1. City of Lynden Ambulance Utility Cost of Service and Rate Study Fire Chief Gary Baar Presented by

2.  RCW 35.21.766 Ambulance Utility Requirements and Approach  Project Tasks  2014 Fire Department Budget and Responses  Cost of Service Analysis and Results  Alternative Rate Scenarios  Questions Page 2 Agenda

3.  Provides for ambulance service to be operated as a public utility  Authorizes the City Council to set and collect rates and charges for regulating, operating, and maintaining an ambulance utility  Requires that rates and charges be based on a cost of service study  Does not allow capital costs for construction, major renovation, or major repair of facilities  Categorizes costs by availability of ambulance service and the demand placed on the service  Exempts Medicaid eligible persons in a nursing home, boarding home, or adult family home and persons who receive in home services Page 3 Key Elements In RCW 35.21.766

4.  Availability costs include the basic infrastructure needed to respond to a single call for service and may include dispatch, labor, training, equipment, patient care supplies, and equipment maintenance costs  Demand costs are based on the burden placed on the ambulance service by individual calls, such as those costs associated with the frequency of calls, distance from hospitals, etc.  Availability costs are uniformly applied across customer classes, while demand costs are based on the calls for service by each customer class Page 4 Ambulance Utility Approach

5.  Conduct Kick-off Meeting  Review and Analyze Fire Dept. Ambulance Costs and Workload Data  Develop Cost of Service Framework and Establish Cost of Service  Identify Customer Classes and Cost Allocation Methods  Calculate Availability and Demand Rates for Each Customer Class  Prepare Reports  Make Presentation Page 5 Consultant Project Tasks

6. Page 6 Lynden Fire Department 2014 Budget 2014 Budget Plus Additional Billing Costs

7. Page 7 2012 Number of Incident Responses

8.  An average of 2.9 full-time line staff and 1.1 volunteers are on duty 24/7  76% of the time spent by full-time line staff and 70% of the time spent by volunteers is for EMS/ Ambulance activities  Administrative staff time (i.e. Fire Chief, Assistant Fire Chief, and Support Services Manager) was split between EMS and Fire based on full-time line staff and volunteer hours, except for 10% of the Fire Chief’s time which is spent on fire plan review and inspections Page 8 Key Cost Assumptions: Labor

9.  EMS and Fire supplies, including EMS medical supplies, were split 60/40 between EMS and Fire  What-Comm 911 and Whatcom County Fire Agencies Radio System (FARS) dispatch services were distributed between EMS and Fire based on total calls for service  Dispatch services provided by the Prospect Fire Dispatch Center are associated with BLS transports to Bellingham and were assigned entirely to EMS  Fleet & equipment maintenance costs were split 44/56 and fuel costs 33/67 between EMS and Fire  Facilities (i.e. fire station) costs were split 40/60 between EMS and Fire  Also included $15,250 of new costs identified by the Finance Department for utility billing services Page 9 Key Cost Assumptions: M&O

10.  For full-time line staff costs, 85% was assigned to availability and 15% to demand. For volunteers, 78% was assigned to availability and 22% to demand  The costs of administrative staff were assigned entirely to availability  Ambulance billing services, EMS supplies, fuel, and Prospect Fire Dispatch Center were assigned to demand  Professional services such as insurance costs and biohazard waste disposal were distributed between availability and demand using the availability to demand ratio for full-time line staff  All other costs were assigned to availability Page 10 Key Cost Assumptions: Availability vs. Demand

11. Page 11 Cost of Service Results

12. Page 12 Cost of Service Adjustments *According to RCW 35.21.766, revenues from the direct billing of individual users of the ambulance service must be netted against the costs of demand. **The $241,743 in budgeted 2014 SAFER Grant revenue has been allocated between fire and EMS based on the results of the cost of service study. Based on the distribution of full-time staff hours, 76% ($182,801) was attributed to EMS, and 24% ($58,942) to fire. * *

13. Page 13 Customer Billing Units *Includes 72 independent living units at Meadow Greens. **Includes 85 rooms at Christian Health Care Center, 107 rooms at Lynden Manor, and 32 rooms at Meadow Greens.

14. Page 14 Customer Class Costs

15. Page 15 Full Cost Recovery Rates - $812,189

16.  Full Cost Recovery  50% Cost Recovery  SAFER Grant Cost Recovery  10 Month 2014 Cost Recovery Page 16 Alternative Rate Scenarios

17. Page 17 Alternative Rates

18. Questions Page 18