Stutsman asked Ambulance Department Director Mike Sullivan if a progress report or site visit had been done with him, and he replied that this is the first one they’ve had. Stutsman said they are pretty informal and they usually have a few questions. Thompson asked Sullivan what issues he is dealing with right now and what trends does he sees that might affect things that the Board cares about, like the budget? Sullivan said that right now they are still in the process of trying to obtain a 5th ambulance. He said they are still waiting for the specifications for the truck to arrive at a vendor they use in Sumner, Iowa. Sullivan said that should be some time in the next 2 months. He said he had originally planned to do this last July, when the money was set aside, and it just didn’t work out for them to get the truck that they had specked as a used ambulance. He said it is still $7,000, and they will hold the truck and use that as a trade in when they buy the new ambulance.

Sullivan said he doesn’t have the end of the year report yet because they are still working on numbers, but that they had 5,241 activities last year. He said he had projected about 5,100, so they are over what he had projected. He said they had a 17% increase in call volume and a 24% increase in actual transports. Sullivan said when the new figures come out for the current year, they will actually be higher. Sullivan said he should have a report prepared for the Board by the end of January, for Fiscal Year 99. Thompson said his budget for November was on target. Sullivan said in the ambulance business projections can be hit and miss. Sullivan said doing mobile care has helped get their numbers up. He said that for their transfer business there hasn’t been any significant change at all, but that it has actually decreased a little bit over the previous 2 years. He said their emergency calls, or 911 calls, have gone up a little bit.

Jordahl asked what differentiates between mobile care and emergency. Sullivan said mobile care is contracted work they do with the University. He said they own and operate the system, and it’s the ground transport system for when their helicopter can’t fly. He said the University staffs it and he provides the drivers because he hires EMT’s. He said they also use it to staff their drivers. Sullivan said the University approached him a year and a half ago about doing that and it generates revenue. He said they provide the drivers and do all the fleet maintenance oversight and scheduling for all the maintenance of the vehicles. He said all the cost is on the University and it doesn’t go through his budget. Sullivan said the only thing his budget accounts for is the personnel time for the EMT’s and then they get reimbursed, plus a margin for that, from the University of Iowa on a monthly basis. Sullivan they gave him a 5 year report before he even got into the contract discussion with them. He said he wanted to see a 5-year report or trend that he had in their business and it had stayed pretty even, about 300 activities a year. He said he then felt that they could do this by using their existing EMT’s. He said they have kind of mastered the scheduling technique, so it really wasn’t incorporating anything new into the operation. He said they just added a few more EMT’s to the service that they used from mobile care and it’s a required call system there, so that works well for them. He said that in addition to that, they can use the EMT’s. He said they have a bigger pool to pick from now because it attracts the part-time employee who knows that there is guaranteed set hours for call, but that extra work can be done, too.

Duffy entered at 1:44 p.m.

Jordahl asked if the drivers hired are EMT’s. Sullivan said they are. He said when you work in the EMS business in Iowa, the State regulates the staffing configurations for ambulances. He said if it’s a transporting ambulance service, a minimum staffing requirement by the State is that you have to have an EMT as a driver. Thompson asked how far they go. Sullivan said they usually only travel around Eastern Iowa, the Northern and Southern part of the State. He said it’s a regionalized center here and now that the Trauma Center Issue has become formalized by the State of Iowa, they have regionalized those centers. He said this part of the State would be the University of Iowa, Central Iowa would be Des Moines Methodist or Mercy Hospital, and Western Iowa would probably be Omaha. He said the small town hospitals would probably use a helicopter, but if weather, maintenance or another flight prohibits it from flying, then they do the transports. He said they also do a lot of driving for their high-risk neonatal team for premature babies born in small town hospitals. He said they’ll drive the team down there, they’ll take care of the baby, and they’ll drive them back. Jordahl said one might say they are spreading Johnson County staff out all over the State, but in actuality they have more EMT’s to draw on to better staff the local service. Sullivan said it is important to know that they are not stretching their resources that staff the County. He said these are people that are hired specifically to do the mobile care. He said even though they are Johnson County employees, they are not going into their scheduled full-time line employees that are scheduled to do that kind of work, the paramedics. He said it is straight forward staffing with EMT’s that are employees of the Ambulance Service, but are providing a driving service for the University of Iowa using their ambulances.

Stutsman asked if Johnson County tax dollars were subsidizing the University of Iowa Hospitals. Sullivan said no. Mike Lehman asked if it was worth the time. Sullivan said it is well worth their time. He said in the agreement, all of the administrative time, all of the management time and any of his own administrative time, all of the clock time and call time is charged to the Hospital. Lehman asked if they are making money. Sullivan said that in their current agreement their margin is 15% right now, with everything taken care of. Sullivan said when they negotiate their contract and there are changes in their wage matrixes, then he will renegotiate the agreement with the University. He said that they have worked closely for a long time with Jeffrey Gauthier, the Administrator for the program at the University of Iowa. Sullivan said he thought they could do this and that it would be a good avenue for the Ambulance Service to generate revenue in an existing market that nobody other than the University was providing. Jordahl asked how long this has been going on and if the revenue numbers are seen in FY 2000. Sullivan said this has been going on a little over a year and a half and the numbers are there.

Lehman asked if the drivers are County employees carried on County insurance. Sullivan said yes. Sullivan explained that when they first looked at and talked about this concept, the University wanted to keep their employees employed because they had existing employees that were dispatchers for the helicopter service. He said when the dispatchers weren’t doing this they were filling in the gaps on the drive schedule for mobile care. He said Gauthier couldn’t keep people to do that and approached him with the concept. Sullivan said he talked to County Insurance Agent of Record Bob Saunders, talked about the risk aspects, talked to the County Attorney’s Office and the University ran it through their legal department, and it was also taken before the Board of Supervisors. He said he signed the agreement with the University and started providing the drivers on the schedule. He said all the scheduling is done at the Ambulance Service and any administrative time, any time by the hour, by the unit, is billed monthly.

Lehman asked how many employees there are. Sullivan said they have 9 EMT’s right now that are just dedicated to the mobile care. He said he would give them the flexibility as Ambulance employees if they want to work a sporting event on a posted schedule. He said they aren’t limited to only Mobile Care. He said that aspect of it, with their time system, enables them to separate them out when they swipe in and out of the electronic system. He said they know when their 8 hour day is half mobile care and half Johnson County services. Jordahl asked if the swiping was a time clock. Sullivan said they have a computerized time clock that they have had for about 3 years. He said they used to do it by hand, but their were 16 different pay scales and a lot of errors. He said he saw this electronic time system and he purchased the program, installed it and everything can be separated out. Jordahl asked if the Ambulance Department’s time system would be applicable to other departments. Sullivan said that he gave books to Information Services Director Jean Schultz earlier in the year and he wasn’t sure if she wanted it just for Information Services or for other County Departments. Sullivan said each of his employees have a little swipe card they use. Jordahl said SEATS Director Lisa Dewey has a grant from ECICOG to put in mobile data terminals on the buses so they can swipe right where they are. Sullivan said if they had the same system in the ambulances they could do it in and out and then if employees were in a satellite location they could just do it on site instead of coming down here. He said it is expensive and could be done. He said he imagines it would be the kind of system they would have in 10 years the bigger they become. Jordahl said grant money could boost the future into the present.

Jordahl said it seems like Sullivan is organized and innovated enough that he would be a prime candidate for grant money if he had time to apply for one. Sullivan said Dewey has given him information on grants. He said it is really hard in the United States right now for the Federal government to tie any direct money into EMS grants. He said the State of Iowa still has grant money for training but it will be gone pretty soon. He said each EMS agency in the County qualifies to ask for a portion of that money to pay for training but he hasn’t done that since he has been here. He says he they have their own budget and he allocates and requests money in the line item. He said it is tough for 12 departments, in this County, to spread that small amount of money out. He said that he would rather see the first responders upgrade themselves and use that money to do that when he can sustain his people on their existing budget and not have to ask for anything there. He said the volunteer departments really use it. He said the paid departments, like Iowa City Fire and his service don’t really request anything from the association to pay for training.

Jordahl said in looking at this centralized system, if Sullivan has a system that works and it would work for Secondary Roads, maybe it will work for a lot of departments. He said maybe there is a way to make one application to modernize the whole County and do it much cheaper than buying it here and there and separately. Sullivan said he has not seen a networking concept to the time system, but he knows it would work in each department. He says it would work in each department because it separates everything out and makes budgeting for him a lot easier because he knows exactly how much money has been spent on sick time, vacation time and hours. Jordahl said if the Human Resource benefit system is going to be computerized they will all have the same stuff. Thompson said it won’t keep track of the employees time per se like a time clock. Jordahl said maybe what has been looked at will only do that. Sullivan said another feature he likes about this system is that it archives almost infinitely so there are no paper records to worry about. He said he can archive it and recall it anytime he wants as well as go back as far as they have had the system and pull up information on any employee. Jordahl asked what format that was in. Sullivan said he isn’t exactly sure but that it’s an infotronic system and it looks like an access database that generates reports and does everything for you. Jordahl said you can just punch it up on the screen instead of having to go somewhere. Sullivan said there are limited computer terminals in the building and security levels so that only management can access this system so an employee couldn’t go to a terminal and change anything. Sullivan said if an employee comes in and forgets to punch in there is a little mispunch slip they can fill out that goes to a manager. He said the manager then enters it into the system by hand and the system shows that it was done by that manager on that date at that time as a hand entry. Sullivan said if you forget to do something or it gets entered wrong, when payroll comes up the system can be pulled in the morning and double checked in a maximum of 2 hours instead of what used to take 3 days. He said everything is just scanned and reports are printed, reviewed, signed and sent over. He said it has paid for itself. He said it was a $3,500 purchase and that included the software and maintenance package at that time. Stutsman said he would have spent that on one weekend. Sullivan said he figured that in almost a year’s time, that was just his administrative time on the weekends doing payroll over 26 periods. Sullivan said it is accurate, too. He said inadvertently he would make mistakes and then spend additional time to that of the weekends making corrections. He said it seemed like an almost never ending process.

Lehman asked if there was a machine at the University. Sullivan said no. Lehman said if someone is going to work there, do they have to come to the Ambulance Building first to punch in which would make Sullivan end up paying road time. Sullivan said all that time is billed to the University. Jordahl said when you are using the scanning time card it’s so tiny he thinks you could get a little box down here for $30. Sullivan said you’d have to have a phone line running in here to do it and the modem to do it. Sullivan said they just report down here when they come in. Jordahl said if they report up there a half hour is saved. Sullivan said when they get called in on an emergency they fill out the misclock form paper and it doesn’t disrupt any record keeping. He said they keep all the copies of the reports that they drive on even though they don’t provide care he still requires all of those copies for accountability that this is what they have done. Sullivan said they don’t bill patients for this service. He said they bill the University for the service that they are providing for the University. He said this way there is no issues with insurance companies or Medicare or anything. He said the University staffs the vehicle, pays the staff, the vehicles are covered under their insurance and between the 2, the use of the vehicles has been extended when it gets busy. Jordahl asked where their nurses are if we have the ambulances. Sullivan said we staff it then and they have voluntary call people they call that are scheduled for call. Sullivan said the driver brings the truck over here and they have extra equipment they put into the mobile care and go.

Jordahl asked, during the Mobile Care transporting, does the County use its won equipment or the University’s. Sullivan said it is the County’s equipment that is used. He said all of the University’s stuff is portable. He said those trucks are only used by the University when the helicopter can’t fly and/or when they have to go get a premature baby. He said they have their own teams over there and everything is in bags so they just take all of their stuff out. He said then when we get into the back of the vehicles they are not stocked like a real ambulance, but they have kits down here that have all of the stuff in them and that are portable. He said anything they use they get reimbursed for, too.

Jordahl asked what the University does if we have staffed our 5th ambulance. Sullivan said they have 2 trucks and only one is used. He said if the University has a call they have a minimum 30 minute window, so when they get a call it takes them about 30 minutes to process internally what they are going to do. He said the University calls them right away through a dispatcher. He said the University is responsible for paging his mobile care people in. He said when his people then get their page they go straight to the garage and they get the vehicle, go to the ER and start the trip so there is never a delay. Sullivan said this service enhances the Ambulance service because it gives them a 5th ambulance now.

Thompson asked Sullivan about the changes coming from Title XVIV that might make him relook at his fees. Thompson asked how he is going to get the place where he comes to the Board with the recommendations by changing fees. Sullivan said he has started the process by talking to other services in the region. He said some service directors believe it is an ethical issue about sharing fee structures. He said that with Medicare, since they accept assignment, he can get fee structures from others that participate, but only those that participate. Sullivan said that right now the ambulance industry does not have the final ruling from HCFA, the Health Care Finance Administration, who writes all policy for Medicare. He said they are going to establish a fee structure for the industry and it is going to be a complicated formulary. He said Iowa is a regional state and they have an idea where Iowa is going to sit. He said that every year Medicare brings out to people what their allowable charges are. Sullivan said between the new laws, the Balanced Budget Act, and HCFA trying to make a determination where they are going to put the fee schedule, there is a lot of issues about kickback and violations of ambulance services that are charging too little for their services.

Sullivan said he has to keep a close eye on what people in the County are charged and what it is costing them to operate the service. He said that for the base fee he charges, it doesn’t matter what service he provides, whether it is everything or the basic stuff. He said it will be construed by Medicare as an antitrust practice in the industry because your fees should be in line with what it costs to operate your service. He said there a lot of ambulance services across the country that come into regions and set up because they are not regulated. He said there are very few states in this country that regulate the ambulance industry, where they would say you can only have one ambulance service for your entire county. Sullivan said the private services that are coming in do not charge realistic fees for what it costs them to operate, so Medicare is saying that is not fair. He said it’s not fair to the beneficiary because you can’t guarantee the same level of care that the other services give them. Sullivan said it’s costing them more to operate because they are providing that level of care. He said you’re not going to guarantee the level. He said you’re going to charge less and the consumer will be confused because they will use the cheaper service but won’t get the care. Sullivan said what the industry has lobbied all along, even through the Balanced Budget Act, is we all want to be on the same playing field with it. He said that if we’re going to provide advanced level care then charge for it, and the same with basic level care so there is no mistake. He said it doesn’t mean everyone needs to charge the same amount of money, but if Medicare does an audit and you’re not charging what is reasonable for your services then they will ask you why you are cheaper than the other providers in the area.

Thompson said a correlation has to be shown between the charge and the actual cost. Sullivan said they have done that. Sullivan said they have a high collection percentage, their reimbursements are private pay and third insurance pay, and there are very few Medicare patients in the County. He said their base fees are well below what is allowable by Medicare, and even if a service charged the maximum allowable, that means that that’s the amount of money that Medicare will pay and reimburse completely. Sullivan said there are a few private ambulance services in Iowa, that charge a lot more for their services because they’ll accept the 10 to 20% write off if they’re charging $600 for a basic transport. Sullivan said that’s not necessary here.

Thompson asked how Sullivan’s charges relate to actual costs. Sullivan said that right now they are in the 50% for Medicare. He said that this spring his plan is to send the Board information showing that this is what Medicare now allows for reimbursement, this is what we currently charge for services, this is our volume and this is the anticipated adjustment in the revenue by doing this. He said the decision to change it any level up to that point will then be up to the Board. He said other ambulance services around have, for competitive reasons, have kept their fees low so they don’t lose a share of their market. He said he wants to present to the Board options relating to what they currently charge, what they generate in revenues based on this collection rate, the volume, what Medicare is reimbursing and what the industry looks like it will do. He said once the fee schedule is established it’s going to be as equitable as possible, but that’s up to HCFA. Sullivan said reports won’t be seen from ambulance directors anymore that say they need to increase or decrease their fees, because that will be done by Medicare. Sullivan said the difficulty with the ambulance industry as a whole is because insurance companies tend to follow that as well. He said this doesn’t apply to insurance companies and we’re still not clear, from the Balanced Budget Act, legally what the ambulance industry can do.

Sullivan said right now it is illegal to charge a higher fee to a Medicare patient than a non-Medicare patient and it should be illegal. He said if they set the fee schedule, physicians not participating, don’t have to charge the same fees to both patient types. He said Johnson County belongs to the American Ambulance Association and they have a powerful lobbying group. He said the fee schedule probably won’t take place until January of next year because there was language in the Balanced Budget Act that the ambulance industry wanted changed and simple little things to the lay person, like being reimbursed for calling 911 in what they think is an emergency. He said it’s all about medical necessity and not about emergency or non-emergency. He said if Medicare feels it is medically necessary to use the ambulance they will reimburse for it and if they don’t then they won’t. Sullivan said an example is that if someone slips and breaks their ankle on the ice, a prudent person would say there is an emergency. Medicare would say that if there were other available means of transportation there at the time, the person should go to the hospital that way because they don’t feel that it is medically necessary to call an ambulance to pick them up. He said it’s all in the documentation. He said if they get there and the ankle is not deformed but it is swollen they still transport and submit it as a non-billable, instead of a billable claim, and go after it on review. He said most of the time on review, based on what the doctor writes, they would get reimbursed for it, but it’s not a guarantee that each time you transport someone you’ll get paid for it.

Jordahl asked if there is a need now to aim a little high to get at least what we need, to be where we want to be, when the fees are set. Sullivan said that every year Medicare submits to all ambulance services that either, participate or bill Medicare, and they’ll let them know that in their region, this is what Medicare will reimburse. He said there are 4 billing methods that a service will use and once you get into that billing method, that’s it, you’re in. He said we bill method 2, which is the preferred method, and it’s base rates and mileage charge. He said when the patient is loaded in the ambulance, Medicare reimburses for the mileage from the scene to the hospital. He said the mileage you get reimbursed by Medicare and Medicaid is all based on loaded miles with the patient, wherever your origination point is to your destination. He said they just came out with a report that indicates there is a window time in the summer that you can do this if you’re a non-participator. He said the Johnson County Ambulance Service participate so all of the reimbursements come directly here instead of to the client, which allows him to have all of the information sent to him about billing services. He said it also leaves that window open at any time if they need to raise their fees or go in to request that. He said if you’re not participating it is kind of like signing up for an insurance policy where you get one sign-in period and then you have to wait 12 months to come back into it. He said that right now our fees and mileage are a lot lower than what Medicare will allow. Sullivan said our fees pay for 50% of our cost. Thompson said they could increase their fees, then.

Jordahl said they want to provide a low cost service for people. He said there is some sort of a philosophy here where they are spending tax dollars to make this service cost less than Medicare would reimburse. He asked if somewhere down the line there was going to be federal involvement in their ability to charge fees that will make it impossible to collect more from Medicare, even if we want to adjust the subsidy to the department, for example. Sullivan said he does not believe there will be a cap on how somebody sets their fee structures. He said all it will be on a fee structure is that’s all Medicare will reimburse. He said if the costs of the Ambulance Department operations double and you can only collect 80% instead 90% of it now, then you either have to increase your market share somehow by diversifying or you have to accept the subsidy going up. Stutsman said we have to be realistic about how much we want to subsidize this and balance it. Sullivan said this is a volume driven business. He said you can charge a lot of fee money and depending on what you charge, your retail fee could be real high. He said people don’t like to do that, though, but sometimes a large market share has to in order to offset the service cost, which then causes customer focus to be lost.

Jordahl said he wants to put tax dollars towards having a service of this quality available. Jordahl said that when you do want to use it you want it to be there and they want it to be there for people who need it. Sullivan said the County’s tax subsidy is keeping a service in operation in a standby mode and that is the expense of operating this kind of business. Lehman said you’ve got no way of knowing how many transports you’re going to do. Sullivan said there are other costs, too, in operating the service. He said you don’t have the luxuries of the private enterprise, like minimum staffing issues, because if you have to have 4 ambulances staffed and 2 people are gone, then you have to find 2 replacements and it’s expensive to do that because of the nature of the work.

Duffy asked about the cost of someone using the ambulance. Sullivan said if someone is brought in as an emergency, the cost base rate would be $185 and then $3.35 on top of that because it’s $3.35 a mile, and there is a minimum requirement of a mile under insurance requirements and you have to bill for that. He said that no matter where you live the base cost for an emergency transport is $185. He said it doesn’t matter what level of care it is, once you’re in the ambulance, from your origination to your destination it is $3.35 a mile. He said there is no charge going out to the call. He said their 911 base rate for a paramedic level call is $345, a cardiac arrest is $455 and a non-emergency transport, where no medications have to be given or IVs started, is $145 with mileage still at $3.35. He said all of these numbers, except the $145 are at 50% of what Medicare allows now. Thompson said she would be in favor of looking at an increase as long as they didn’t exceed actual costs.

Sullivan said they do have write-offs. He said waiving fees is not a good practice, but he has established hardship guidelines based on the federal poverty guidelines. He said they have had no trouble with it and have used it no more than half a dozen times in any given year. He said all they ask is that if a client doesn’t have insurance, is on Title XVIV or just can’t afford it, they show a proof of income, like a bank statement or tax report. He said that if they have children or are single parents, it all fits into a discount system that sets a legal federal guideline discount and the discount varies. He said they can then work with payment arrangements.

Sullivan said he feels they operate an outstanding level of care in this community that is second to none state-wide and probably one of the best in the country. He said that there is approximately a $1.4 million budget and he looks at revenue generated and that’s the offset he looks at and what is left. He said he is amazed, due to size of area they have, that they are able to operate at the level they are providing now.

Stutsman asked how Sullivan is doing with performance evaluations. Sullivan said he is doing well. He said the managers and supervisors that he has evaluate their specific shift since they are all assigned to one shift. He said he does the evaluations on Stephen Spenler, the Field Supervisors, Barb Christenson and Ann Campbell. He said he finished the evaluations and is right on time with them. He said he finished the evaluations on Jerry Robison and Becky Lloyd. He said this month he has Dave Dvorsky and Corey Bonnett. Thompson asked if Sullivan uses the evaluation tool that the Board uses. Sullivan said the same evaluation tool is used for everybody.

Stutsman said you have to look at whether using the ambulance is practical for everyone because of who will pay for it. Sullivan said if they get to a house where somebody doesn’t need to go in an ambulance, they don’t take them. He said they will help them out to the car or stay with them until someone can come to get the person. He said there is no charge for that even though they responded to the call. He said they get a lot of calls and thank you cards, which he posts on a bulletin board for people to see. He said they rarely get calls from upset people. He said the questions and concerns he gets are about fees and whether they are reasonable and he explains it all to the caller and then they understand.

Lehman said people think they pay taxes so why pay again, but what they’re paying for is the luxury of having the standby service when it’s needed. Sullivan said every agency that does EMS that is transporting in this Country, whether it’s city or county service, all bill for their services. Jordahl said the 50% makes sense to him because you pay half and the County pays half. Sullivan said that this indicates to Medicare that 50% of the services in the region that report are charging more. Stutsman asked if going to 50% would be an increase in fees. Sullivan said they are at the 50th percentile for reimbursement. He said he will show the Board the fee schedules to reimburse by Medicare, how many ALS and BLS emergencies they run, how many miles a year they charge for and what the increase would give with generated revenue. Thompson asked if by next year when the fees are established, if future increases would be based on whatever we have. Sullivan said future increases can go anywhere you want them to go and future reimbursements are going to be tied directly into what that fee schedule is by Medicare.

Thompson said that Jordahl is right in that there would be some advantage to be at their maximum fee at the time they freeze it. Sullivan said that it isn’t going to guarantee you, based on the reimbursement formulary that they use, that same reimbursement fee. Sullivan said that when the new fee formulary comes out they’ll say you can charge $200 but we’re only going to reimburse you $180 for it, and then next year when we make our adjustments as Medicare, then maybe it’ll catch up with your $200 fee and maybe it won’t. He said you can’t go beyond what they’re going to reimburse you for that way. He said if you do that’s your write-off. Jordahl asked if the County can raise the fee that it wants Medicare to reimburse us for after we set the fee this year and Medicare comes back with their figure of what they will pay. Sullivan said it makes more sense to increase what they are charging now because it’s allowable with Medicare. He said whatever the gap is in dollars, you can make the determination of where you put the reimbursement rates for the Ambulance Service. He said he would tie it into what it’s going to generate in revenue on current volume and show that if they are OK here and don’t run 2000 more calls then they will stay here and kind of level out the reimbursement. He said to get it up higher where it should be and then when Medicare comes in with their formulary and sets everything up, all of the ambulance services will be set. He said those that are really low and using it for market competitiveness will take longer to catch up. Sullivan said all the fee schedule is going to do is tie us directly to the fact that this is what Medicare is going to reimburse. He said they are no longer going to see large exponential increases for Medicare. Thompson said she would like to get as close to their maximum as possible without exceeding our actual costs. Stutsman said she would, too, because she thinks there is an issue about if it’s fair to ask the Johnson County taxpayers to subsidize something that we’re not taking advantage of and that’s additional federal dollars. She said she would be interested in what they would have to make up if they don’t go with the higher rates. Jordahl said another way of looking at that is in order to do that they are going to indirectly tax the people who utilize the ambulance service over the next year or so or however long such rates are in effect. He said the additional cost of the ambulance trip rate would go up like $100-150 per trip that they would have to pay. Stutsman said she wonders how many this would affect and how many really are total private pay on ambulance calls. Sullivan said he would get those numbers. Duffy said that if it gets too high people might not call when they should.

Thompson left at 2:44 p.m.

Sullivan said there are people who don’t use the service partly because it is expensive and partly because they will be responsible to pay the bill if it’s not medically necessary under Medicare guidelines. He said the Ambulance Service does all it can. He said Medicare wanted to establish the fee structure for a twofold purpose. He said one is to control cost and the other is to control fraud. He said he would have the numbers and the report to the Board by April and then at that point they can discuss it at a Tuesday meeting or have a work session over it. He said it’s a good thing to do but that it is a sensitive issue.

Duffy asked how many people work here now. Sullivan said there are 52 including him. Lehman asked if it is more lucrative to work for the County or at the University. Sullivan said it is more lucrative to work at the County.

Recessed at 2:48 p.m.; reconvened on January 6, 1999 at 9:43 a.m. with Thompson present.

(Continued in Part 7)