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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