SR-111285-6EFD: TCT: bg
Council Meeting 11-12-85
T0:
FROM:
SUBJECT:
Introduction
MAYOR AND CITY COUNCIL
CITY STAFF
AMBULANCE SERVICES
Santa Monica, California
CQ-(-
NOV 12 1985
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This is to recommend that Council authorize the City Manager to negotiate and execute
a contract with Schaefer Ambulance Company for the provision of ambulance services for
persons who are transported at the request of police officers or City Paramedic staff
to an emergency medical facility from a location in the City of Santa Monica.
Background
Persons located within the City of Santa Monica who require transport to an emergency
medical facility can be transported in one of two ways: a) either by City Fire De-
partment paramedic staff or b) by private ambulance company. Due to cost considerations
and staff limitations, current City policy generally is to use City Fire Department para-
medic staff to transport a patient if the patient is in a life-threatening condition.
If a patient is not in a life-threatening condition, Schaefer Ambulance Company is con-
tacted to provide the transport service. The Schaefer Ambulance Company has been the Los
Angeles Caunty contract ambulance company for Santa Monica because it is the only private
ambulance company located in or near the City of Santa Monica.
When a patient is transported by City paramedic staff, the patient is billed for this
service by the Schaefer Ambulance Company on behalf of the City. For the performance of
this billing service, Schaefer retains 30% of all payments received. The Schaefer billing
system is utilized because City staff believes it is the most cost efficient manner to
perform this type of billing procedure. During FY 1984/85, City paramedics transported
749 patients. Of these transports, 539 (72%) were paid by the patient and 210 (28%)
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Mayor and City Council Page 2.
were considered uncollectable. A transport is considered uncollectable if .the patient
does not respond to three separate billings over a period of six weeks.
When a patient is transported by the Schaefer Ambulance Company at the request of the
City, Schaefer bills the patient for this service. During FY 1984/85, Schaefer trans-
ported 1,621 patients in the City of Santa Monica. Of these transports, 1,329 (82%)
were paid by the patient and 292 (18%) were considered uncollectable.
Prior to 1982, Schaefer billed Los Angeles County under provisions of the Countywide
Emergency Aid Plan (EAP) for all uncollectable transports performed by its staff in the
City of Santa Monica. In turn, Los Angeles County, billed the City of Santa Monica.
The County, and subsequently the City of Santa Monica, was billed at approximately 60%
of the uncollected bi]1. In 1982, Los Angeles County implemented an Ambulance Block
Grant Program to replace the EAP. Under the Ambulance Block Grant Program, Los Angeles
County pays Schaefer a flat amount each month and, in turn, bills the City $3,890/month
for all uncollectable transports performed by Schaefer. This monthly payment was estab-
lished on the basis of the average number of actual uncollectable transports over the
preceding five years.
For FY 1985/86, Los Angeles County notified the City that it would pay Schaefer for all
uncollectable transports involving indigent residents of the County but that the City
would continue to be responsible for paying Schaefer for all uncollectable transports,
involving non-indigent persons. This change in payment responsibilities resulted from
a successful lawsuit brought by the City of Lomita and others which maintained that the
County was responsible for emergency medical transport of resident indigents as well as
for their emergency medical care. However, the Los Angeles County Superior Court has
issued a temporary order until November 7, 1985 restraining the County from implementing
Mayor and City Council
Page 3
this new ambulance service plan and change in payment responsibilities to allow cities
sufficient time to determine how they wish to provide emergency transport services for
uncollectable non-indigent patients.
Available Emergency Transport Service Provision Options
The service options available to the City of Santa Monica are as follows:
#l. Go out to bid for ambulance services.
Due to a need for quick response times, this option offers no practical or useful
purpose as there is only one ambulance company located. in or within a close proximity
to the c;ty of Santa Monica. Past efforts to utilize ambulance companies outside
the general area have not proven acceptable. Further, there does not appear to be
sufficient economic benefit to cause an ambulance company to open a facility in Santa
Moni ca.
#2. Contract with the County of Los Angeles to provide a County administered emergency
ambulance system for non-indigent persons. The County would charge an administra-
tion fee of approximately 10% of total billings. This is essentially the same plan
that was terminated. The differences are the 10% fee and the provision for the
County to pay transport costs for resident indigents.
#3. Assign all emergency transport services to Santa Monica Fire Department paramedics,
The Fire Department does not recommend this option due to lack of sufficient per-
sonnel and equipment resources.
#4. Contract directly with Schaefer Ambulance Company which is the same company that
would be used by the County if Option #2 is exercised.
Twenty Southern California cities were surveyed to determine which of the above options
they have chosen to implement. In several cases, Fire Department-provided paramedic
rvlayor and City Counci]
Page 4
ambulance service had been in existence for several years. For over-flow, these depart-
ments also contracted with private ambulance companies. In almost every case, the cost
of this over-flow transportation service is collected directly from the patient by the
ambulance company with the agreement that the city will reimburse if the ambulance company
fails to do so. Of those cities that contract for ambulance needs, the majority has
elected to administer the program themselves rather than utilize the County services.
Budget/Financial Impact
The City's FY 1985/86 budget contains $74,000 of appropriation authority for ambulance
services in account number 01-300-304-000-503. This budget figure was prepared while
the Lomita case was pending and, therefore, a high estimate was used.
Assuming that Schaefer's actual operating and collection experience for FY 1984/85 will
approximate its FY 1985/86 experience and conservatively assuming that none of the 292
uncollectable transports would be resident indigents, the payments by the City to
Schaefer for the period November 1985 - June 1986 are projected to be approximately
$13,600. This projected expenditure in conjunction with continuation of the Ambulance
Block Grant amount of $3,890/month for the period July-October 1985, yields a projected
total FY 1985/86 expenditure of approximately $29,200. Hence, sufficient FY 1985/86
appropriation authority is available to pay the Schaefer Ambulance Company for the trans-
port, at the request of the City, of uncollectable non-indigent patients.
Recommendation
It is recommended that City Council approve Service Provision Option #4 and authorize
the City Manager to negotiate and execute a contract with Schaefer Ambulance Company for
the provision of ambulance services in the City of Santa Monica and to include a further
~~ayor and City Counci 1
discussion of the issue of uncollectables in those negotiations.
Page 5
Prepared by: James F. Keane, Chief of Police
Thomas C. Tolman, Fire Chief
Reference Contract
No. 4599 (CCS).