The Mono County Paramedic Program continues to exact a burdensome cost impact to the County, and there are no painless fixes. So following a disappointing consultant report from Fitch and Associates on how to cut costs last fall, and an impasse in County/Paramedic negotiations earlier this year, the Board of Supervisors agreed to hold a workshop with the Association in efforts to keep the conversation on the program moving forward.
The Association seized the opportunity to present the Supervisors with ideas of its own, hoping to sway the legislative body to look at giving the department more money from other pots, and actually charge for services rendered rather than cut back on personnel as Fitch had suggested.
At Tuesday’s regular Board meeting, Association President Rick Mitchell came before the Board in the workshop format with thoughts on a cooperative planning effort between the County and the Association. All of the Paramedics had reviewed Mitchell’s presentation and had the opportunity to comment on it, leaving Mitchell with the impression that it fairly represented the entire Association.
Mitchell explained that the medics were in favor of helping offset the $2.7 million burden the program puts on the County’s General Fund, but that they preferred to do so through revenue-raising methods, rather than cost-cutting.
“Fitch had a different focus then what should happen,” Mitchell said. “They wanted to cut personnel but then also wanted a lot of new programs. We want to avoid their ‘cut it to fix it’ approach.”
The Fitch Report suggested changing the system so that an EMS rig would be manned with one EMT and one Paramedic, rather than the current setup of two medics. This switch would be done over time through attrition. The Report also suggested that the County look at starting a Paramedicine Program. However, without enough or any input from vested parties and the community, the report left many, including the previous Board, with a bad taste in their mouth.
Mitchell wasn’t kidding when he said the focus of his presentation was on ways to raise revenue. He presented three ideas to cut costs, and about a dozen ways to generate revenue.
The three cost cutting measures were: cutting A-87 indirect costs, first responder funds, and removing the Fitch Consultant line item of $65,000 from the Paramedic’s budget.
Then he switched gears to revenue enhancement. Seemingly the most controversial idea he threw out was a rearrangement of the County’s Prop 172 funding. Prop 172 was a permanent sales tax increase approved by the voter in 1993 for first responder services.
“I realize this idea would just be taking money from one pocket and putting it into another,” Mitchell said.
Currently the medics don’t get a dime of this funding.
“It all goes to the Sheriff’s Department and the DA’s [District Attorney] office,” Mitchell said. “Twenty percent could justifiably go to the medics.” A number that Supervisor Fred Stump said he and Mitchell had discussed.
In 2012/13 the County received $1.2 million from this funding source. The language in the measure is loose enough that the DA’s office has been able to qualify to receive the funding over the years.
“172 was written to support emergency services and included law enforcement,” said Supervisor Stump. “It was oriented to any vehicle with emergency lights.”
“It [the fund distribution] can be changed,” said new County Finance Director Leslie Chapman. “It is at the County’s discretion.”
However, taking this money from the Sheriff’s Dept. and the DA could leave the County simply robbing Peter to pay Paul. The Sheriff’s Dept. and DA may require backfilling from the General Fund if this change occurred, leaving the Board back where it started.
Other ideas included a resident subscription program where a family would pay a fee that exempts them from the out of pocket expenses of an ambulance ride.
“Emergency services are usually covered by insurance companies, so it would only apply to non-emergency situations,” Mitchell explained. “But it would be a good tool to get in the door and educate people.”
Billing for service rendered was another idea. Currently, according to Mitchell the following services rendered by the Paramedics are currently not billed: CARE FLIGHT transfers, diabetic emergency drug treatment, SVT cardiac emergency treatment, asthma and other breathing treatment, and fire camp and fire line stand-byes. Mitchell suggested the Board consider a substantial base service fee, pointing out that some of these medications cost between $800-$1,000.
One criticism of the program has been that the paramedics aren’t kept busy enough so Mitchell suggested the County stop contracting with a private company for Mental Health Transfers and have the medics do it instead. These are mental health transfers requiring an ambulance, and currently the contract cost is $78,000.
Mitchell’s presentation also suggested an optional, Euro-style Ski Area Subscription Fee. When purchasing a ticket, skiers and riders would have the option to buy some insurance for the day with a dollar or two added to their ticket price.
Supervisor Byng Hunt said that was a good idea, but he wasn’t sure Mammoth Mountain CEO would go for it right now, since a new tax is already going to be placed on lift tickets once the Business Improvement District in Mammoth is in place.
“Even though it’s optional, there’s still the administration of it,” Hunt said.
Lastly, claiming that it was one of the very few things he agreed with Fitch on, Mitchell pointed to raising ambulance fees as another way to increase revenue for the program. Fees were last raised seven years ago.
All of Mitchell’s numbers added up to a savings of approximately $1.1 million to the Paramedic Program’s bottom line.
Mitchell also suggested structural changes to the department for long-term viability and accountability.
“Ambulance fees are the department’s single largest funding source at $1.2 million,” Mitchell explained. “Raising the number of transports to the hospital would raise revenue.” He suggested revisiting an idea that had been discussed with Gary Myers, former CEO and current Acting CEO at Mammoth Hospital regarding incorporation of the hospital’s two ambulances into the Paramedic Program.
Mitchell also suggested creating a Paramedic/Fire District on lands outside any existing fire district such as Swagger Creek, Devil’s Gate and Conway Ranch.
“If incorporated into a County or special Paramedic/Fire District, fire mitigation fees could be collected and divided with the nearest FPD [Fire Protection District] paying them something for the services they now provide for free,” stated Mitchell’s report. “A small percentage of property tax arising from those inside a new district could be divided between the Paramedic Program and the closest FPD who would now, by contract, provide the same structural fire protection services they had previously been providing under a Sphere of Influence obligation.”
“Some of these ideas are complex and may not be logistically feasible,” Stump concluded.
“It’s going to have to have a General Fund Subsidy,” Supervisor Tim Fesko said. “It just comes down to how much. Let’s keep the momentum going.”