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

 RCW 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

 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

 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

 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

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

Page Number of Incident Responses

 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

 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

 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

Page 11 Cost of Service Results

Page 12 Cost of Service Adjustments *According to RCW , 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. * *

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.

Page 14 Customer Class Costs

Page 15 Full Cost Recovery Rates - $812,189

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

Page 17 Alternative Rates

Questions Page 18