITE. THANK YOU. UH, JUST KIND OF WANTED TO REITERATE AND KIND OF GO OVER THE STATE BILL THAT WAS RECENTLY PASSED, UM, IN THE 88TH REGULAR SESSION. AND WHAT THIS IS, THIS PROPOSED BILL IS TO AMEND OUR CURRENT LAWS REGARDING CURRENT HEALTHCARE COST SURPRISE BILLING ACT TO INCLUDE GROUND AMBULANCE SERVICES. ITS AIM IS TO PROTECT PATIENTS REQUIRING THE SERVICES OF A GROUND AMBULANCE FROM UNEXPECTED BILL AMOUNTS BY ELIMINATING THE ABILITY TO BALANCE BILL FOR AMOUNTS ABOVE THEIR INSURANCE COMPANY'S FEE SCHEDULE, EXCUSE ME, AND EXCHANGE. IT IS GONNA DIRECT THE COMMERCIAL HEALTH PLANS TO REIMBURSE OUT OF NETWORK GROUND AMBULANCE AGENCIES SUCH AS US AT THE RATES SET BY LOCAL GOVERNMENT ENTITIES SUCH AS OUR CITY COUNCIL. SO THIS IS ALSO WHY IT'S IMPORTANT FOR US TO LOOK AND EVALUATE AND, UM, UPDATE OUR EMS BILLING FEES RIGHT NOW. 'CAUSE THIS IS SCHEDULED TO GO INTO EFFECT JANUARY OF 2024. AND SO SOME OF THE BIGGEST THINGS ON HERE, WHAT WE'RE GONNA HAVE TO DO TO COMPLY IS IN JANUARY, ONCE THEY NOTIFY US THAT THE DATABASE IS ESTABLISHED, WE WILL GET ON AND REGISTER OUR RATES THAT IS APPROVED BY COUNCIL AND THEN WE'RE GONNA BE LOCKED INTO THOSE RATES TO WHERE WE'LL ONLY BE ABLE TO INCREASE THOSE ON AN ANNUAL BASIS AT 10% HIGHER FROM THE PREVIOUS YEAR. CAN I ASK A QUESTION THERE? THE, UH, THAT ANNUAL INCREASE, UM, DO WE HAVE TO PASS A SPECIFIC VOTE THAT YEAR OR CAN IT BE SOMETHING THAT WE PREDEFINED, SAY IF WE WANTED TO BUILD INTO WHATEVER WE APPROVE WHEN WE UPDATE THE RATES TO SAY ADJUST IT BY THE LESSER OF 10% OR SOME MEASURE OF INFLATION. EXCUSE ME. THAT'S QUITE, SO THAT'S EXACTLY THE CASE. YOU HAVE A CHOICE OF BUILDING IT INTO YOUR FEE SCHEDULE. WE HAVE A LOT OF AGENCIES BILL FOR THAT DO EXACTLY THAT, SAY 3% FOR EXAMPLE. UM, JUST BUILD IT INTO THE FEE SCHEDULE. YOU DON'T HAVE TO GO CA CAN WE GET COMPLEX LIKE THE LESSER OF 10% OR A MEASURE OF INFLATION? WELL, YEAH, YOU WOULD PROBABLY WOULDN'T WANT INFLATION, RIGHT? YOU PROBABLY WANNA DO IT BASED ON MEDICAL TREND OR SOMETHING LIKE THAT, WHICH BECAUSE YEAH, SOME MEASURE, YEAH, SOME OBJECTIVE MEASURE. AND THIS IS RUSS HARMS, UH, HE IS WITH WHITMAN, WHICH IS OUR CURRENT BILLING, UH, ENTITY. AND HE'LL BE ABLE TO ANSWER THOSE, THOSE QUESTIONS DIRECTLY. OKAY. SO, BUT WE CAN DO IT THAT WAY, RIGHT? WE CAN HAVE A, SOMETHING WORDED LIKE THAT. IT DOESN'T HAVE TO BE A 60%. IT CAN BE THAT'S RIGHT. AS LONG AS IT DOESN'T EXCEED THAT 10% FOR THE, FOR THE NEW BILL. YES. OKAY, PERFECT. ALL RIGHT. UH, THIS IS OUR CURRENT BILLING RATES. UM, BLS IS 800 911 FOR OUR ADVANCED LIFE SUPPORT. TWO, UM, MILEAGE. WE CHARGE 21. AND THEN CURRENTLY OUR TREATMENT, NO TRANSPORT IS $150. [00:10:01] AND THIS IS FOR THE CALLS THAT WE GO OUT ON. EITHER WE WERE REQUESTED AND TREATMENT WAS GIVEN. UM, AND THEN THAT PATIENT DECIDES AT THAT POINT THEY DO NOT WANT TO BE TRANSPORTED. UM, THERE'S STILL A BASE FEE TO GO AHEAD. I HAVE A QUESTION ABOUT THAT. SO WE'RE BUILDING PEOPLE WHO DID NOT CALL THE AMBULANCE THAT DO NOT WANNA GO TO THE HOSPITAL IF THEY DID NOT CALL THE AMBULANCE. SO IF I FELL OUT, YOU CALLED THE AMBULANCE FOR ME AND I WOKE UP AND SAID, OH, YOU KNOW, I HAVE A HISTORY OF SEIZURES, I DON'T NEED TO GO TO THE HOSPITAL, THEN NO, WE DO NOT BILL THOSE. AND UM, OUR QUALITY ASSURANCE BILLING IS WHO REVIEWS THOSE AND MAKES SURE THAT THOSE GET PULLED PRIOR TO GOING BILLING. WE DON'T, WE DON'T BILL, I KNOW YOU CAN'T BILL MEDICARE, BUT WE DON'T BILL PRIVATE INSURANCE FOR THAT. WE EVEN, EVEN MEDICARE, EVERYTHING GETS BILLED. UH, NOW MEDICARE DOES NOT REIMBURSE FOR THE TREATMENT, NO TRANSPORT. BUT THEN Y'ALL WILL GET THE DENIAL FOR THAT, CORRECT? THAT'S RIGHT. WE BILL FOR DENIAL, BUT, AND THEN THAT PRIVATE INSURANCE WILL, THE PROBLEM IS YOU'RE, HOW ARE YOU GONNA GET THE INSURANCE INFORMATION IF THEY'RE NOT, THEY'RE REFUSING, THEY'RE NOT GONNA GIVE YOU, BUT I BET THEY WILL. MOST TIME THEY WILL. AND I CAN LET RUSS KIND OF GIVE A VERY QUICK SUMMARY ON HOW THAT GOES. WHEN WE DON'T GET THAT BILLING INFORMATION FROM THE PATIENT, THEY DO HAVE WAYS TO RUN THEM AGAINST THE DATABASE. RIGHT? I'LL LET YOU EXPLAIN THAT. SURE. SO ESSENTIALLY WE RECOGNIZE THAT IT'S A 9 1 1 RESPONSE. SOMETIMES THERE'S TIME TO GET INFORMATION, SOMETIMES THERE ISN'T. SO WHAT WE MAKE SURE WE DO ON THE BILLING SIDE OF IT, IT'S, IT'S NOT NECESSARILY SKIP TRACING, BUT PART OF IT IS SKIP TRACING. TRY TO FIND INFORMATION, TALK TO PATIENTS, TALK TO PATIENTS AND THEIR INSURANCE COMPANY SOMETIMES ON THE PHONE. UM, BUT GOING THROUGH A LOT OF STEPS TO MAKE SURE THAT WE GET THE INFORMATION THAT WE NEED SO THAT WE CAN BUILD THE INSURANCES IF THEY HAVE IT. EVEN IF THEY DON'T LEAVE IT ON A, ON A CALL. GOOD. IN ADDITION TO THOSE BILLING BASE RATES THAT YOU SEE, WE ALSO BILL FOR MEDICATIONS AND SPECIALIZED PROCEDURES. SO IF WE'RE DOING AN, AN ADVANCED PLACEMENT OF A CHEST TUBE, THEN THAT IS SOMETHING THAT WE BILL THAT'S OUTSIDE OF OUR NORMAL, UM, TREATMENT PARAMETERS. SO THAT IS BILLED SEPARATELY. WHAT MARGIN DO YOU PUT ON THOSE ITEMS? UM, CURRENTLY, UH, THOSE ARE, WE GO OFF OF OUR CONTRACT PRICING THAT WE DO FOR THE MEDICAL SUPPLIES. AND IT IS A 200% COST OVER THAT. OKAY. CAN, CAN YOU GO OVER THE DIFFERENCE BETWEEN THE BASIC LIFE SUPPORT, THE ADVANCE SUPPORT ONE AND THE UH, TWO? SO YOUR BLS, YOUR BLS, UH, LIFE SUPPORT IS GOING TO BE MINOR ILLNESSES, INJURIES, UH, THEY DON'T REQUIRE ADVANCED TREATMENTS. THEY MAKE UP ABOUT 25% OF OUR TOTAL CALL VOLUME. THE ALS IS MORE SIGNIFICANT. I, UH, I AND INJURIES, UM, CHEST PAINS, INITIAL STROKES, UM, ANYTHING THAT REQUIRE A MORE IN-DEPTH ASSESSMENT. AND WE'LL NEED MORE ADVANCED PROCEDURES. YOU'RE GONNA HAVE AN IV PLACEMENT, UM, CERTAIN MEDICATIONS, EVEN AN AIRWAY PLACEMENT, UM, SOMETHING THAT'S GOING TO SUSTAIN THEIR LIFE. AND THEN OF COURSE YOUR AL AALS TWO, THESE ARE YOUR MORE, UH, THESE ARE YOUR SICKEST, THIS IS THE HIGHEST ACUITY PATIENT. THIS IS YOUR CPR CALLS, UH, MAJOR TRAUMA CALLS. THESE ARE MULTI-SYSTEMS THAT WE'RE HAVING TO DO MULTIPLE TREATMENTS ON. UH, AND THAT'S HOW THOSE ARE DIFFERENTIATED AND THAT'S SET OFF OF THE MEDICARE GUIDELINES. MEDICARE GUIDELINES, THANK YOU. BUT NOT, BUT NOT THE COST OF IT, BUT THE, RIGHT, JUST THE DEFINITION, THE CRITERIA FOR EACH ONE OF 'EM. THERE ARE MANY AGENCIES THAT ACTUALLY DO THE SAME COST FOR ALL THREE LEVELS, RIGHT? UM, ALS MAKES UP 73% OF OUR CALL VOLUME. AND THE A ALS TWO IS 2%. SO THE MAJORITY OF OUR PATIENTS THAT WE RUN ARE GONNA FALL IN THAT ALS CATEGORY. IN FACT. UH, SO YOU'LL HEAR US REFER TO CMS AND THAT IS CENTER OF MEDICARE AND MEDICAID. AND AGAIN, THAT'S WHO SETS, UM, THE AMOUNTS THAT AMBULANCE PROVIDERS CAN BILL FOR MEDICARE AND MEDICAID PATIENTS. AND, UH, WHICH IS VERY IMPORTANT FOR YOU TO KNOW BECAUSE 55% OF OUR REVENUE COMES FROM MEDICARE AND MEDICAID PATIENTS. AND, UH, SO HERE'S WHAT OUR CURRENT RATES ARE COMPARED TO WHAT MEDICARE IS CURRENTLY ALLOWING FOR US TO BILL THEM FOR. SO ANYTHING OUTSIDE THE, THE AMOUNTS LISTED FOR THE ALLOWABLE, THOSE ARE AUTOMATICALLY WRITTEN DOWN. AND UM, ACTUALLY I HAD WHITMAN KIND OF PREPARE A QUICK, JUST A, A COMP, UH, COMPARISON SHOWING, YOU KNOW, IF YOU HAVE A PATIENT THAT DOESN'T HAVE MEDICARE VERSUS IF YOU DO, SO THE ONE THAT DOES NOT, WE CAN BILL THE FULL AMOUNT FOR HOWEVER, THE MEDICARE PATIENT, WE'RE ONLY ABOUT, YOU KNOW, WE'RE ONLY ALLOWED TO BILL A CERTAIN AMOUNT. WE HAVE A SENIOR COMING INTO TOWN, AND AGAIN, THIS IS JUST RECONFIRMING WHAT OUR CURRENT PAYER [00:15:01] MIX IS. UH, THE MAJORITY OF THE PATIENTS IN LEAGUE CITY HAVE MEDICARE. WE'RE 55%. CURRENTLY MEDICAID MAKES UP 5%. OUR PRIVATE INSURANCES ARE 15%. UH, AUTO INSURANCE, WE LEFT IT UP THERE. IT'S 0%, BUT IT'S ACTUALLY NEGLIGIBLE. IT'S BELOW 1%. AND UM, OF COURSE PRIVATE PAY OR IN UNINSURED, THOSE ARE AT, UH, 24%. AND SOME OF THOSE ACTUALLY DO HAVE INSURANCE AS WELL. IT'S JUST THEY DON'T LET US KNOW IN TIME OR THEY USUALLY LET YOU KNOW AFTER THE FACT AFTER WE BILLED THEM THAT, OH, HEY, I DO HAVE INSURANCE. ALL THIS IS A RATE COMPARISON THAT WE DID. THIS IS OF OUR LOCAL ENTITIES. UM, IF YOU SEE LEAGUE CITIES AT THE TOP, WHAT WE DID WAS WE PLACED IT IN THE ORDER FROM LOWEST TO HIGHEST BASED ON THAT ALS ONE CATEGORY, SINCE THE MAJORITY OF OUR PATIENTS ARE THE ALS ONE. AND YOU CAN SEE CURRENTLY WE'RE, UM, AT SOME OF THE LEAST AMOUNT OF BILLING RATES. AND THEN I ALSO HAVE HIGHLIGHTED WHAT THE MEDIAN IS, AND I DID THAT BASED OFF OF JUST OUR LOCAL, UH, THE LOCAL ENTITIES THAT ARE ON HERE. I WAS SPECIFICALLY ASKED TO LIST, UM, LIKE GALVESTON COUNTY, UM, OUR GALVESTON COUNTY AMBULANCE AUTHORITY. THEY'RE LISTED RIGHT BELOW THE MEDIAN. AND UM, AS WELL AS, UH, WEBSTER, WHAT THEY'RE BEING CHARGED. UM, AND THEY'RE IN THE, UH, TOP CATEGORY. WE ALSO WANTED TO SHOW YOU WHAT TEXAS DEPARTMENT OF INSURANCE PUT OUT. UH, IN 2022, THEY DID A STUDY, UH, THEY COLLECTED DATA FROM 2020 THROUGH 2021. AND THIS IS WHAT THEY PUT OUT IN 2022. THIS IS THE MOST RECENT DOCUMENT THAT WE HAVE FROM THE TDI THAT SHOWS WHAT AVERAGE BILLING RATES ARE ACROSS THE STATE. UH, THE TOP LINE IS SHOWING WHAT STATEWIDE IS. AND OF COURSE WE'RE IN EAST TEXAS CATEGORY, SO I ALSO HIGHLIGHTED THAT TOO. AND AGAIN, THE RATES LISTED HERE ARE, ARE FROM 2020 AND WE'RE HOPING ONCE EVERYBODY DOES START REGISTERING THEIR RATES IN 2024 WITH TDI, WE'LL HAVE MORE ACCURATE INFORMATION TO SEE WHAT'S GOING ON WITH EVERYBODY'S BILLING RATES THROUGHOUT THE STATE. ALL RIGHT, SO HERE IS WHAT OUR PROPOSED RATES ARE. AS YOU CAN SEE OUR CURRENT, THIS IS THE MEDIAN THAT I SHOWED ON THE LOCAL AREA AND, UM, WHAT WE'RE PROPOSING. AND HERE IN A FEW MINUTES I'LL SHOW YOU WHY WE'RE PROPOSING OUR RATES TO, UM, TO THESE AMOUNTS. UM, BEFORE WE GO ON THOUGH, I DO WANNA SHOW BY MOVING OUR RATES UP TO THOSE PROPOSED AMOUNTS, I HAD WHITMAN WORK ON SOME PROJECTIONS FOR US TO SHOW WHAT THE POTENTIAL REVENUE CAN BE IF WE DO INCREASE THOSE RATES. AND I'LL LET RUSS KIND OF EXPLAIN THAT A LITTLE BIT MORE. RUSS, CAN YOU, WHEN, WHEN I'M LOOKING AT THE, UM, THE SPREADSHEET THAT WE HAD HERE WHERE IT SHOWED THE BILLINGS AND THE PAYMENTS, AND SO WE'VE GOT THAT PROPOSED. IF WE JUST GO WITH THE CURRENT TWO, THE, UH, 2 MILLION 2 54, 8 56, HOW DO I GET THAT NUMBER? AND SO THEN WITH THE PROPOSED 2,000,750, UH, I KNOW THAT'S FOR THE 2024. HOW DO I GET THAT NUMBER? SORRY, HE WAS SHOWING THE WRONG NO, NO PROBLEM. SO TO TO YOUR POINT, UH, IT'S BASED ON YOUR PAYER MIX. UM, SO OUR PROJECTION IS BASED ON, WE'VE BEEN DOING YOUR BILLING FOR MANY YEARS, UH, AND WE DO KNOW WHAT EVERYBODY AROUND US DOES AS WELL, BUT IT'S BASED ON THE PAYER MIX. UM, SO WE SAY HERE'S THE FEE INCREASE. IT'S NOT GONNA HAVE ANYTHING TO DO WITH MEDICARE OR MEDICAID BECAUSE THAT'S A FEE SCHEDULED THAT YOU'RE STUCK WITH, BUT IT IS GOING TO SHOW UP AS AN INCREASE IN YOUR PRIVATE INSURANCE. THAT'S THE PREDOMINANT AMOUNT THAT IT'S GOING TO BE. SO THAT'S WHAT OUR PROJECTIONS COME INTO. IT'S BASED EXACTLY ON THE PERCENTAGES OF YOUR PAYER MIX WITH THE NEW RATES OR THE ESTIMATED RATES. O OKAY, SO MY QUESTION IS, IF WE LOOK AT THE FISCAL YEAR 23 AND WE LOOK AT THE CHARGES, UM, WE'VE GOT 3,000,075 AND THEN WE'VE GOT $852,000. OKAY. AND JUST KNOW ON THAT SLIDE THAT YOU'RE LOOKING AT WITH THOSE NUMBERS, THAT IS PARTIAL, THAT'S OCTOBER THROUGH APRIL. AND SO IT'S NOT THE COMPLETE FISCAL YEAR FOR 23, BUT THOSE WOULD ADD UP TO ABOUT 3.8 MILLION AND THIS IS A LOT LOWER. AND THOSE ARE GROSS. CORRECT. SO YOUR FIRST, UNDER YOUR CHARGES THE, LET ME GO BACK. SORRY. THAT'S THE CHARGES NOT THE COLLECTIVE. RIGHT. OKAY. AND, AND IT IS BROKEN DOWN TO YOUR GROSS CHARGES AND THAT'S PRIOR [00:20:01] TO THOSE, UH, MEDICARE MEDICAID WRITEDOWNS THAT WE'RE REQUIRED TO DO. SO YOU HAVE BOTH THE, UM, PULL THAT CORRECT. OF COURSE THAT DOESN'T MAKE IT HERE RIGHT BEHIND US IS A LITTLE BIT BETTER. SO, SO SIR, I, I, MY APOLOGIES. WHICH LINE ARE YOU ASKING THE QUESTION ABOUT? DOWN THE 3 MILLION. IF WE JUST LOOK AT THE, THE FISCAL YEAR 23 SO FAR. SO WE'VE GOT THE 3 MILLION, UM, IN THE ALS AND THE 800,000 IN THE BLSE. SO I'M SAYING THAT'S THREE POINT GO OVER TO THE PAYMENTS. CORRECT. AND THOSE ARE YOUR CHARGES. SO, SO WE ONLY, OUR REVENUE DEFINITION IS ACTUAL PAYMENTS. IT'S NOT OUR BILLING. THAT'S RIGHT. CORRECT. OKAY, PERFECT. THAT EXPLAINS IT. THANK YOU. OKAY, ANY OTHER QUESTIONS ON THE PROPOSED THE INCREASE, UM, PROJECTION ? SO HOW DID WE COME UP WITH THE PROPOSED RATES? UM, WHAT WE WERE TRYING TO DO IS LOOK AT WHAT OUR COSTS ARE TO RUN, TO RUN A CALL, YOU KNOW, WHAT ARE OUR COSTS? AND THIS IS WHAT THE UM, THE BIG SHEET THAT I HANDED OUT THE WORKSHEET , UH, THIS, WE DID A UNIT HOUR ANALYSIS AND WHAT WE DID WAS WE TOOK IN OUR BUDGET INFORMATION AND PLUGGED IT INTO THE WORKSHEET. UM, I WILL SAY THERE'S TWO DIFFERENT ONES UNDER FISCAL YEAR 22. UH, THE DARKER BLUE, THE AMENDED IS THE FIRST TIME I DID IT, I DID NOT INCLUDE OVERHEAD COSTS FROM THE CITY. AND THEN, UH, THE BUDGET OFFICE WENT BACK AND, UH, PROVIDED ME WITH OVERHEAD COSTS. AND THAT'S WHAT WE INCLUDED IN THAT AMENDED. AND THEN THOSE SAME COSTS WERE INCLUDED WHEN WE DID THE FISCAL 24, UH, PROJECTIONS OR ESTIMATES. AND, UM, WE ALSO, BEFORE MOVING ON AND DOING OUR CALCULATIONS, WE WENT BACK TO MAKE SURE WE REMOVED OIL AND GAS VEHICLE REPAIR AND MAINTENANCE AND MOTOR POOL LEASE LEASE FEES. UM, SINCE WE CHARGED AN ADDITIONAL MILEAGE, WE DID NOT WANT THAT. WE WANTED TO MAKE SURE THOSE COSTS WEREN'T INCLUDED IN OUR BASE RATES. WELL THEN YOU, THEN YOU BETTER THEN YOU'RE REMOVING THE MILEAGE FROM THE REVENUE AS WELL, RIGHT? NO, IT'S, SO WHY WOULD YOU SEPARATE, YOU CAN'T REMOVE THE EXPENSE WITHOUT REMOVING THE REVENUE. UM, THEY'RE STILL KEEPING THE REVENUE. IT'S JUST NOT ON THIS PAGE. CORRECT. SO WE'RE, IT'S ON A MILEAGE PAGE, RIGHT? SO WE, WE CHARGE MILEAGE. SO YOU HAVE YOUR BASE RATE AND THEN WE'RE CHARGING MILEAGE ON TOP OF THAT BASE RATE. AND WE WERE INSTRUCTED TO MAKE SURE WE WEREN'T LOOKING LIKE WE WERE DOUBLE CHARGING FOR. SO I GUESS INFORMATION THAT'S CHARGING FOR MONEY, I DON'T UNDERSTAND WHY YOU WOULD BACK IT OUT BECAUSE IT'S, IT'S IRRELEVANT. IT'S, IT'S IRRELEVANT WHAT YOU'RE GETTING REVENUE ON BECAUSE THE EXPENSE IS WHAT MATTERS, RIGHT? THE REVENUE IS NOT GOING TO NECESSARILY MAKE UP THE EXPENSE. SO WOULDN'T WE, WE HAVE TO CHARGE FOR THE COMPLETE AMOUNT OF EXPENSE AND THEN JUST RECOVER IT ON THE MILEAGE. I NICK, IT'S NOT GOING TO RECOVER. I THINK THEY'RE JUST SHOWING THIS SHEET MATCHES THAT BLSA LSS CORRECT. ONE AL S TWO NOT THE MILEAGE. AND THEN THE MILEAGE IS A SEPARATE THING. IT'S A TOTALLY SEPARATE THAT HAS TO EQUATE. BUT WHY WOULD IT, THAT'S, THAT'S WHAT I'M SAYING. THAT'S, IT'S NOT GOING TO EQUATE BECAUSE THE WAY MEDICARE WORKS IS NOT GOING TO, YOU ARE GOING TO LOSE MONEY ON IT. SO YOU'RE GONNA SHOW, I I GUESS MY, MY ENTIRE POINT IS THAT WHEN WE'RE LOOKING AT THE EXPENSES, WE NEED TO CAPTURE ALL THE EXPENSES. YOU CAN'T BACK OUT PART OF THE EXPENSES, RIGHT? THEY THEY'RE THEY ARE CAPTURING IT. THEY'RE NOT CAPTURING IT. 'CAUSE THE MILEAGE DOES NOT FULLY CAPTURE WHAT WE'RE SPENDING IN AUTO, IN IN CARING FOR THE, FOR THE AUTOMOBILES. DOES IT OR DOES IT NOT? DOES NOT. IT'S CAPPED. NO, NO. OH, FROM MEDICARE? YES, BUT WE'RE NOT FULLY CAPTURING THIS EITHER. SO WE CURRENTLY CHARGE, WHAT'S THAT GONNA CHANGE A MILE? MEDICARE REIMBURSES NINE. ONE THING THAT WE LOOKED AT WHEN WE WERE DOING THIS UH, STUDY FOR THE ACTUAL COST OF US DOING THE BUSINESS, LIKE THE MAYOR'S TALKING ABOUT WAS ALL THE OVERHEAD COSTS, BUT THE ACTUAL FLEET MAINTENANCE, THE OIL, THE GAS, EVERYTHING THAT WOULD NORMALLY BE INCLUDED. UH, TO THE MAYOR'S POINT TOO, THAT TALKING A BUDGET, IT WAS OPTED TO TAKE THAT OUT SO IT WASN'T ESSENTIALLY DOUBLE BILLING, DOUBLE PAYING FOR WHAT WE ARE ALREADY CAPTURING. SO WE, IS THERE A RULE THAT WE HAVE TO CHARGE MILEAGE THERE? I THINK WHAT THE MAYOR'S GETTING AT IS CAN WE WORK THE AVERAGE COST FOR THE TRANSPORTATION INTO THE, THE A-L-S-B-L-S CHARGES AND NOT CHARGE MILEAGE [00:25:01] SO YOU'RE NOT DOUBLE BOOKING THAT. BUT WOULD WE GET MORE RECOVERY OUT OF IT THAT WAY? YOU, YOU WOULDN'T GET THE ADDITIONAL BECAUSE THEY'RE GONNA PAY, THEY'RE NOT GONNA PAY THAT NINE. YEAH, JENNIFER, RIGHT? THAT'S ACTUALLY NO, MY ACTUAL POINT IS THIS, IS THAT THE MILE, WHAT YOU GET REIMBURSED IN MILEAGE IS IRRELEVANT BECAUSE IT DOES NOT ACTUALLY COVER THE TOTAL AMOUNT. SO THE WAY YOU SHOULD PROBABLY LOOK AT IT IS TAKE THE TOTAL AMOUNT FOR A CALL. SO TAKING ALL THE OVERHEAD, INCLUDING VEHICLE MAINTENANCE IN THAT, AND THEN TAKING THE MILEAGE AS JUST ANOTHER FORM OF REVENUE AS ANOTHER FORM OF REVENUE. IT'S JUST A, IT THAT'S JUST A FORM OF REVENUE THAT COMES OUT ON ALL SIDES OF IT TO LOOK AT IT AS SAYING THAT WE ARE GETTING REIMBURSED, WE'RE WE'RE NOT GETTING REIMBURSED. 'CAUSE IT'S, IT'S NOT EVEN DESIGNED SO THAT YOU'LL EVER BREAK EVEN ON IT. 9 CENTS, 9 CENTS A MILE IS LESS THAN ANY OF US GET REIMBURSED. RIGHT? WHAT'S THE REIMBURSEMENT? 50 CENTS A MILE, 60 CENTS A MILE BY THE SOLID. RIGHT. NOT DOLLARS, WHATEVER. SO IT'S, IT'S, IT'S, AND THESE ARE, THESE ARE INCREDIBLY EXPENSIVE UNITS TO MAINTAIN. SO I JUST USUALLY I THINK YOU JUST PUT IN ALL THE REVENUE AND THEN ALL THE EXPENSE AND COME OUT THE BACKSIDE WITH IT. IS, IS HOW I WOULD THINK THAT YOU WOULD DO IT. WE, WE, WE CAN LOOK AT OBVIOUSLY I DON'T THINK IT ACTUALLY LIKE CHANGES ANYTHING BECAUSE EITHER WAY WE'RE LOSING, AT THE END OF THE DAY WE LOSE $4 MILLION ON THE E EMS A YEAR, WHICHEVER WAY WE CUT IT. SO NOW IT'S JUST ABOUT MINIMIZING THE LOSSES WITH THE, WITH THE MILEAGE. IF WE SET THE MILEAGE AT WHATEVER MEDICARE COVERS CHARGE HAS MILEAGE TO MAKE SURE WE GET THE MOST OUT OF THEM ON THAT. BUT THAT ONLY, WE SAY IT ONLY APPLIES TO SAY THE FUEL, TAKE ALL THE REST OF THE, THE FLEET EXPENSE AND WORK THAT IN AS ADDITIONAL OVERHEAD THAT GOES INTO THIS MATH. THAT MIGHT BE THE WAY TO REALLY MAXIMIZE THE AMOUNT WE'RE GETTING. SO I THINK YOU JUST MAXIMIZE THE TOTAL AMOUNT THAT YOU CHARGE 'EM ANYWAY AND YOU DON'T HAVE TO PROVE IT 'CAUSE THEY ONLY PAY UP TO A CERTAIN AMOUNT MEDICARE AND THEN THE PRIVATE INSURANCE. AS LONG AS YOU'RE WITHIN THE REASONABLE AND CUSTOM AREA, THEY'RE GONNA PAY IT. SO YOU CAN JUST, I MEAN THE STUDIES ARE GREAT BUT YOU JUST STICK THE RATES AS HIGH AS POSSIBLE AND GET THE MOST OUTTA THE PRIVATE INSURANCE COMPANIES AS YOU CAN. I'M GOING, YOU DON'T HAVE TO PROVE TO THE PRIVATE INSURANCE COMPANIES ANYTHING, BUT I WOULD LIKE TO GET AS MUCH OUT MEDICARE AS POSSIBLE. YOU CAN ONLY GET THAT'S WHAT I'M TRYING TO, YOU CAN ONLY GET THE MAX. YOU CAN'T, THERE'S NO FORMULA THAT GETS ABOVE IT. WELL YOU AT LEAST HAVE TO GET THE MILEAGE AT THE NINE NINE WHATEVER TO GET THE MAX. RIGHT? YOU WANNA MAX MILE BUT WE'RE ALREADY THERE. RIGHT. WE'RE NOT GONNA LOWER IT. RIGHT. BUT I'M SAYING DON'T JUST ROLL IT ALL IN AND SAY DO IT ALL HERE. I WOULD HOLD THAT AT LEAST AT THE MINIMUM TO GET THE MAX OUT OF THEM. OF COURSE. OKAY. I I'LL THAT AND THAT IS THE WAY WE, EXCUSE ME, MY APOLOGIES. THAT IS EXACTLY THE WAY WE BILL IT. UM, SO YOUR FEE IS BEST CASE SCENARIO. HOW MUCH DO WE WANT TO CHARGE FOR EACH ONE OF THESE LINE ITEMS INCLUDING MILEAGE? UM, AND KNOWING FULL WELL THAT MEDICARE AND MEDICAID ARE GONNA GO IN AND SAY WE'RE NOT PAYING THAT, WE'RE GONNA PAY THIS, BUT PRIVATE INSURANCE IS GONNA SAY YES, WE ARE PAYING THAT SO WE WILL GET THE MAXIMUM FROM YOUR GOVERNMENT PAYERS. UM, AND YOU'LL GET THE MAXIMUM AS WELL FOR THE PRIVATE INSURANCE IS SO IGNORING ALL THE DETAILS OF, OF THE SAUSAGE MAKING HERE, AT THE PROPOSED RATES, WE'RE STILL LOSING SOME MONEY, RIGHT? ABOUT $4.4 MILLION. OKAY. SO WE COULD SIT HERE AND POLISH A TURD ALL WE WANT, BUT UM, YEAH, I MEAN I THINK RAISE IT TO MATCH WHATEVER THE HIGH ONE IS AND THAT GETS US THE, THE MOST COVERAGE ON OUR, OUR INVESTMENT, RIGHT? YEAH. AND WE, WE GO FROM LOSING 4.9 TO 4.4, WHICH IS SLIGHTLY BETTER. SO LITTLE, A LITTLE SHIFT CALL IT SPENDING NOT LOSING. AND WOULD IF WE, IF WE DO START TO GO TO WHERE MORE OF THE FIRE DEPARTMENT, THEM THEMSELVES ARE RESPONDING TO THE BASIC EMS, DO WE STILL BILL THIS OR IS IT ONLY IF AN AMBULANCE SHOWS UP? THIS IS ONLY FOR THE AMBULANCE. OKAY. SO SO IF A FIRETRUCK COMES TO DO THE UM, THE BASIC SERVICES, THAT'S, THAT'S FREE. YES. CORRECT. OKAY. SO WE DON'T BILL FOR LIFT ASSIST. OUR, SO OUR FIREFIGHTERS ARE OF COURSE THEY'RE NOT AT LEAST AT THE MINIMUM EMT OR EMT AND HIRE TO BE ABLE TO DO THAT FOR US. THEY DON'T CAPTURE PATIENT REPORTS AND ALL THAT. THEY ACTUALLY HAVE TO WAIT FOR AN AMBULANCE TO GET THERE IF THE PATIENT IS INJURED. SO IF IT, IT'S JUST A LIFT ASSIST, THAT'S WHAT IT IS. AND THOSE ARE VERY, VERY FEW NOW THAT FIRE GOES ON WITHOUT EMS BEING THERE. SO WE DON'T DO THAT. DO YOU CHARGE 150 REFUSAL AT THE TIME OR IF EMS IS REQUESTED, RIGHT? YES. OKAY, SO YOU'RE GETTING SOME MONEY JUST NOT SO WE WERE ROLLING FIRE OUT FOR LIFT ASSIST QUITE OFTEN. RIGHT. [00:30:01] AND WE'VE STOPPED DOING THAT. NO, THAT WAS THE, THAT'S WHAT I WAS PLANNING, THAT WAS MY INTENT TO DO THAT TO HELP LESSEN THE EMS COSTS AND ALL THAT, BUT IT ENDED UP NOT WORKING OUT. OKAY. MORE EXPENSIVE TO SEND THE FIRE TRUCK THAN SEND IN THE AMBULANCE A WHOLE FIRE TRUCK. YEAH, IT IS. BUT IT'S ALSO WHEN YOU TUBE AMBULANCE PERSONNELS OR MT. CAN'T PICK SOME OF THE PATIENTS UP. NO, I GET OR CARRY 'EM FROM A THREE STORY HOUSE. I JUST, YEAH. EXPENSIVE. CAN YOU GO, CAN YOU GO BACK TO THE DEFENSE RIGHTS? SO FOR EXAMPLE, TREAT NO TRANSPORT IS GOING FROM ONE 50 TO 3 75 AND THEN WE'LL LOOK AT, WE'LL LOOK AT A COUPLE DIFFERENT WAYS TO DEAL WITH THE VEHICLE COSTS AND MAKE SURE THAT WE'RE CLOSING. IF WE NEED TO ADJUST THOSE, WE WILL. YEAH. AND NICK KNEW THE WORDS BETTER THAN ME, BUT WHATEVER, UH, MEASURE OF, OF INCREASE TO TIE THIS TO. YEAH. SO I, I WOULD SAY JUST TIE IT TO THE LESSER OF 10%, WHICH IS THE CAP. RIGHT? 10% OR MEDICAL TREND ON THE MILLIMAN TREND REPORT. THE LESSER, THE LESSER OF THE TWO. OKAY. SO WHAT MIGHT AS WELL JUST SAY 10% 'CAUSE IT HASN'T BEEN LESS THAN THAT IN YEARS, BUT WE LIVE IN WEIRD TIMES. YEAH, . YEAH. YEAH. SO THEN WE WOULD BRING AN ORDINANCE BACK AT THE NEXT MEETING OR THE DECEMBER 12TH? PROBABLY THE DECEMBER 12TH. OKAY. COOL. GREAT. ANY OTHER QUESTIONS? NO, DEFINITELY A WORTHWHILE EXERCISE. THANK YOU GUYS FOR STAYING ON TOP OF IT. THANK YOU. I APOLOGIZE FOR THANK YOU. RUNNING LATE. YOU STILL GOT IT DONE QUICKER THAN ALL OUR OTHER WORKSHOPS, SO WE'RE GOOD. ALRIGHT AT 5 32. THERE BEING NO FURTHER BUSINESS. THIS MEETING IS ADJOURNED. * This transcript was created by voice-to-text technology. The transcript has not been edited for errors or omissions, it is for reference only and is not the official minutes of the meeting.