HomeMy WebLinkAboutKWPH Enterprises dba American Ambulance-Emergency Ambulance Services Advanced Life Support Paramedic Ambulance Services_A-22-374 A-17-218.pdf COU Y Count of Fresno Hall of Records,Room 301
2281 Tulare Street
Fresno,California
!" Board of Supervisors 93721-2198
1856C) Telephone:(559)600-3529
FREC' Minute Order Toll Free: 1-800-742-1011
www.co.fresno.ca.us
August 23, 2022
Present: 5- Supervisor Steve Brandau, Supervisor Nathan Magsig, Supervisor Buddy Mendes,
Chairman Brian Pacheco, and Vice Chairman Sal Quintero
Agenda No. 32. Public Health File ID: 22-0711
Re: Approve and authorize the Chairman to execute Third Amendment to Agreement with K.W.P.H.
Enterprises, Inc., d.b.a.American Ambulance to authorize an increase in maximum allowable user fee
rates,with no change to the term of January 1,2018 through December 31,2027, or compensation
maximum of$9,035,155
APPROVED AS RECOMMENDED
Ayes: 5- Brandau, Magsig, Mendes, Pacheco,and Quintero
Agreement No.22-374
County or Fresno Page 32
co
Board Agenda Item 32
O 1S56 O
FrZEIn
DATE: August 23, 2022
TO: Board of Supervisors
SUBMITTED BY: David Luchini, RN, PHN, Director, Department of Public Health
SUBJECT: Third Amendment to the Agreement with K.W.P.H. Enterprises, Inc., d.b.a.
American Ambulance
RECOMMENDED ACTION(S):
Approve and authorize the Chairman to execute Third Amendment to Agreement with K.W.P.H.
Enterprises, Inc., d.b.a.American Ambulance to authorize an increase in maximum allowable user
fee rates,with no change to the term of January 1,2018 through December 31, 2027, or
compensation maximum of$9,035,155.
On June 13, 2022, American Ambulance submitted a written request to the EMS Agency Director requesting
an increase to maximum allowable user fees with the justification of increasing wages for EMTs, Advanced
EMTs, and paramedics. The proposed represents an increase of approximately 24%; however, the result
will only be an approximately 7.9% increase in actual revenue because nearly 90% of patients transported by
American Ambulance have fixed rates under Medi-Cal or Medicare, which will not increase under the
recommended action. The County's agreement with American Ambulance requires that the Board of
Supervisors approve any user fee adjustments proposed by American Ambulance. There is no Net County
Cost associated with the recommended action. This item is countywide.
ALTERNATIVE ACTION(S):
There is no viable alternative action. Should your Board not approve the recommended action, American
Ambulance will not be able to remain competitive for wages for EMTs and Paramedics.
FISCAL IMPACT:
There is no increase in Net County Cost associated with the recommended action. The proposed
Amendment only changes the user fees that American Ambulance is allowed to bill a patient. American
Ambulance does not receive a subsidy from the County for the provision of ambulance services and is only
funded through its user fees. Under the Agreement, the County compensates American Ambulance
approximately$50,000 annually for transport of Fresno County Jail and Fresno County Juvenile Justice
Campus inmates and patients eligible from the County's Medical Indigent Services Program with 1991
Health Realignment funds, which will not be impacted by the user fee adjustment. Sufficient appropriations
and estimated revenues are included in the Department's Org 5620 FY 2022-23 Recommended Budget and
will be included in subsequent budget requests for the duration of the contract term.
DISCUSSION:
On May 16, 2017, the County entered into an exclusive operating agreement No. 17-218 with K.W.P.H.
Enterprises, Inc., d.b.a. American Ambulance, for the provision of emergency ambulance services.The
County of Fresno page 1 File Number:22-0711
File Number:22-0711
Agreement contains specific performance requirements for ambulance and dispatch services, including
response times, dispatch center operations, and public education and training.
On October 20, 2020, the County executed the first amendment to the EMS Provider Agreement with
American Ambulance for the relocation of the emergency services dispatching and dispatcher training
operations, as well as to make clarifying revisions to the existing EMS Provider Agreement relating to the
integration of the operation of the new EMS Communications Center.
On June 8, 2021,the County executed the second amendment to the EMS Provider Agreement with
American Ambulance to extend the agreement for an additional five-year term from January 1, 2023 through
December 31, 2027, and to allow American Ambulance to implement an Emergency Medical Technician
training program.
On June 13, 2022, American Ambulance submitted a written request to EMS Agency Director requesting an
increase to maximum allowable user fees with the justification of increasing wages for EMTs, Advanced
EMTs, and paramedics. Since the beginning of the COVID pandemic, the healthcare systems, including
ambulance services, have been impacted by a significant shortage of workers entering the healthcare
industry. Locally, hospitals, ambulance providers, and small public safety agencies are struggling to recruit
and retain employees.American Ambulance, as well as most ambulance providers in the valley, are seeking
user fee adjustments in an effort to recruit new employees, increase employee retention and maintain a
competitive pay scale.
While American Ambulance's proposed user fee represents an increase of approximately 24%, the result
will only be an approximately 7.9% increase in actual revenue because nearly 90% of patients transported by
American Ambulance have fixed rates under Medi-Cal or Medicare, which will not increase under the
recommended action. Patients with private insurance will be most impacted by the increase.
This is the first user fee increase that American Ambulance has requested since the ambulance agreement
was implemented on January 1, 2018. The ambulance agreement will expire on December 31, 2027.
REFERENCE MATERIAL:
BAI #34, June 8, 2021
BAI#34, October 20, 2020
BAI #14, May 16, 2017
ATTACHMENTS INCLUDED AND/OR ON FILE:
On file with Clerk-Third Amendment to Agreement with American Ambulance
On file with Clerk- Fee Rate Increase Request
CAO ANALYST:
Ron Alexander
County of Fresno page 2 File Number:22-0711
Agreement No. 22-374
1 THIRD AMENDMENT TO AGREEMENT
2 THIS Third AMENDMENT TO AGREEMENT(hereinafter"Amendment") is made and entered
3 into this 23rd day of August , 2022, by and between COUNTY OF FRESNO, a Political
4 Subdivision of the State of California, Fresno, California (hereinafter"COUNTY"), and K.W.P.H.
5 Enterprises a California Corporation, doing business as AMERICAN AMBULANCE, whose address is
6 2911 E Tulare St. Fresno, CA 93721 (hereinafter"CONTRACTOR").
7 WITNESSETH:
8 WHEREAS, COUNTY and CONTRACTOR entered into Agreement number 17-218, dated May
9 16, 2017 (hereinafter"Agreement"), pursuant to which CONTRACTOR agreed to provide emergency
10 ambulance services to COUNTY; and
11 WHERAS COUNTY's local emergency medical services agency ("EMS Agency") duly
12 established the Fresno County Emergency Medical Services Exclusive Operating Area for the
13 exclusive provision of emergency ambulance services; and
14 WHEREAS, the Agreement was amended for the first time on October 20, 2020, identified as
15 County Agreement 17-218-1; and
16 WHEREAS, the Agreement was amended for the second time on June 08, 2021, identified as
17 County Agreement 17-218-2; and
18 WHEREAS, on June 13, 2022 CONTRACTOR submitted to the COUNTY's EMS Agency
19 Director a written request to adjust user fee rates primarily due to a proposed increase in wages for
20 EMTs and paramedics to remain competitive and increase employee retention in the tight labor market
21 with EMS workers; and
22 WHEREAS, COUNTY and CONTRACTOR now desire to amend the Agreement in order to
23 raise the user fees charged for emergency ambulance services.
24 NOW, THEREFORE, for good and valuable consideration, the receipt and adequacy of which
25 is hereby acknowledged, COUNTY and CONTRACTOR agree as follows:
26 1. That the existing County Agreement No. 17-218, Page Sixty-Seven (67), beginning with
27 Paragraph One (1), Line Five (5) with the word "The" and ending on Line Eighteen (18)with the word
28 "minutes", be deleted and the following inserted in its place:
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I "The maximum allowable fees that Contractor may charge patients for
2 services under the Agreement are limited to the following fees.
3 a. BLS Rate .......................................................................... $1,234.00
4 b. BLS Emergency Base Rate ............................................I...... $1,974.00
5 c. ALS1 Base Rate ................................................................ $1,481.00
6 d. ALS1 Emergency Base Rate ................................................. $2,344.00
7 e. ALS2 Base Rate ............................................................... $2,736.25
8 f. Paramedic Intercept ......................................I................... $1,741.25
9 g. Critical Care Transport .......................I............................ $3,233.75
10 h. Mileage (rate per mile) .................................. $49.00 per loaded mile
11 i. Non-Transport—ALS Treatment Fee ......................................... $500
12 j. Non-Transport—Ambulance Treatment Fee ........................I......... $200
13 k. Stand-by rate (waiting with patient) ........................ $40.00/15 minutes
14 I. Special Event Stand-by (dedicated unit) ................I.... $50.00/15 minutes"
15 2. That the existing County Agreement No. 17-218, Page One Hundred Three (103),
16 beginning with Paragraph One (1), Line Three (3) with the words 11. Insurance"and ending on Page
17 One Hundred Five(105), Line Six (6) with the word "better", be deleted and the following inserted in its
18 place:
19 11. INSURANCE
20 With respect to performance and work under this Agreement, the Contractor shall
21 maintain and shall require all of its subcontractors to maintain in full force and effect insurance as
22 described below:
23 Without limiting the County's right to obtain indemnification from Contractor or any third
24 parties, Contractor, at its sole expense, shall maintain in full force and effect, the following insurance
25 policies or a program of self-insurance, including but not limited to, an insurance pooling arrangement
26 or Joint Powers Agreement(JPA) throughout the term of the Agreement:
27
28
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I a. Commercial General Liability
2 Commercial General Liability Insurance with limits of not less than Two Million
3 Dollars($2,000,000.00) per occurrence and an annual aggregate of Four Million Dollars($4,000,000.00).
4 This policy shall be issued on a per occurrence basis. County may require specific coverages including
5 completed operations, products liability, contractual liability, Explosion-Collapse-Underground, fire legal
6 liability or any other liability insurance deemed necessary because of the nature of this contract.
7 b. Automobile Liability
8 Comprehensive Automobile Liability Insurance with limits of not less than One
9 Million Dollars($1,000,000.00) per accident for bodily injury and for property damages. Coverage should
10 include any auto used in connection with this Agreement.
11 C. Professional Liability
12 Professional Liability Insurance with limits of not less than One Million Dollars
13 ($1,000,000.00) per occurrence, Three Million Dollars($3,000,000.00) annual aggregate. Contractor
14 agrees that it shall maintain, at its sole expense, in full force and effect for a period of three (3)years
15 following the termination of this Agreement, one or more policies of professional liability insurance with
16 limits of coverage as specified herein.
17 d. Worker's Compensation
18 A policy of Worker's Compensation insurance as may be required by the
19 California Labor Code.
20 e. Molestation
21 Sexual abuse/ molestation liability insurance with limits of not less than One
22 Million Dollars ($1,000,000.00) per occurrence, Two Million Dollars ($2,000,000.00) annual aggregate.
23 This policy shall be issued on a per occurrence basis.
24 f. Cyber Liability
25 Cyber liability insurance with limits of not less than Two Million Dollars
26 ($2,000,000) per occurrence. Coverage must include claims involving Cyber Risks. The cyber liability
27 policy must be endorsed to cover the full replacement value of damage to, alteration of, loss of,or
28 destruction of intangible property (including but not limited to information or data)that is in the care,
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1 custody, or control of the Contractor. Definition of Cyber Risks. "Cyber Risks" include but are not
2 limited to (i) Security Breach, which may include Disclosure of Personal Information to an
3 Unauthorized Third Party; (ii) data breach; (iii) breach of any of the Contractor's obligations under
4 [identify the Article, section, or exhibit containing data security obligations] of this Agreement; (iv)
5 system failure; (v) data recovery; (vi) failure to timely disclose data breach or Security Breach; (vii)
6 failure to comply with privacy policy; (viii) payment card liabilities and costs; (ix) infringement of
7 intellectual property, including but not limited to infringement of copyright, trademark, and trade dress;
8 (x) invasion of privacy, including release of private information; (xi) information theft; (xii) damage to or
9 destruction or alteration of electronic information; (xiii) cyber extortion; (xiv) extortion related to the
10 Contractor's obligations under this Agreement regarding electronic information, including Personal
11 Information; (xv) fraudulent instruction; (xvi) funds transfer fraud; (xvii) telephone fraud; (xviii) network
12 security; (xix) data breach response costs, including Security Breach response costs; (xx) regulatory
13 fines and penalties related to the Contractor's obligations under this Agreement regarding electronic
14 information, including Personal Information; and (xxi) credit monitoring expenses.
15 g. Additional Requirements Relating to Insurance
16 Contractor shall obtain endorsements to the Commercial General Liability
17 insurance naming the County of Fresno, its officers, agents, and employees, individually and
18 collectively, as additional insured, but only insofar as the operations under this Agreement are
19 concerned. Such coverage for additional insured shall apply as primary insurance and any other
20 insurance, or self-insurance, maintained by County, its officers, agents and employees shall be excess
21 only and not contributing with insurance provided under Contractor's policies herein. This insurance
22 shall not be cancelled or changed without a minimum of thirty(30) days advance written notice given
23 to County.
24 Contractor hereby waives its right to recover from County, its officers, agents,
25 and employees any amounts paid by the policy of worker's compensation insurance required by this
26 Agreement. Contractor is solely responsible to obtain any endorsement to such policy that may be
27 necessary to accomplish such waiver of subrogation, but Contractor's waiver of.subrogation under this .
28 paragraph is effective whether or not Contractor obtains such an endorsement.
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1 Within Thirty (30) days from the date Contractor signs and executes this
2 Agreement, Contractor shall provide certificates of insurance and endorsement as stated above for all
3 of the foregoing policies, as required herein, to the EMS Director, County of Fresno, Department of
4 Public Health — EMS Division, 1221 Fulton Street, Fresno, CA 93721, stating that such insurance
5 coverage have been obtained and are in full force; that the County of Fresno, its officers, agents and
6 employees will not be responsible for any premiums on the policies; that such Commercial General
7 Liability insurance names the County of Fresno, its officers, agents and employees, individually and
8 collectively, as additional insured, but only insofar as the operations under this Agreement are
9 concerned; that such coverage for additional insured shall apply as primary insurance and any other
10 insurance, or self-insurance, maintained by County, its officers, agents and employees, shall be
11 excess only and not contributing with insurance provided under Contractor's policies herein; and that
12 this insurance shall not be cancelled or changed without a minimum of thirty (30) days advance,
13 written notice given to County.
14 In the event Contractor fails to keep in effect at all times insurance coverage as
15 herein provided, the County may, in addition to other remedies it may have, suspend or terminate this
16 Agreement upon the occurrence of such event.
17 All policies shall be issued by admitted insurers licensed to do business in the
18 State of California, and such insurance shall be purchased from companies possessing a current A.M.
19 Best, Inc. rating of A FSC VII or better"
20 3. The parties agree that this Amendment may be executed by electronic signature as
21 provided in this section. An "electronic signature" means any symbol or process intended by an
22 individual signing this Amendment to represent their signature, including but not limited to (1) a digital
23 signature; (2) a faxed version of an original handwritten signature; or(3) an electronically scanned and
24 transmitted (for example by PDF document) of a handwritten signature. Each electronic signature
25 affixed or attached to this Amendment (1) is deemed equivalent to a valid original handwritten
26 signature of the person signing this Amendment for all purposes, including but not limited to
27 evidentiary proof in any administrative or judicial proceeding, and (2) has the same force and effect as
28 the valid original handwritten signature of that person. The provisions of this section satisfy the
-5 -
1 requirements of Civil Code section 1633.5, subdivision (b), in the Uniform Electronic Transaction Act
2 (Civil Code, Division 3, Part 2, Title 2.5, beginning with section 1633.1). Each party using a digital
3 signature represents that it has undertaken and satisfied the requirements of Government Code
4 section 16.5, subdivision (a), paragraphs (1) through (5), and agrees that each other party may rely
5 upon that representation. This Amendment is not conditioned upon the parties conducting the
6 transactions under it by electronic means and either party may sign this Amendment with an original
7 handwritten signature.
8 4. The Parties agree that this Third Amendment is sufficient to amend the Agreement, as
9 previously amended, and that upon execution of this Third Amendment, the Agreement, First
10 Amendment, Second Amendment, and this Third Amendment together shall be considered the
11 Agreement.
12 The Agreement, as hereby amended, is ratified and continued. All provisions, terms,
13 covenants, conditions and promises contained in the Agreement and not amended herein shall remain
14 in full force and effect.
15 ///
16 ///
17 ///
18 ///
19 ///
20
21
22 ///
23 ///
24 ///
25 ///
26 ///
27 . ///
28 ///
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1
2 EXECUTED AND EFFECTIVE as of the date first above set forth.
3
I
4 CONTRACTOR COUNTY OF FRESNO
i
5 K.W.P.H. Enterprises, dba American
6 Ambulance I
7
C 0- 0j"
9 (Authorized Signature) Brian Pacheco, Chairman of the Board of
10 1 Supervisors of the County of Fresno
11
12 Print Name &Title
13
ATTEST:
Bernice E. Seidel14 Agz"
i Clerk of the Board of Supervisors
County of Fresno, State of California
15 (Authorized Signature)
16
Print Name&Title Deputy
18 Chief Financial Officer or Corporate Secretary
19
20 Mailing Address
2911 E. Tulare St
21 Fresno, CA 93721
22
23
24
FOR ACCOUNTING USE ONLY:
25
Fund: 0001
26 Subclass: 10000
ORG: 56201695
27 Account: 7295
28
-7-
,z
AMERICAN
A M B U L A N C c
June 13, 2022
Daniel J. Lynch, Director
Fresno County Community Health Department
Emergency Medical Services Division
1221 Fulton Mall/P.O. Box 11867
Fresno, CA 93775
Dear Mr. Lynch:
American Ambulance requests approval for a user fee adjustment to certain charges, as detailed
in Attachment-1 to this letter, in accordance with Section V.C. of the Exclusive Operating Area
(EOA) Agreement between the County of Fresno and American Ambulance.This is the first user
fee adjustment requested since the beginning of our current EOA contract on January 1, 2018.
The proposed increase is estimated to yield a 7.93% increase in net revenue per transport
(Attachment-2). The expected revenue increase is a best case estimate, since only
approximately 10% of our patients have private insurance, which is the only payer that will
potentially pay an increased charge. Approximately 90% of our patients will be unaffected by a
user fee increase. Our estimate assumes insurance companies will continue to pay the same
proportion of charges they currently do. However, the reality is that insurance payers of all
types are increasingly denying claims due to their retroactive determination that the transport
lacked medical necessity. In most of these cases, we must either accept a reduced payment or
completely write-off the bill. Many of these patients do not pay their bill in full due to the
prevalence of insurance plans with high deductibles and copays. We also have a generous
hardship write-off policy that reduces personal financial liability exposure for our patients.
The primary reason for the fee adjustment is to offset increases to hourly employee wage scales
for EMTs paramedics emergency dispatchers and support staff that were necessary to attract
and retain EMS workers during an extremely tight labor market. Since the beginning of the
Current EOA Agreement, starting wages have gone up 44.9% for EMTs, 31.1% for paramedics
and 34.2% for dispatchers without a corresponding increase to user fees (Attachment-3).These
increases were partially driven by state-mandated increases to the minimum wage, but also due
ACCREDITF!)
Sinn 2000
—2— June 13, 2022
to labor market conditions. Not factoring increases in previous years, the hourly employee wage
increases for 2022 alone represent a $2.65 million increase in annual expenses, and we project
another $2.4 million increase to wages beginning January 1, 2023. Despite these dramatic
increases, staffing shortages continue, as with EMS providers across the country (Attachment-4).
While there are factors impacting employee hiring for nearly every industry, EMS was affected
particularly hard by the COVID-19 pandemic.
The California Ambulance Association has been leading a grassroots effort, along with
Assemblymember Freddie Rodriguez, for the State of California to increase Medi-Cal
reimbursement to ambulance providers in this year's State budget to provide necessary funding
for competitive EMS worker wages and benefits to improve employee recruitment and
retention. In his letter to the California Assembly and Senate Budget Subcommittees,
Assemblymember Rogriguez rightly points out, "The last time ambulance providers received a
Medi-Cal base rate increase was 1999. However, this increase was cut in 2013, and was never
replaced in future budgets. Our Medi-Cal rate is the same today as in 1999, but when adjusted
for inflation is equal to $63.00." He adds, "For ambulance providers to be able to offer
competitive wages and benefits, we need sustainable funding and reimbursement through the
Medi-Cal program." (Attachment-5). Unfortunately, those efforts to increase Medi-Cal funding in
this year's budget were unsuccessful, leaving little hope for increased Medi-Cal reimbursement
for the foreseeable future. As a result, our only option to fund ongoing employee wage
increases is through a user fee adjustment.
American Ambulance is consistently among the lowest cost ambulance providers in California.
Since January 1, 2018, throughout the current contract with Fresno County, American
Ambulance has not requested an increase to its fees. We would prefer to not make this request,
but believe it is required to support wages necessary to recruit and retain EMS workers in the
current labor environment and assure stability of our !ocal EMS system.
We are prepared to meet with you and your staff to discuss questions you may have or provide
any required supporting detail. Please contact me personally regarding this request.
Sincerely,
Todd R. Valeri
President/CEO
Attachment-1
Proposed Ambulance User Fee Schedule
Current fee I Proposed fee
BLS Base Rate $995.00 $1,234.00
BLS Emergency Base Rate $1,592.00 $1,974.00
ALS1 Base Rate $1,194.00 $1,481 .00
ALS1 Emergency Base Rate $1,890.50 $2,344.00
Mileage (rate per loaded mile) $39.50 $49.00
Special Event Stand-by (dedicated unit per 15 minutes) $40.00 $50.00
ALS2 Base Rate (no change) $2,736.25 $2,736.25
Paramedic Intercept (no change) $1,741.25 $1,741.25
Critical Care Transport (no change) $3,233.75 $3,233.75
Non-Transport -ALS Treatment Fee (no change) $500.00 $500.00
Non-Transport -Ambulance Assessment Fee (no change) $200.00 $200.00
Stand-by rate (waiting with patient per 15 minutes) (no change) $40.00 $40.00
Attachment-2
Charge and Collections Analysis per Transport
Net revenue increase/transport% 7.93%
Current Average Proposed Current Estimated Proposed
Average Charge Average Average Collection Average
Charge per Incease per Charge per Collection per Increase per Collection per
Revenue Increase Transports Transport Transport Transport Transport Transport Transport
Fixed Reimbursement payers
(Medicare, Medi-Cal,uninsured,
contracts,goverment payers) 102,861 $2,077.99 $498.72 $2,576.70 $409.45 $0.00 $409.45
Non-fixed payers
(Private Insurance) 12,014 $2,315.84 $555.80 $2,871.65 $1,943.87 $432.10 $2,375.96
Total/Average 114,8751 $2,102.86 $504.69 $2,607.551 $569.93 $45.19 $615.12
Attachment-3
S-L-arting Wage by Position
5-year
2018 2019 2020 2021 2022 increase
Emergency Medical Technician (EMT) $32,148 $34,944 $39,021 $41,205 $46,592 44.9%
Paramedic $49,591 $50,581 $54,600 $62,608 $65,025 31.1%
Emergency Dispatcher-I $33,226 $34,398 $39,239 $42,042 $44,590 34.2%
U.S.Ambulance Companies Sound Alarm on Workers in Short Supply Attachment-
(9122, 12:39 PA
Health Law & Business
U.S. Ambulance Companies Sound Alarm on
Workers in Short Supply
By Alex Ruoff
March 25, 2022, 2:00 AM
• EMS companies ask lawmakers for aid to curb heavy turnover
• Ambulance groups say worker shortage hurts emergency response
Ambulance companies are warning they face a major worker shortage that could slow emergency response times across
the country if nothing is done to help them.
Industry groups are lobbying Congress to fund training programs for emergency response personnel, and to boost
Medicare pay for ambulance workers. They're hoping these changes can accompany any broader efforts in Congress to
address workforce shortages facing the health care industry.
The groups say the problem is widespread: nearly everywhere in the country, emergency response crews are struggling to
fully staff ambulances.
"I don't know of a service out there right now that isn't feeling a worker pinch," said Shawn Baird, president of the
American Ambulance Association.
https:/(news.bloomberglaw com(health-iaw-and usn• s _- _c_=-_ r e_ z arm-on-.venters- snort-supp s Page 1 of
U.S.Ambulance Companies Sound Alarm on Workers in Short Supply 6/9/22, 12:39 PI,
ti-
EMS
Emergency medical technicians carry a patient involved in a car accident into an ambulance in Joplin, Mo., in August 2021.
Photographer: Angus Mordant/Bloomberg via Getty Images
The ambulance industry has complained that Covid relief money distributed to health-care providers was never given
directly to them. Federal officials sent out rounds of funding to rural providers and hospitals, but not specifically
ambulance companies. That fund has now run dry.
Turnover among paramedics and emergency management technicians ranged from 20% to 30% annually in 2020,
according to a survey the American Ambulance Association released late in 2021. That means ambulance services can
expect to replace their entire staff roughly every four years.
Bureau of Labor Statistics data show health care in general enjoys a lower-than-average rate of employment separations.
The health industry in 2021 had a 39% separation rate, compared to an overall average of 47%.
Read more: Hospitals Push for Crackdown on Pricey Nurse Staffing Agencies
Increased Demand
The ongoing Covid pandemic has increased demand for medical personnel, from physicians to nurses and EMTs, accordin;
to Department of Labor data. At the same time, nurses and other professions that require similar training as first
responders command a higher salary.
https://news.bloombergla.,i.com!iiear,h-iaLv-ana-cuss❑essr,j-s-a:no.iance--emcar-. --_ c. ,_ _- n-ac_: -suppt; Page 2 of
U.S.Ambulance Companies Sound Alarm on Workers in Short Supply 6/9/22,12:39 PK
The median annual wage for EMTs and paramedics was $36,650 in May 2020, about half the pay of a registered nurse,
according to the Bureau of Labor Statistics. Nursing does typically require more education and training, however.
Most ambulance services are regional, and many are publicly run or financed, but they aren't treated the same as fire and
rescue or hospitals, Baird said. EMTs often aren't eligible for tax credits for training programs like nursing and doctor
programs are, or for funds set up for firefighters, he said.
"We're just a little sliver that got lost in the middle," Baird said.
Privately-owned ambulance companies say the worker crunch is hitting them too.
American Rescue Plan Boosted Pay of 740,000 Pandemic Workers
Ted Van Horne, chief operating officer of Global Medical Response, said it's nearly impossible for ambulance companies
like his to compete with hospitals on wages. Horne said his company, one of the largest emergency response companies it
the country with 38,000 employees and backing by private equity, spent $230 million in added expenses for Covid-related
employee assistance in 2020, as well as increased wages.
Despite the higher spending, there's still higher-than-average turnover, he said. "We have this gap, a massive health care
shortage right now," Horne said.
That shortage of personnel can slow response times, he said.
Turning to Congress
Ambulance groups are hoping Congress will come to their aid.
Baird said ambulances don't get reimbursed enough by Medicare or Medicaid and are asking Congress to boost payments
to emergency responders. The group didn't specify specific amounts. They're also asking for money to train new EMTs to
help fix the long-term short supply of workers.
The typical cost of a ground ambulance trip ranges from $224 to $2,204 per transport, according to a Government
Accountability Office report. Medicare pays 80% of any approved ambulance costs once a beneficiary hits their yearly
deductible.
Sens. Bernie Sanders (I-Vt.) and Tina Smith (D-Minn.) Wednesday introduced legislation to authorize a $500 million grant
program to support emergency medical response needs. It would fund training and recruiting volunteers and buying new
equipment, among other provisions. It would also call on federal health officials to report on financial challenges around
EMS crews and make recommendations to Congress on how to address them. The legislation currently has no Republican
cosponsors.
"EMS and fire department calls have skyrocketed during the pandemic," Smith said in a statement. "Yet too often, these
emergency services are understaffed and underfunded."
o contact the reporter on this story: Alex Ruoff in Washington at aruoff@bgov.com
Mips://news.bloomberglavr.com/health-la,:r-and-business?j-s-arno...ance-co-panies-souse-aar- cn-:.o-ters .n-short-supp Page 3 of
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Attachment-
LEGISLATIVE OFFICE BUILDING ( VI E CHAIR
1020 N STREET.ROOM 360B .�3�PtYiG KELLY SEYARTO
SACRAMENTO,CA 95814 MEMBERS
(916)31g_3802 �Ct�jQrTjll ��r1�e�jtItttLtrc CECILIAAGUTAR-CURRY
FAX(916)319-3612 LISA CALDERON
CONSULTANT ADAM GRAY
MIKE DAYTON MARIE WALDRON
CHRISTOPHER WARD
ASSOCIATE CONSULTANT
RYAN FLEMING ASSENIBL) C'Oi1'IRIIT I EE OV
COMMITTEE SECRETARY EMERGENCY MANAGEMENT
TAYLOR GONSALVES
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May 20. 2022
Dr. Joaquin Arambula
Chair
Assembly Budget Subcommittee Number 1.
Health and Human Services
1021 O Street, Suite 8230
Sacramento, California 95814
Senator Susan Talamantes Eggman
Chair
Senate Budget Subcommittee Number 3.
Health and Human Services
1020 N Street, Room 502
Sacramento, CA 95814
Dear Chairs Talamantes Eggman and Arambula:
On behalf of the undersigned Members of the Senate and Assembly,we respectfully request an
increase in the Medi-Cal base rate for ambulance transports to $350, which is still below cost for
service but high enough to ensure California providers can offer sustainable living wages that
attract new recruits and increase wages for current employees to improve retention.
Decades of below cost Medi-Cal reimbursement, combined with Medi-Cal expansion, is
crippling California's ability to recruit and retain qualified emergency medical technicians
(EMTs) and paramedics. Unfortunately, this issue has been building long before the pandemic
started, and it now threatens to undermine the stability of our emergency and non-emergency
ambulance transport infrastructure. To address our retention and recruitment issues, ambulance
providers need a Medi-Cal increase that ensures a sustainable living wage for caregivers, now
and into the future.
Both ambulance service providers and the labor unions that represent the EMS workforce in
California have joined to support this request. Ambulance employers and employees setting
aside differences to join in an effort is indicative of the dire need, and how critical it is the
I-cuislature take this action. which is necessary for the followino reasons:
California ranks 46th in the nation for ambulance Medicaid reimbursement:
The cost of providing ambulance services in California is the highest in the nation, but the state's
$111 Medi-Cal reimbursement rate ranks 46th in the Country. Even our neighboring states have
significantly higher Medicaid reimbursement rates. with Arizona reimbursing $408 for a
Medicaid patient.
California has not funded a Medi-Cal increase for ambulance services since 1999:
The last time ambulance providers received a Medi-Cal base rate increase was 1999. However.
this increase was cut in 2013. and was never replaced in future budgets. Our Medi-Cal rate is the
same today as in 1999, but when adjusted for inflation is equal to $63.00.
The majority of patients reimburse below- cost, or pay nothing for ambulance services:
Current reimbursement rates for Medi-Cal and Medicare patients do not cover the costs of an
ambulance transport. Indigent care, which is often provided for free, cost providers millions in
losses a year, and commercial health insurers often deny coverage for our services or seek to pay
rates below our costs or below a provider's set local government rate.
For ambulance providers to be able to offer competitive wages and benefits, we need sustainable
funding and reimbursement through the Medi-Cal program.
Thank you for the consideration of our request. If you have any questions, please contact my
Chief Consultant of the Assembly Emergency Management Committee at (916) 319-3667.
Sincerely,
FREDDIE RODRIGUEZ CONNIE LEYVA
Assemblymember. 52nd District Senator, 20"' District
Chair. Assembly Committee on
Emergency Management
MELISSA HURTADO JAMES RAMOS
Senator, District 14 Assemblymember, District 40
ADAM GRAY BILL DODD
Assemblymember, District 21 Senator. District 3
I
TIMOTHY GRAYSON REBECCA BAUER-KAHAN
Assemblymember, District 14 Assemblymember. District 16
BILL QUIRK BOB ARCHULETA
Assemblymember, District 20 Senator, District 32
BLANCA RUBIO
Assemblymember, District 48
CC
Chair of the Assembly Budget Committee
Chair of the Senate Budget Committee
The Governor
Speaker
Senate President pro Tempore