• Ambulance Director Mike Sullivan: FY 00 Budget: Ambulance (03)
• County Treasurer Cletus Redlinger: FY 00 Budget: Treasurer (14)

Chairperson Bolkcom called the Johnson County Board of Supervisors to order in the Johnson County Administration Building at 1:37 p.m. Members present were: Joseph Bolkcom, Jonathan Jordahl, and Sally Stutsman; absent: Charles Duffy and Stephen Lacina.

Ambulance Director Mike Sullivan said his presentation was laid out in the same format that the instruction forms were laid out for all the department heads. He said he would start with the Fiscal Year ‘99 re-estimated expenses. He said he estimated a 2% decrease in expenses for Fiscal Year ‘99. He stated he had done some additional cost/benefit analysis on purchasing equipment and he decided that they're going to hold off on it until after Fiscal Year ‘99. He said a couple of vendors have given him the opportunity to split costs between this Fiscal Year and next Fiscal Year on a couple purchases. Sullivan stated this is the reason for the decrease. He said most of the adjustments were made in the personnel services lines, not wholly in payroll benefits. He explained the other changes were made in medical supply and medical equipment purchase lines.

Sullivan said he reestimated a 10% increase in revenues because they have been running a lot more EMS responses. He said that increase in revenues was directly tied into what Barb Christianson and he estimate for Fiscal Year ‘99. He stated they began accepting assignment of Blue Cross/Blue Shield in addition to Medicare so all the payments come directly to the Ambulance Service, rather than to the patient. He stated that significantly reduces their accounts receivable cycle and their write off is very minimal. He said that's where the Title 19 and Medicare fees come in so that's where the increases have taken place in the budget. Sullivan stated it's directly related to accepting assignment.

Sullivan stated at a one percent department increase, he would have $13,795 available and he would put all that money in the part time wages line. He said his priority for Fiscal Year 2000 is to meet the additional staffing needs and that requires an additional 1,460 unit hours. Sullivan stated at a performance standpoint, they operate at $67 per unit hour currently, which is very efficient. He said with this percent increase, they'd still be below $68. He projected a call volume increase of 5-6 %, which they are currently seeing. He said it will carry into Fiscal Year 2000. He said that's 235 to 282 additional calls. He stated with a 2% increase, he would put $22,170 into the part time wages line. He said the part time wage requirement that he needs could be met at the 2% department increase, with other line items adjusted. He said at a 3% increase, he would already be at the part time wage requirement and he would take the additional funds and place them in stationary and forms line item. He said they have State and Federal mandates for documentation and Medicare compliance mandates that require additional documentation needs, and he is adjusting the cost for that. Sullivan stated with increased public relation supplies, which is a new line item placed in their budget, would allow them to expand their CPR and First-Aid programs they offer to the community. He said these are revenue generating programs and the extra money would go into ambulance maintenance increases because it's another priority. He said the medical equipment increase would be to replace equipment as needed. He said they are working very well with 12 EKG capabilities which are used in the pre-hospital setting. He stated they only purchase equipment like this after performing a cost/benefit analysis. He said he considers if the money is available and if it's something that's beneficial to the patient and the medical community as a whole. He stated at a 3% department increase, he could meet all of his needs for Fiscal Year 2000.

Lacina arrived at 1:47 p.m.

Sullivan said the 4% increase and above are beyond what he needs but he put the increases in stationary and forms and pharmacy and drugs. He said there is stability in the costs because they have a secured vendor with the University of Iowa and they have annual agreements with them. He explained they don't necessarily lock the costs down but they get them at a slight mark-up from hospital cost. He stated he can wait to put any additional money in this line item until a 4% increase. He said last year they looked at their fleet replacement schedule that he provided to the Board. He stated this fiscal year they initially wanted to replace Adam 22, the oldest unit in the fleet. Sullivan said they did have it scheduled but he thinks they can stretch it to 2001 when he looks at his capital expenditure worksheet. He said at a 4% increase, any additional money he had he would put in the Ambulance 22 line but it's a safe factor because they no longer have those service agreements because they're not available. He stated he would also put additional funds in the radio equipment maintenance line. Sullivan explained they are working with the City of Iowa City on having additional 800 MHz channels available to them, which would enhance communication between ambulances. He stated at 5 %, he would put the additional money in pharmacy and drugs, which would reflect a more realistic amount. He said the pharmacy and drugs line items have been typically overspent because of not doing cost/benefit analyses of using medications. He said they are really downsizing what they carry, in line with the Medical Director and what the hospitals think they should be using. Sullivan said he would spend additional funds on staff development, which would offer all employees the additional educational opportunities at the Ambulance Service and add additional funds on the Ambulance 21 and 23 maintenance lines. He said the medical equipment line would be increased to allow replacement within the same budget cycle, if the Board chooses to replace them in one budget cycle. He said they could do that at 5 %.

Sullivan stated revenues should increase by 10% to carry into Fiscal Year 2000. He said the increases will be seen in the Medicare and Blue Shield call fee line items they have. He said they have a small Medicare base but a significant Blue Shield base of clients they serve. He said all of these payments are made directly to the Ambulance Service when they accept assignment from the insurance providers. He said it increases their billable collection percentage with the minimal write off. He said these are avenues they take at the Ambulance Service to maximize reimbursement. Sullivan explained the Title 19 call fees increase will be minimal because they don't have the client base that utilizes Title 19 that much. He stated that would change as the population configuration changes. Sullivan said Medicare will increase and there will be a small increase in the ambulance stand-by fees for Fiscal Year 2000. He said it will be approximately an additional $65,000 in revenues. He stated that should appear at this end of this budget cycle too.

Sullivan said on the payroll worksheets they are requesting funding for an additional 1,460 unit hours because of the projected EMS response requests. He said they currently have 14 full time positions and 27 part time positions. He explained he had put a cap on 14 full time employees. He said 27 part time employees includes 9 people who operate the Mobile Care Program Force. He said the additional hours would be staffed by part time employees.

Sullivan said on capital expenditures, Adam 22 could wait until 2001 and the total cost is locked now at $84,000, so he'd be requesting half that to be set aside in that fund. He stated Adam 20 would be the next to be replaced in that line and he anticipates replacing it in Fiscal Year 2002. He said the total cost for that would be $86,850. He said he would be requesting $28,833 in Fiscal Year 2000 if it's a possibility. He said replacing Adam 21, the 3rd ambulance on that rotation, in Fiscal Year 2003, totaling $89,000 so he's requesting $22,500 this Fiscal Year. He said there's an option of purchasing a 5th ambulance to respond to the additional EMS response growth and utilize moving the ambulances into a longer rotation. He explained they would replace it with a used ambulance, either in 2001 for $21,580 or a trade out they could remount for less than the $10,000 he would be asking for. He said as soon as he gets a lock on that from the University of Iowa he will tell the Board. He said that would be an acceptable option by splitting the $9,000 in half and still look at 2001 as a replacement date. He said they currently have 3 cardiac monitors and a new one would replace an old Life Pack 10 so all of their ambulances would have this technology, which he would like to replace in 2001. He said that total cost is locked at $14,500 with the company that they use so he'd request half that in Fiscal Year 2000. Sullivan stated he'd like to replace the telephone system in Fiscal Year 2002. He said he doesn't have an amount or a vendor yet. He said that 2002 is the time they want the Ambulance Department connected with fiber optics so they could do it all at one time. He said an estimation was between $10,000 and $12,000.

Duffy arrived at 1:52 p.m.

Sullivan said the other capital expenditure in the building is the copy machine that he'd like to replace in Fiscal Year 2000. He said they currently have a lease agreement that expires in 1999 and the cost of the copy machine at government pricing is $6,653. He stated the Morton Building has been discussed with the Space Needs Committee. He explained they don't have a sophisticated plan in place for this yet but it would cost $65,000 so he'd request $32,500 in Fiscal Year 2000 for that. He said he'd also like to replace the carpeting in the classroom at $5,000 in Fiscal Year 2001 so he'd request half that be set aside in Fiscal Year 2000. He stated he has received 4 bids on storage construction at a cost of $4,000 and he'd like that in Fiscal Year 2000 so they can build the cabinetry they need in the Ambulance Department to store their training equipment, educational equipment and products. He explained there's nothing there now where they can store the stuff in the right way. Sullivan said he had three priorities for the technology budget. He stated the first is a scanner with high resolution, which costs $500 in Fiscal Year 2000, because it would be a better way to manage the documents. He said his second priority would be a laser printer, a 4000 TN, which costs $1,450 and priority 3 is a laptop computer. He said he looked at the laptop over 2 Fiscal Years at that cost because when they do their 2001 mandate from the State for documentation, it would allow his Assistant Director to become more mobile in collecting data from the hospitals. He said he doesn't anticipate anything further between the 2 hospitals and the Ambulance Service so they're going to have to become more mobile. He said the best way to become more mobile is to have a 166 laptop.

Jordahl asked if the Morton Building would be heated and furnished. Sullivan said it would be finished. He said they have other plans they are looking at ahead of it but he wants to start planning for it now. Jordahl said the County Storage Building is nearly full so maybe they should build enough for everybody. Sullivan said most of his records are active but he stores inactive records in the storage complex on the property adjacent to the Ambulance Service. He said active records are kept in the Ambulance Service and most inactive records are destroyed. Jordahl asked how soon they'd need to have access to the materials that might be stored. Sullivan said if it's inactive, he wouldn't need immediate access to those records whatsoever. Bolkcom asked if the storage space was for equipment they use. Sullivan said they have 3 walls that store all the CPR equipment, training equipment, public relations supplies, and educational supplies. He explained it's in boxes and baskets. He stated with the cabinets, they could put stuff away and make better use of the wall space. Duffy asked if the $65,000 was just an estimate. Sullivan said it was just an estimate for a 40 by 45 Morton building that's finished. Duffy said there are other companies with different names that make good buildings too. He said it would probably have to be put out on bid. Sullivan said he would do that but not without the land to put it on. Bolkcom asked what the status of the land for the building was. Sullivan said there was no report on that and he needed to meet with Pat White again. Lacina asked if Sullivan still had the line items for public relations and community education in the budget. Sullivan said yes, that it was all in 2712. He said they moved the money from CPR lines 2711 into 2712 so all the public education is taken out of one line item. Stutsman asked if the line item budget was in e-mail. Board of Supervisors Deputy Administrative Assistant Deana Pillard said it was. Lacina asked if from the ‘99 base to his request without increase, he's looking at $1,400,000 and change. He asked if the tax asking portion was about $124,000. Sullivan said yes. Lacina asked if he would foresee amortizing the building. Sullivan said he projected that as a one year payoff. Lacina said that building a building and setting up a payback schedule amortizing it over a few years would soften the blow. Sullivan said there will be a variable in the actual bids. Bolkcom asked if he was projecting a $124,000 in expenditures next year. Sullivan said yes. Lacina said the expenditures were going up more than that. Sullivan said the 3% would put him at that. Duffy asked if that included the wage increases. Sullivan said it did at 3%. Duffy said he always asked that. Jordahl asked what the total expenditure for ambulances was. Sullivan stated it would be set aside in the capital expenditure fund and would be about 108 to $110,000. Bolkcom asked if the capital projects increase was at the 3% increase. Sullivan said yes. Bolkcom then asked what the total number increase on that 3% was. Sullivan answered 1.5 and noted that ambulance was currently at 1.4.

Bolkcom asked if the proposed ambulance replacements were necessary and timely. Sullivan noted that the current ambulances were going over 100,000 miles. He added that any re-mount option would not be cost effective. Bolkcom wondered about another ambulance company coming into the area. Sullivan named the 2 extant ambulance companies, Southeast Iowa, a non-emergency company, and Coralville Medical Transport, a transfer service that desires to expand its services. Bolkcom asked what would go in the case of a 2% increase. Ambulance saving is decreased, Sullivan said, and there would be less rotation with the ambulances; staffing needs could be met as they are a priority. Duffy asked if Medicare was cutting back on senior citizens and people with disabilities. He also asked if ridership was not going to be increased. Ridership or volume will increase, Sullivan assured. Sullivan also said the Medicare base is low, that Medicare has made it more difficult for patients to receive payment for ambulance services if guidelines are not followed. He said that had been taken care of, that that explains why reimbursements were maximized and why assignment Medicare is accepted. He mentioned discussion of a future federal government mandate for a fee schedule for ambulance services, noting the Ambulance Department's preparedness. In conjunction, Sullivan pointed out that rates hadn't increased since 1990.

Jordahl, referring to earlier discussion of competing ambulance services, asked what aspects of Ambulance Department's budget requests are specifically targeted at making the County's service more competitive in a competitive environment, and secondly asked what could be done to make the County's services more competitive, noting the delicacy of the issue concerning some people's position that public services should not engage in competition for market share. Jordahl then wondered if there is a way to limit the competition's range of service. Lacina responded by noting that the private service will take the profit center from the County, leaving County taxpayers supporting the really critical vitals, leaving the County with the softer money. Stutsman noted Sullivan's plan positioned the County to be as competitive as possible. Sullivan noted the 32 year presence of the Ambulance Department, its various and extensive community programs, and its relationship with the County's hospitals as evidence that the Department is viewed as dependable and reliable. Lacina briefly added that private services are often fly-by-night. Supervisor-elect Mike Lehman asked if service and maintenance was in house or farmed out. Sullivan said the ambulance maintenance is dealt with by one company, the internal/radio work is handled by another company. Pillard informed the Board of a correction on the additional 1,460 hours Sullivan was asking for, noting that those hours did not include the cost of benefits for those hours. Sullivan added that these hours would be equivalent to half-time benefits.

Duffy left at 2:31.

County Treasurer Cletus Redlinger acknowledged that nothing was done to the Treasurer's Department's budget. He said some money was placed in the technology budget. Stutsman inquired of the technology department money. Redlinger replied that the money was for 10 bar code readers for the Tax Department at approximately $350 per reader. Redlinger noted that the readers would speed up processing of tax statements. Lacina asked if those readers could also be used for vehicles. Redlinger replied in the negative. Pillard noted the entire budget consisted of requests for $4,500 for the bar code readers and $1,500 for replacement of old printers. Jordahl wanted to hear about possible projected need for computers now rather than later. Treasurer-Elect Tom Kriz said that would be difficult.

Stutsman asked about safety issues. Redlinger noted the prohibitive cost of bullet-proof glass. Cameras were mentioned by Lacina and Redlinger. Redlinger said Kriz might be able to work something out in Cedar Rapids. Lacina said he thought it would cost between 5 and $7,000. Lacina asked if the salary survey affected the Treasurer's Office. He asked if they had anybody in between the union. Deputy Treasurer Deb Jensen said they did not. Stutsman said the cameras would probably come out of Pat Langenberg's budget anyway. Bolkcom asked if they budgeted for the 27th pay period in individual budgets or set aside a chunk of money like they did last year. Redlinger said he understood that everyone was to put it in. Bolkcom said that way they won't have to have it twice. Redlinger asked if there was money set aside for that. Duffy said half of it was.

Bolkcom asked how Redlinger would describe his computer capabilities in his office. He said there's probably enough flexibility in the computer budget that Information Services Director Jean Schultz oversees that if they needed new PCs, there would be resources to do that. Redlinger stated Schultz was in the process of replacing one in Vehicle Registration and she just did one in the Tax Department. Lacina asked if they were all Windows compatible. Redlinger said the one in their office is not but Schultz is talking about replacing it. Lacina asked about the old DOS one on the left side of the card file. Redlinger stated that was state equipment. Lacina said it was Motor Vehicle's. Lacina commented that that was old. Jensen said they were changing too. Redlinger said they were supposed to come out in January with a terminal and printer that will print all the forms and stickers on demand. Bolkcom asked if there were any questions. Kriz said his comment was geared for a couple years down the road. He said it was a long term process and he couldn't make that decision in 2, 6 or 8 months but maybe in a year. Jordahl said he encouraged him to come forward in a timely manner if he saw things that would enhance operations of his office. Kriz said budget amendments weren't the most idealistic. He stated they also have to address hours. Jordahl asked if it would bring any additional staff costs that should be reflected in the budget. Kriz said he hoped not and he hoped to flex times. He said there's a lot of homework to be done. He stated he anticipates changing it.

Pillard asked if everyone was getting the information. She asked if there was anything she could improve upon. Jordahl said he couldn't get it from the e-mail in the Board room. He said they couldn't be downloaded. Bolkcom asked if he could load the budget worksheets on to the A drive. Jordahl said he didn't think it was necessary. Lacina said he pulled the 9 year history on their revenues, expenses and all their charts to keep a sense of where they are going. He said it was in last year's packet. Pillard stated she had those done but she forgot to print them out. Stutsman asked if they were getting a final technology budget. Pillard said Jean Schultz would present that and departments were being asked to present what they want out of that pool. Lacina asked if capital expenditures would be excluded this year because it's in a separate fund. He said it will distort the graphs if it's included. He said they may want to track all the expenses relevant to a department. Jordahl said the bottom line request from taxes this year is what they should graph. He said the reason for pulling it out was to look at those increases and to encourage people to set money aside. Stutsman said they are still going to have to look at the budget a variety of ways.

Adjourned at 2:46 p.m.

Attest: Tom Slockett, Auditor

By Casie Parkins, Recording Secretary