HomeMy WebLinkAboutRES NO 41-99RESOLUTION NO. 4 I - 9 9
A RESOLUTION ESTABLISHING
SUPPLEMENTAL AMBULANCE
SERVICE CHARGES
WHEREAS, Section 5.10.120 of the Bakersfield Municipal Code sets forth the
procedure for certificate holders to request rate schedule increases, and for the City
Council to review and modify the rate schedule; and
WHEREAS, the ambulance operators have requested an additional category for
disposable supplies to recover costs for supplies formerly provided by hospitals, due to a
change in local hospital policy and the Kern County EMS hospital resupply policy; and
WHEREAS, the ambulance operators have agreed to continue their past practice
of restocking first responders (including the City Fire Department) with medical supplies
used for patient care at no cost to the City; and
WHEREAS, the City Council has considered changes proposed by the ambulance
operators in the City of Bakersfield; and
WHEREAS, the City Council has determined that supplemental ambulance service
charges are necessary to provide for an appropriate medical response by ambulance
operators.
NOW, THEREFORE, BE IT RESOLVED by the Council of the City of Bakersfield
that the supplemental charges for ambulance service are hereby set as follows:
Disposable Supplies
(Disposable supplies include any, and all advanced life support
("ALS") or basic life support ("BLS") supplies utilized during patient
treatment, and any drugs and medications included within the Kern
County EMS scope of practice and within the Medicare
reimbursement list. This excludes item(s) restocked by hospitals or
provided by certified first responders, unless the item(s) used by
certified first responders are replenished by ambulance providers.
Charges shall be itemized and the maximum charge for ALS or BLS
medical supplies shall be $100.00 and the maximum charge for those
drugs and medications included within the Kern County EMS scope
of practice and within the Medicare reimbursement list shall not
exceed $275.00. The total amount charged under this category shall
not exceed $375.00 )
--Page 1 of 2 Pages-
The above rates are supplemental to those established in Resolution No. 27-99 and
additional service charges shall not be added thereto. The above rates shall take effect
the day following the adoption of this resolution.
...... o0o ......
I HEFIEBY CERTIFY that the foregoing Resolution was passed and adopted
by the Council of the City of Bakersfield at a regular meeting thereof held on
APR 14 1999 by the following vote:
AYES:
NOES:
ABSTAIN:
ABSENT:
COUNCILMEMBER CA~i;ON, DeMOND, MAGGARD, COUCH, ROWLES, SULLIVAN, SALVAGGIO
COUNCILMEMBER OnE.
COUNCILMEMBER (l n ~.
COUNCILMEMBER A~.
CITY CLERK and Ex~O~io Clerk of the
Council of the City of Bakersfield
APPROVED APR li 1999
BOB
MAYOR of the City of Bakersfield
APPROVED as to form:
HALL
AMBULANCE.
SERVICE
INCORPORA TED
1001-21st STREET BAKERSFIELD, CA 93301-4792
(805) 322-1625 FAX (805) 322-1638
March 22, 1999
Councilwomen, Pat DeMond
Chairperson Budget and Finance Committee
City Council
City of Bakersfield
°* GOLDEN EMPIRE,
AMBULANCE
2700 F STREET BAKERSFIELD, CA 93301-4792
(805) 325-9141 FAX (805) 325-'r524
Dear Chairperson DeMond,
Our letter of February 10, 1999 requested that Hall Ambulance Service, Inc. and Golden Empire
Ambulance be granted by the City of Bakersfield the means to begin itemized billing for medical
supplies and drugs as we are presently doing in the County. Itemized billing would be besides
the normal and customary ALS and BLS rates already in place.
Hall Ambulance Sen'ice. Inc. and Golden Empire Ambulance requests using three categories to
bill for medical supplies and drugs. Attachment I specifies those three categories as ALS
medical supplies, BLS medical supplies and Drugs/Injections. In addition, we have provided an
inventory of items most often included in each category.. It is important to remember that the
Kern County EMS Agency requires ambulances to carry medical supplies and drugs under
County and State established protocols. At times the EMS Agency will change these protocols.
Interaction with hospitals or physicians might dictate changing or upgrading particular medical
supplies. Such changes to treatment procedures and protocols must allow tbr a flexibility in
these lists. Items in each category are listed as "included but not limited to." This flexible
treatment would allow us to make changes in supplies carried on our an~bulances as required by
the County EMS Agency without petitioning the City Council at every. change.
An itemized billing for medical supplies and drugs is the only mechanism. in most instances, that
payers: i.e. Medicare. MediCal, insurance companies. l-IMOs, etc.. will accept to reimburse
ambulance providers. Under our proposal each patient xvill receive an itemized statement of
medical supplies and drugs used. However. we would also propose a maximum dollar amount
charged be placed on each category. The maxinmm that we could charge to any one patient for
ALS medical supplies would be $100.00. The maximum amount tbr BLS supplies would be
$100.00. Under the category of drugs and medicalions, the maximum amount would be $275.00.
Overall, we propose a cap of $375.00/br a combination of a patient's medical supply and drug
charges for any single transport. Attachment II :provides several scenarios on billing tBr medical
supplies and drugs that might help you to understand the process. However. these examples of
dollar amounts might be diftierent depending on whether Hall Ambulance Service, Inc. or Golden
Empire Ambulance transported the patient.
Page -2 -
Our original intention had been to provide to the City Council, for approval, a list of medical
supplies and drugs suggesting a dollar amount for each item on the list. However, the nature of
private business made that a difficult, if not impossible, task. Each company uses different
vendors for supplies, purchases supplies at different prices and employs different mark up
percentages. Approval by the City Council. of the maximun~ allowable charges and the overall
cap on amounts for medical supplies and drugs would give a patient reasonable assurance of fair
billing. Any patient, having questions concerning charges for medical supplies, drugs and
medications, would have the opportunity to bring those questions to the ambulance companies
individually or to the Coun.ty EMS Agency or to the City Council. Ambulance services must
maintain documentation of medical supplies and drugs used for patient care reports and for
individual payer reimbursement.
Hall Ambulance Service, Inc. and Golden Empire Ambulance Service remain committed to re
supplying the fire department with medical supplies that they use in patient care at no cost to the
city.
Therefore, Golden Empire Ambulance Service and Hall Ambulance Service, Inc. request, under
the ordinance, a hearing for the changes to the City ordinance allowing for patient billing of
medical supplies and drugs. We would hope this hearing could be scheduled as soon as possible.
Yours truly,
Harvey L. Hall i
President/Founder
Hall Ambulance Service, Inc.
John F. s
Presid t/CEO
;o n m ir m u ance Service
peAbl
attachments:
Page -3 -
ATTACHMENT I
ALS Medical Supplies (including but not limited to):
Name/Description
Airway (covered only if non reusable)
Bandages/Dressing/Gauze
Cannula
Catheter/IV Tubing
Cervical Collar
Mask (oxygen)
Obstetrical Kit
Restraints (covered only if non reusable)
Linens (covered tier diagnosed contagious)
BLS Medical Supplies (including but not limited to):
Name/Description
Airway (covered only if non reusable)
Bandages/Dressing/Gauze
Cannula
Catheter/IV Tubing
Cervical Collar
Mask (oxygen)
Obstetrical Kit
Restraints (covered only if non reusable)
Linens (covered for diagnosed contagious)
Drugs and Injections (including but not limited to):
Name/Description
Adenosine (adenocard)
Adrenaline, Epinephrin up to 1 ml ampul
Aminophylin, up to 250 mg
Succinylcholine Chloride, up to 20 mg
Hydralazine HC1, up to 20 mg
Maximum $100
Medicare billinl~ codes
A0398
A0398
A0398
A0398
A0398
A0398
A0398
A0398
A0398
MaximumS100
Medicare billin~ codes
A0382
A0398
A0382
A0382
A0382
A0382
A0382
A0382
A0382
Maximum $275
Medicare bi!linff codes
J0150
J0170
J0280
J0330
J0360
Page -4-
Atropine sulfate, up to 0.3 mg
Calcium gluconate (Kaleinate)
Dexamethasone sodium phosphate, up to 4mg/ml
Diphehydramine HC1, up to 50 mg (Benadryl, Benahist)
Glucagon hyrochloride
Furosemide, up to 20 mg (Lasix)
Lidocaine HCI, 50 cc
Mannitol, 25% in 50 ml
Meperidine HCI, 100rag
Midazolam HC1 (Versed)
Morphine sulfate, up to 10 mg
Morphine sulfate (Astramorph PF, Duramorph)
Nalozone HC1. (Narcan)
Oxytocin, up to 10 units
Sodium chloride, 0.9% per 2 ml
Diazepam. up to 5 mg (Valium)
Magnesium sulfate
Potassium chloride
Normal saline solution, 1,000 cc
Normal sale solution, sterile 500 cc
5% dextrose/Normal saline 500 cc
Sterile saline or water up to 5 cc
5% dextrose/water D5W 500 ml
D-5-W, 1.000 cc
Ringer's lactate, up to 1,000 cc
Albuterol sulfate. 0.083% per ml (Proventil)
Albuterol sulfate 0.5% per 1 (Proventil, Vetoolin)
Epinephrine
Bretylium Tosylate, Bretylot~
Calcium chloride
Dopamine hydrochloride
Sodium Bicarbonate
Verapamil hyrochloride, Calan. Isoptin
J0460
J0610
Jll00
J1200
J1610
J1940
J2000
J2150
.12175
J2250
J2270
J2275
J2310
J2590
J2912
J3360
J3475
J3480
J7030
J7040
J7042
J705l
J7060
J7070
J7120
J7620
J7625
J7640
90799
90799
90799
90799
90799
Page -5 -
ATTACHMENT II
The attached page contains three (3) scenarios of patient transports that we deal with on a
daily basis. Beside those treatments or procedures that we are requesting the ability to
charge for, an amount has been inserted for example purposes. This amount would vary
depending on the pricing mechanism of either Golden Empire Ambulance or Hall
Ambulance Service, Inc. Had the total ALS Medical Supplies cost more than $100, then
the maximum charged would have been $100. The same ~vould hold true/br the
medications or injections of drugs. Had the actual cost of the drugs exceeded $275, then
the maximum cap of $275 would have been charged to the patient. In no scenario was
this the case. Finally, had the total cost tbr medical supplies and drugs combined
exceeded $375 then the cap of $375 ~w~uld have been applied instead of the actual
amount.
We hope this has been helpful and clarifies any questions you might have about our
proposal.
Average Pammedic Scenarios with Treatments that are prescribed by the
Kern County EMS Department, EMT-Paramedic Protocols #4200.3591-.3595
Kern County EMS Department, Prehospital Spinal Iramobilization Policies and Procedm'es ~4200.3295
1) Traumatic Cardiopuimonary Arrest (breathing and heartbeat stops due to some
form of trauma, usually severe vehicle accidents or victims of violent crimes).
endotracheal intubation (a tube is placed into the windpipe)
bag valve mask(used to ventilate a patient that cannot breath on their own)
oxygen (administered via the tube that is in the windpipe)
ECG monitoring (constant & continuous monitoring of the heart's status)
spinal immobilization (cervical collar, head blocks, and backboard)
IV access (two IV lines are started to replace fluid/blood loss via a fluid challenge)
thoracic decompression (cook catheter placed to re-inflate the lungs, one or two)
M.A.S.T. application (use of pneumatic trousers to off set low/no blood pressure)
bandages/dressings (used to stem the flow of blood)
epinephrine (used to improve CPR and help excite a heart that has stopped beating)
atropine (used to help restart a heart that is not beating)
lidocaine (used to control erratic heart behavior if the heart starts beating again)
dopamine (used to raise blood pressure if the heart starts beating again)
2) Acute Congestive Heart Failure with Respiratory Compromise (difficulty
breathing due to fluid in the lungs from the back up of blood in a weak or damaged
heart)
4--.11r
.a..,e.
/...r..,,¢7
4Z. ~7
#/cA ,,t,g ToM/
oxygen (administered at a high rate via a mask)
IV access (necessary for the administration of medications)
ECG monitoring (this condition is directly related to the status of the heart)
nitroglycerin (administered usually more than once, increase the size of veins/arteries)
lasix (administered to facilitate the removal of fluid from the lungs)
morphine sulfate (administered to increase the size of veins/arteries)
~5. ~7
,/.a . 5o
in severe cases:
positive pressure ventilation (bag valve mask used to force pure oxygen into lungs)
endotracheal intubation (performed when the patient is to tired to breath on their own)
3) Decline in level of consciousness(due to vehicle accident ~fnd trauma to the head)
go. 3¢
oxygen (administered at a high rate via a mask:)
spinal immobilization (cervical collar, head blocks, backboard)
IV access (necessary for medication/fluid administration)
ECG monitoring (constant & continuous monitoring of the heart's status)
bandages/dressings (to stem the flow of blood loss and protect a wound)
glucose analysis (check of blood sugar)
,,~¥.4 7
/5,37
in cases where the patient is unconscious:
dextrose (administered to rule out low blood sugar)
narcan (administered to rule out meditation/drug induced unconsciousness)
77o/.1,4zS ,r/
~"'"~ ~ HALL
, ~'~~ AMBULANCE,
SERVICE
INCORPORA TED
10al-21~ STI~EET BAKErSFiELD, CA 93301-4792
(805) 322-1625 FAX (805) 322-1638
February, 1 O, 1999
GOLDEN EMPIRE ·
AMB ULAN CE
2703 F STi~E,rF BAKERSFIELD, CA 93301-4792
(805) 325-9t41 FAX (8C,5) 325-t524
Pat DeMon& Council Member
Chairperson Budget and Finance Committee
City. Council
Cit?' of Bakersfield
Dear Chairperson DeMond.
Until February. 1 of this year, Kern County hospitals and Kern County. ambulance providers had a
long-standing agreement providing for the restocking, by hospitals. of specific medical supplies
and drugs. These medical supplies and drugs would have been used or administered by the
paramedic before the patient arrived at the hospital. The hospitals would. in turn, resupply the
ambulances after the call. The hospitals then could charge the patient to recoup the costs of these
medical supplies and drags. On February. 1, 1999. the hospitals in Bakers field and the
surrounding commtmities decided that. legally, they could no longer restock ambulance
providers with medical supplies or drugs except Morphine and Valium.
Hail ,~rnbutance Service, Inc. and Golden Empire .,-xa'nbutance have spent considerable time
trying to calculate the financial impact that this change will have on our businesses. The
resupply agreement between the hospitals and ambulance providers has not covered all medical
supplies or drugs. Hall ,ambulance Service, Inc. and Golden Empire Ambulance have, over the
years, incorporated into the costs of doing business a si.mn.i~cant portion of these medical supply
costs. However, we believe 17t8.11 ,ambulance and Golden Empire ?xanbulance will see a
substantial increase in the dotlax amount of medical supplies and drugs purchased during this
ne,-ct fiscal year. This is the amount we ,rill no longer receive in resupply from the hospitals.
,Medical supplies are one of our biggest financial line items. For either ambulance provider to
increase its medical expenditures, to the extent that we anticipate, is a serious matter. Hall
Ambulance and Golden Empire Ambulance both a~ee that we must, by necessity,, begin
charging our patients for these medical supplies and drugs. To bill patients will not be an easy
task. Ambulance providers face a m.vriad of different billing rules for the various pay sources,
such as Medicaxe, MediCal, managed .care, insurance companies, city. or county,. We also know
that two of our major pay sources, Medicare and MediCal. will only pay us a small portion of the
actual cost of the medical supplies and drugs. Despite all of the difficulties. we are determined to
maintain the high standard of c,.are that the citizens of Bakers~eld and Kem County. have come to
expect.
Page-2-
The Kem County Ambulance Ordinance provides only that we notice the EMS Department in
writing of any rate changes. We have done so. Our bills to patients in the county will now
reflect itemization for these medical supplies and drugs to a maximum of $375.00.
The current regulated rate structure. under which we operate within the City of Bakersfield. does
not allow us to charge patients for medical supplies or drugs used in their treatment. Our
agreement with the City provides that we can request the City of Bakers field tbr rates changes
once a year by December 3 I. [n liter. we submitted a rate change request on December 31.1998.
We did not include a request t~r a method or amount to charge for medicat supplies or drugs. At
the time. we hoped that we could change the stance of the hospitals so they would continue
restocking ambulances. However, we were unsuccessful.
Because of the nature of this crisis, we respectfully request that the City of Bakers~eld grant us
the means by which we can begin billing immediately for medical supplies and drugs.
Therefore. this would mean that besides the normal and customary ALS and BLS base rates. we
would send each patient an itemized billing of' all medical supplies and drugs used in their care.
An itemized list of medical supplies and drugs gives each patient accurate information about
their treatment. We will charge patients for only those medical supplies and drugs used by the
paramedic betbre arrival at the hospital. Billing requirements by such payors as MediCal
requires that the ambulance providers document these itemized costs. In addition. because of the
costly nature of certain of the drugs used. we are willing to place a cap of $375.00 on the charges
that any one patient will pay.
Hall Ambulance Service. Inc. and Golden Empire Ambulance appreciate any help that you. your
committee and the City Council ,,rill give us on this matter.
Yours truly,
H ce 'f/ ......." enrose