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HomeMy WebLinkAbout2002-07-15 Special Called Regular Meeting and Workshop Meeting MINUTES OF THE SPECIAL CALLED REGULAR MEETING AND WORKSHOP MEETING OF THE LA PORTE CITY COUNCIL JULY 15, 2002 1. 2. 3. 4. Call to Order The meeting was called to order by Mayor Norman Malone at 6:00 p.m. Members of City Council Present: Councilmembers Chuck Engelken, Howard Ebow, Peter Griffiths, Barry Beasley, James Warren, Charlie Young, Bruce Meismer and Norman Malone Members of Council Absent: Mike Mosteit Members of City Executive Staff and Cit~ployees Present: City Attorney Knox Askins, City Secretary Martha Gillett, City Manager Robert Herrera, Director of Emergency Services Joe Sease, Human Resources Manager Lorie Doughty, Human Resources Specialist Cindy Gates, Human Resources Specialist Kendra Williams, Assistant City Manager John Joerns, Director of Finance Cynthia Alexander, Director of Administrative Services Carol Buttler, City Manager's Administrative Assistant Crystal Scott, Assistant Director of Finance Michael Dolby, Police Chief Richard Reff, Director of Public Works Steve Gillett Others Present: Reverend Bobbye Worsham, Spero Pomonis and a number of other citizens. Reverend Bobbye Worsham of Second Baptist Church of La Porte delivered the invocation. Mayor Norman Malone led in the Pledge of Allegiance. Council considered approving the Minutes of the Regular Meeting and Workshop Meeting on July 8, 2002. Motion was made by Councilmember Warren to approve the Minutes of the Regular Meeting and Workshop Meeting on July 8, 2002. Second by Councilmember Griffiths. The motion carried. Ayes: Engelken, Warren, Young, Meismer, Ebow, Beasley, Griffiths and Malone Nays: None Abstain: None 5. EXECUTIVE SESSION -PURSUANT TO PROVISION OF THE OPEN MEETINGS LAW, CHAPTER 551.071 THROUGH 551.076, AND 551.084, TEXAS GOVERNMENT CODE, - (CONSULTATION WITH ATTORNEY, DELIBERATION REGARDING REAL PROPERTY, DELIBERATION REGARDING PROSPECTIVE GIFT OR DONATION, PERSONNEL MATTERS, CONFERENCE WITH EMPLOYEES DELIBERATION REGARDING SECURITY DEVICES, OR EXCLUDING A WITNESS DURING EXAMINATION OF ANOTHER WITNESS IN AN INVESTIGATION) Council retired into Executive Session at 6:04 p.m. Council reconvened the Council Meeting at 7:32 p.m. • ! City Council Minutes 7-15-02 -Page 2 7. PETITIONS, REMONSTRANCES, COMMUNICATIONS, AND CITIZENS AND TAXPAYERS WISHING TO ADDRESS CITY COUNCIL There were not any petitions, remonstrances, communications, or citizens wishing to address Council. 8. Workshop was called to order by Mayor Norman Malone at 7:33 p.m. Director of Administrative Services Carol Buttler discussed the City Medical Insurance Fund. EMS Chief Chris Osten reviewed EMS billing charges. Council agreed to move forward with new billing charges. Council also agreed to change the existing transport policy where EMS can now transport patients to the Texas Medical Center. Council agreed to allow this to happen for a period of one year. 9. Closed Workshop and reconvened Regular Meeting at 9:22 p.m. 10. Administrative Reports City Manager Robert Herrera reminded Council of the Mayor and Council dinner on Thursday, July 18, 2002, and the AMCC Conference scheduled on July 25-27, 2002. 11. Council Comments Councilmembers Engelken, Ebow, Griffiths, Beasley, Warren, Young, and Meismer brought items to Council's attention. 12. Adjournment There being no further business to come before Council, the Special Called Regular Meeting and Workshop Meeting were duly adjourned at 9:22 p.m. Respectfully submitted, Martha Gillett City Secretary Pa ed and ap d o this the 22°d day of July 2002. Gl1Z p~ - fp,~ ~ o~~~~~ Norman Malone, Mayor i C • A • CITY COUNCIL WORKSHOP JULY 15, 2002 EMPLOYEE HEALTH SERVICES ~MEDICAL~ FUND -SUMMARY WHAT IS SELF-FUNDING? Self-funding • provides employers the option of allotting funds to operate a health plan for employees. The employer is responsible for a portion but not all of the claims risk. Excessive loss is avoided with the assistance of stop loss coverage. • provides employer the ability to reinsure catastrophic claims separately (through stop loss coverage) by establishing a maximum predictable level of claims costs that are the responsibility of the employer fund. A separate insurance company assumes the risk for excessive individual and aggregate claims. The insurance company establishes a minimum limit that claims cost must reach (based on previous claims history) before reimbursement is due. • provides more flexibility for plan design and financial controls than a traditional insurance plan. HOW LONG HAS THE CITY OF LA FORTE BEEN PARTIALLY SELF-FUNDED? WHAT IS THE PROCESS? The City has been partially self-funded since 1983. Medical fund revenues and expenditures are accounted for in an Internal Service Fund. Revenues are considered as: • Charges to each department's budget -pre-established equal amount per full-time employee. • Premiums paid by employees for dependent coverage -payroll deduction. • COBRA premiums paid by former employees. • Premiums paid by retirees. Expenditures are considered as: • Claims administration -fees to a Third Party Administrator (TPA). • Claims paid -actual payments for medical & Rx claims; includes any reimbursements from Stop Loss Carrier for costs of catastrophic claims. • Re-insurance premiums - to separate carrier for Stop Loss coverage. The City has been paying 100% of premiums for employees; employees have been contributing a portion for dependent coverage. City Council Workshop July 15, 2002 Page 2 of 3 • Current premiums paid by each employee per Month for Medical Coverage: $ 0.00 Employee only $49.83 Employee plus spouse $43.33 Employee plus children $56.33 Employee plus family WHAT IS HAPPENING WITH MEDICAL COSTS IN GENERAL? Premiums for medical and costs are increasing nationally at an average of 15%, but even more so in Texas at an average of 25%, in an attempt by organizations to retain health coverage for their employees. In March 2001, the City made a decision to carry individual stop loss coverage and exclude the aggregate coverage. With the information available at the time, this decision appeared to be appropriate. However, in hindsight, this may not have been a correct decision given actual claims costs paid during the stop loss contract year. (See attached Council Agenda Request and backup). WHAT OPTIONS ARE AVAILABLE TO THE CITY OF LA FORTE TO ADDRESS MEDICAL COST ISSUES? To sustain the City's medical fund, staff is researching the effects of increasing premiums to the fund, increasing deductibles and co-pays, and reducing benefits. Implementation of a Disease Management Program should help control costs for serious diseases that can contribute to catastrophic loss claims (diabetes, hypertension). CHAPTER 17Z OF THE LOCAL GOVERNMENT CODE Chapter 172 of the Texas Local Government Code governs health benefits provided by local governments. However, a local government must adopt Chapter 172, formally by ordinance, to be exempt from certain mandates by the Texas Department of Insurance. Adopting Chapter 172 allows a local government to form a risk pool (a designated self-funded entity), with trustees overseeing fiduciary responsibilities. By not having adopted Chapter 172, the City of La Porte was obligated to meet a recent state mandate to provide medical benefits to dependent grandchildren, in addition to dependent children, up to age 25 rather than the previous age limit of 19. Since this is not atime-sensitive topic, staff plans to present Chapter 172 at a future City Council meeting requesting adoption of this chapter of the Local Government Code. City Council Workshop July 15, 2002 Page 3 of 3 • STAFF INITIAL RECOMMENDATION • • Remain partially self-funded, but continue to monitor the impact of health care costs. • Effective October 1, 2002, increase employee's portion of dependent coverage premiums as listed below: Current Proposed Type Coverage $ 0.00 $0.00 Employee only $49.83 $99.66 Employee plus spouse $43.33 $86.66 Employee plus children $56.33 $112.66 Employee plus family COMMENTS Responses to a recent survey by the Texas Department of Insurance indicate that traditional insurance costs have not been competitive when compared to self-insured costs. During the current fiscal year, several surrounding cities opted for traditional insurance plans. However, some cities (with a large enough employee base) are returning or are considering returning to the self-funded approach, due to the desire for lower premiums and more control over the plan. Those organizations that self-insure do so for financial reasons, as well as, for the ability to design a plan that is more beneficial to employees with lower deductibles and higher benefits than what traditional insurance can provide. Additional backup for this Council packet will be distributed on Friday, July 12, 2002, by 4:00 pm. • The Welch Company Two Memorial City Plaza June 26, 2002 820 Lessner, Suite 1470 Houston, Texas 77024 T: 713.827.8755 F: 713.461.5788 To: City Council, City of LaPorte www.thewelchco.com From: Neal W. Welch, Healthcare Consultant Subject: Downstream Healthcare Action Plan In preparation for the City Council Workshop on JulylSth, I have assembled a package of information designed to encourage your consideration of new initiatives tied to the continued operation of the City of LaPorte medical plan. These initiatives are focused on improving the health of plan participants as the most realistic long range remedial action against double digit medical inflation. Only by improving the general health of the participants can we ever realistically expect to manage the heahh care costs of the plan. To this end there are a great many new ideas in the market place that point us in the proper direction. If we're willing to embrace some new concepts, our long term outlook for healthcare costs should become more manageable. The first set of graphs illustrates the "hockey stick" curve. Although, we'll spend more time with these graphs during the workshop, I think they speak for themselves in describing healthcare utilization patterns in the City's plan. The graphs also help us to understand where and how to approach health care guidance for plan participants. We will discuss in greater detail the concepts shown on illustration 6. Over the past few years in response to client requests, our firm developed a "Model for Health Plan Review". We believe this model gives a Plan Sponsor the proper roadmap to review each segment of their plan. Armed with the proper data, the administration and consultant should be able to target areas where cost or illness abnormalities exist, prioritized these abnormality categories, and subsequently install appropriate remedial action /programs. Now is the time to drill down into the actual medical data contained within the plan and develop a user friendly yet disciplined healthcare program for at least the next three years. We look forward to creating a City of LaPorte downstream plan based on this outline and your guidance. We would then propose to return with that plan and its applicable timetable for your approval. Ahhough there is no guarantee that each action will produce a measurable outcome, it is fair to assume that without this proactive if not somewhat methodical agenda, we have little hope of overcoming the medical inflation experienced by our plan in the last few years. We look forward to your thoughts and the Workshop on the 15th. Cc: Mr. Bob Herrera Ms. Carol Bottler The Welch ~°"'Ra"'' Model for Health Plan Review _• Qufline of six components of a Model for Health Plan Review Effective healthcare management cannot be accomplished only at renewal. Proper administration and management is a year round effort that requires amulti-year commitment to a calendar of events. -• Each district is different, but we believe all healthcare plans should under go a thorough six step review. The components of that review are: 1) Risk Evaluation and Management 2) Benefit Plan Design Evaluation 3) Alternative Healthcare Delivery System Review 4) Disease Management 5) Pharmacy Management 6) Finance and Administration Review i ~ The Welch C0"'Pa"y Risk Evaluation and Manaaement -- Part one of six components of a Model for Health Plan Review We believe in using a six step approach to a benefit plan consulting engagement. -- The first step, Risk Evaluation and Management, uses a "wide angle lens" to view how all benefit programs sponsored by a district fit into the group as a whole. Often, the benefit package make-up is a result of past programs. The "we've always done it this way" mentality is weighed against market factors to be sure the current programs squeeze the most out of the benefit dollar while meeting the needs of the employees. While most effort in this area is concentrated on the medical plan, other healthcare coverages such as dental and vision can benefit from this investigation. -~ Included in Risk Evaluation and Management are the following disciplines: ~ Industry Age, Cost, and Risk Assessment - Industry Utilization Graphing Optimum Provider Utilization - Needs versus Health Assessment Sites of Care Evaluation - Demand Management The result of this first evaluation will provide the consultant with a priority list of projects within the benefit categories, as well as a measure of expectation and outcome from the investigation. • The Welch cO11p~'y Plan Design Evaluation -- Part two of six components of a Model for Health Plan Review ~ Plan ©esign Evaluation utilizes the knowledge gained through the previously completed Risk Evaluation and Management review. Armed with a priority list of projects, and a reasonable measure of outcomes, the consultant can begin "drilling down" into the subset categories, that should ultimately generate the most efficient designs customized to the district's workforce. -~' Specific benchmarks used in Plan Design Evaluation include: - Participant awareness - Cost sharing, shifting, and steerage - Demographic design - Needs-based approach - Fulfillment - Industry coverage comparison - Rewards based alternatives We very often find that the design of a plan of benefits does not meet the needs of the majority of the participants. Yet the traditional first reaction is "it will cost more" to make plan changes. After a full review we might discover that it won't cost more to customize a plan. In fact, many expensive provisions of a benefit program can be re- engineered, which allows highly identifiable components to be improved. -- Our worst enemy in Plan Design Evaluation is complacency. Think how much healthcare delivery has changed in the medical, dental, and vision arenas in the last few years, and how little we've done to react to those changes in our plan design. The Welch c~,P~y f~ Alternative Healthcare Delivery Systems -~ Part three of six components of a Model for Health Plan Review Armed with the knowledge gained from steps #9 -Risk Evaluation and Management and #2 -Plan Design Evaluation, the consultant must ascertain which delivery mechanisms produce the best service for the most efficient price. Sometimes the delivery system resides "outside the box," so the plan sponsor may need to consider some non-traditional methods. -- As boutique delivery systems mature within the healthcare field, their impact on plan dollars can be very positive. A perfect example would be the popularity of Employee Assistance Programs in the past and the subsequent reduction in mental and nervous disorder costs within health plans. -~ Some of the A/temative DeliveN Systems to be reviewed include: - Direct provider contracting - Illness specific services - Exclusive Provider Organizations - Network contract evaluation - Centers of excellence - Pool alternatives It may be mandatory that the health plan be organized in aself-funded atmosphere to facilitate the inclusion of many of the altemative delivery systems. The self-funded environment more than the insured environment should produce the data needed to direct, implement and evaluate the impact of the altemative delivery systems. • The Welch CO~'pa"'y Disease Manaaement ~~ Part four of six components of a Model for Health Plan Review The traditional healthcare consulting engagement focuses on the administrative components of a plan. Contracts, fees, networks, plan design, customer service, claims administration etc. are all evaluated to determine their appropriateness to the entire employee group. -- These services are all very important. However, they do not address the actual illnesses that cause the healthcare plan expense. The study of the actual illnesses and approaches to their care is called Disease Management. After years of review and study health plan sponsors have grown to understand the "80/20" rule. Simple stated 20% of claims account for 80% of dollars. With this axiom in hand should we not focus on the 20% of claims (therefore claimants} for the most dramatic improvement in plan performance? The action of focusing on the 20% of claims is the essence of Disease Management. -~ As an example, in school districts we are always fearful of how the cost of pre-mature infants could ruin a plans performance. Given the young female demographic nature of a districts population, this is a real concern. However, in recent years without a change in demographics the incidence of pre-mature infant births has not only decreased in frequency, but in cost as well. Many years of consulting has shown that by concentrating on the 20% you will find budding problems in the 80% population. Therefore, a thorough consulting engagement should embrace: :' Discharge rate analysis - Cost impact triggers ~ Recidivision Illness prevention - Length of stay analysis Chronic illness analysis The mechanics utilized to discover disease trends within a group quickly produce risk /reward scenarios for action by the consultant and plan sponsor. Simply stated you must treat the disease to make the patient well. In our case, you must treat the prevalent diseases to make the plan well! The Welch Company • Pharmacy Management -• Part five of six components of a Model for Nealfh Plan Review -~ Phamtacy Management is the newest entry into the Model for Health Plan Review. Five years ago many health plans experienced pharmacy expense that was less than 5% of total plan costs. Today that number is 15%+, and is projected to be 30%+ by 2005. Believe it or not this trend may not be completely detrimental. Many medical procedures now enabled by pharmaceutical breakthroughs replace surgical procedures at a lower overall cost. Then why all the fuss? -~ The answer lies in the imbalanced delivery of pharmaceuticals in traditional health plans. To correct this imbalance a thorough consulting engagement will produce a pharmacoeconomic analysis using the following tools: - Plan design review - Formulary development /rebate assessment Drug utilization review - New drug therapy - Exclusion medications - Therapeutic mix -- It is interesting to note that this latest entry into the Model for Health Plan Review has the best data available. Pharmacy Benefit Managers (PBMs) must produce extensive data to support medical treatment plans. Therefore, plan sponsors like providers of service (physicians) can have access to the same data. The difference is, of course, the physician manages the patient's care, while the plan sponsor manages the entire plan. We, like the physicians, must be scientific with our approach to Pharmacy Management. The Welch Company • Finance and Administrative Services -- Part six of six components of a Model for Health Plan Review This latest of the six components of the Model for Health Plan Review very often receives the greatest amount of attention because of its impact on finances. Although it is a very important component of a review, it is by its nature "not medically necessary." -- Instead, this component deals with the expenses surrounding the health plan, not the expenses generated through the delivery of healthcare. Therefore, this review is administrative in nature and often contains the foNowing: ~ Managed care vendor evaluation, selection, implementation ;~ Insurance or reinsurance placement ~ Budgeting and forecasting ;' Downstream study /analysis v Funding priorities Defined contribution alternatives > Outsourcing, co-sourcing. -- "The best plan, poorly implemented, is perceived as a bad plan." What a shame it would be to comprehensively review a benefit plan, make informed decisions about its future, and then implement it improperly. 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N ; N W 7 N = fD = N N O ~ fA O) Hf V ~ fA O) fA O ~ EA O df O (A O fA N N A ~ f0 ~ GA O W ~ ~ N fA O LA 69 fA dl N fA tU~ d1 A (A !A N O <O O O ~ Q7 O ~ O O) Of I O) OD V f n7 W I ~ O ~ V O O p ~ ~ V N Of W W W f0 CD ~ y = ~ CJ N N OD O ~ v N N J- V• O IV O V O N O Of ~ V N N O ~ N ~ O A A O N W W W O < N ~ ~, r N d+ N w En W O En O c~ 10 ~ f0 d, W V !r A ' O O V A N p N O O ~ IV ~ ~ (J V O O A 4W W N A fr O O Of O O ~ W N ~ ~ W 0 N v 7 ~. G -p ~ ~ O 3 ~ ~ o ~ n ~ pr ~ ~ g A ~ r ~f Z D Z D Z D Z D Z D ~ g g ~ ~' % Q ~= \V T TC N Op~~ro z N ~ F~p~ ~ O,J~ FN SvRFO~ o FF ~ ~S,9 ~ m v_ Vs~~'V ~ cFco uzi c m m C 3 ~~FM~~MS ~~SFO ~~R~o Np~~oe Yc~ r,Fs .~`~ ~~Fo FSCR'p ~ r~oh ~MpCO \ Y ~~TFS sT0\ ~pSS ~~' l F A ,,~ o ~ 4 ~ J m •.x,.. July 12, 2002 TO: Councilmembers Executive Staff RE: Agenda Item #8A LJ Carol Buttler Director of Administrative Services Please add the attached information to your July 15, 2002, City Council Workshop Agenda Packet as follows: 1. March 2001 Agenda Request and exhibits after page 3 of the medical fund summary. 2. Graph of Comparative Premiums right before the survey of surrounding cities. Thanks, Carol ~~ REQUEST FOR CITY COUNCIL AGENDA ITEM Agenda Date Requested March 19 2001 Requested By: Department: A~**+~^~~trative 5ervice~ Report: Resolution: Ordinance: Exhibits: Bid Tab Exhibits: Letter from Consultant Exhibits: Vendor .ist Ayprooriation Source of Funds: Medical Fund Account Number: 014 6144 515 6012 Amount Budgeted: X120,000 Amount Requested: $$73,a5ct Budgeted Item: YES NO SUMMARY & RECOMMENDATION The City's stop loss insurance is due to renew on April 1~. This insurance covers payment of all claims for any one employee or dependent whose medical charges exceed $100,000. The current policy also includes an aggregate amount for all employees and dependents of approximately $1.87 million. This means that if all Gaims exceed $1.87 million, the insurance carrier would ,pay 100% of all claims over that amount. Our current carrier is Houston Casualty Corporation (HCC), with an annual premium of $107,319. HCC was the only company to bid on the new contract. Their bid for specific stop loss was $146,907 and aggregate stop loss is $24,515, for a total of $171,422. They also raised the attachment point from $1.87 • million to $2.55 million, meaning the claims would have to exceed that amount before they pay 100%. The City's catastrophic loss rate has been nearly non-existent. Although there are several employees or dependents who may have catastrophic claims, none have reached the $100,000. The City could save $24,515 this year by omitting the aggregate stop loss coverage. In all the years since becoming self insured, Gaims have never exceeded the attachment point. Even with the premium, the City would be responsible for an additional $678,093 before this coverage became effective. Staff recommends opting for specific stop loss only this year, at an annual cost of $146,907. Action Required by Council: Authorize approval of bid by HCC Benefits, to provide specific stop loss insurance coverage at an annual cost of $146,907. Aaproved for City Council Agenda ' ~~/ her Robert T. He era, City Manager -~ l G I Date 1~ u • O a J ._ .` Q. V ~ ~ L 0 J ~.+ O t{} lD Ql Q .if U (p m Q ~ ~ ~ V O ~- r d' ~ p '" O n (jj p O ~ f~ ~ GOD O ~ '~ ~ °tl O O Op N (0~7 ~ ~ COV- CD5 N O ~ n- N ~ N ~ ~ O O tp ~' ip :II ~O ~ O t~ ~ I~ N ~ O t~+ GD ~ ~ fi) r y fA ~ r ~ f/i tR EN ~ N} ~ ~ GO (D ~ O O _ ~ ~ O O O O ~ ~ ~ m " ~ ~ st ~ O. ~ C V ~ t p" O N ms O N O ~ ~ ~ ~ N ~ r fR t7 49 O r p ~ ~ 4. ~ ~ M ~ p N ~ e .. 43 ~'" ~ t r. ~ fR fR to ,,:.~c f O O N +r T f~ O <O t0 ~ O O N r io U O (O O O N N M ~ ~ 0 ti O O f O ~ . O N to O ~ ~ lfl ~ N CM CD O 0 (h V' O) ~ ~ 0 ~ v~ E ~_~ . ~_ ~ , .. ~ E ~ E ~ m ~ a` m i •. .E m ` ~ a y ~ ~ s ~ ~ d s ". N m d ~ a ~ j J N ` ~ ~ ~ C ~o m O LL d Q .. m ~o , q ~, ~ S D Q1 v a~i a m In a~ m u. a~ a 'N m °' m a .~ m U j ~ o o ? ~ ~ ~ ~ o ~ ~ 3 d ~ x ~ ~ ~ c ~ E E c o ~' o ~' o o c ~ , . ;.y;.~~ ~ ¢ v w w Q V ~ v v a Q ~ c ~ ~'~ cn Q F- r ~ COI O ~ N ~ N 0 0 0 N ~ r ~ 00 ('7 C'7 fop ~ r N C`7 ~~~ ~~ ~w~ ,~ ~ ~ °~ c ~ ~ ~ D m 0 a E W 0 al v a R m 0 N U v 3 • The Welch Company Employee Benefits Consulting & Brokerage ~~_ 820 Lessner, Suite 1470 Houston, Texas 77024 713/827-8755 welchco@msncom -~L4 EMAIL MEMORANDUM TO: Louis Rigby FROM: Diana L. Roma noli _ i~~~ g RE: Stop-Loss Proposal Comparisons DATE: March 12, 2001 As you know we received one (1) proposal last week on the RFP for Stop-Loss Insurance Coverage. Attached is a spreadsheet that outlines the proposal this year as well as the last three years. The following are a few notes discussing the proposal, the market and the City of LaPorte Health plan. The Proposal • Current vendor, consistency is good. • Rates up in part due to the many employees with target diagnosis. • Aggregate coverage out of reasonable consideration. The Market • Market-wide increase of approximately 25%. •:• Less competition, fewer stop-loss insurance companies (via acquisitions). • Coverage under-priced for many years. • International supply of re-insurance dwindling. City of La Porte Health Plan • Potential of claims, little activity now. • Employee population is low for strong market. (including retirees) • State legislation of no lasering deters proposals. • TML not recognized vendor for many stop-loss companies. At this point you may wish to unbundle the two coverages and consider specific Stop-Loss only. While the decision is completely up to you, we wish only to point out that the $2,500,000 aggregate attachment point maybe difficult to reach. Therefore, the $25,000 premium should be reviewed. Attachments City of LaPorte ~_ • RFP Distribution for Stop-Loss Responses Due March 8, 2007 ~~,». M.:::.. ... ~ .,:~:,~.:5.rr.~.:.. :., Jrk ,.< .. .rr. n. ... ice . ...... .......r. <......... .. ... u.......e .. ......... k<..i ~~. .. a. ,... v. .. : .., .. .[:... .... .. ... >..u..: .. ..Y ../':p .>.. .. tk' f...:.: 'KS ....:.. :. .. .J::... .. ......: ...:. ,,..::. a: ~.,:. .M9.4.. .r .... ~1. ,wr... ah...,,.,.:.5{s.,r..........N:........k'~5.:/ i ~ < ~ . k ~~. . ..... .:w. ., .. .. .... r. <. .:.. . ........ .. ...... ....... k5 . ...... ... .. .~,... ..,..a.....:.:. -.:.:.......,-: :... ~^r,: ... :. . ~ xi ac dY ..c:,.:....:..~~::::.: ~.: ..,Y::! ~ K} arc.,.:.<...<. . Y `2v 3~'} 4ikt ,a^:..r.:.,5.. ~: a~J k'S' ~' c SJ.~%.' rFk`v:..:..>1::::.5rrr^ Y. ,y.,~{,.~. 3!. sr4:~: . ::~;:r4 ~:'y .. %!~5f'{;riRfs; ` n. r ...:.... .r.. .: >~.. .~... . `:.s .w;.;.: . K . 5.; ~'yo5 ar ~ c.,\:£'....~...:v ~.rR c, a 6.r.y?;k':~. v'~ ;h'r;jXYr.4 . ~y'~bir< .: .:~ 'rc2:~. ,"•3::;~zk::2~" _; 'y,"'. f.,, ~: 2'?... Y+: k~Y .r>5k.~':T.'.'~rc r.~,~: ,~ 5. , .~.;;Com a ..~ ;5':5t~. ...Y~~ :.,::~.... .: .r.. . 4< satr c 2 • < ~~ ::, : , . K<f.<„~,r v, :5,.. . ; ,:,. .`.`.fi: ~k ;;'k ~y::~s's"s"".~,~ 4.x:1 <y:~' :x:k::Ph ~hn . ., , : : A: ~ :, y~,'r f: a 'z •:h`,t`:k)? ~ A i %h : r: i3~~5" Qi~ir. 's3S?.C. cS,Yk:~ ~^ w x {u,. ..:L.Y"~:':::r . Pasta. ~ 3.: ~ : : c'nY•...:. -: G ~,^ ..k.~ ~. ~Y rAate ~ ..: r..~. r,xz> .. .. ..:A,><x.,. ...~.r.5.».. .<. .. vk... ... ..... , :#:..... ...~:~...: w::: u.: a'. F 7 ..v .:. .<, ir... .. ...,:.:cv,.. » ,., .:>.C:..f: .,, r,.z.. ..:.< ..: ..,.. "< rY' :..,LrS.:.:. .. :u x~,:: a<..u :,<:.~.,:< ,y :?rr5r~~r:~ .. ,/:~i'?; & K«r,..r.^.:r.. .K4:. .,..:..,. S v, Y` :.. v. :.r,:. .r;;.<c...ck`..:~^'.~ : :;.< ~. / ;kw :4Neira. ~:..;& <I <'SS( . : : ,. : r./rsa Y :~ y:.nv..: C'.~.J~^ :`:.:.L:,...cEn j v..,m :::~;,~.., fw , .:..,,.v ..... .:.: ^;;~'?'..x~~ .: L,<u..: :.... Y..,. v:: ^ . 5yyi~r $..W:,.Y, : aS<: < " .'X'<kr i5 c Lrr..4Kr.r.c . 'k i,~5, T :' : i 'iS.. A:~'iy . "^5:.. ::~:.<: FF: `. "~c~.r, b:hr.'ia5.~~~k, ~ yri' :4::R "^y~"N Y f '2E,~, , : , . < American Stop-Loss Phil Erikson 250 Commercial Street, Suite 200 2/2/01 $2.34 No Worcester, Massachusetts 01608 508-845-9836 response HCC Benefits Corporation Chris Slezak 16415 Addison Road, #670 ~ 2/2/01 $2,34 received Addison, Texas 75001-3268 888-941-9532 Highmark Life & Casualty John Perrin 20405 SH 249, Suite 490 2/2/01 $2,34 declined Houston, TX 77070 281-379-5421 Medical Excess Debbie Kadonada 3080 Bristol Street, Suite 100 2/2/01 $2.34 declined Costa Mesa, CA 92626 800-634-7462 Arbor Benefit Group Karen Harrison- 17218 Preston Road, Ste 400 Drews 2/2%01 $2.34 declined Dallas, Texas 75252 972-735-3183 Sun Life of Canada Daniel Bowen 440 Louisiana, Ste 1520 2/2/01 $2.34 declined Houston, Texas 77002 713-236-8340 Trustmark Insurance Company L. Brent Schultz 363 N. Sam Houston Parkway East 2/2/01 No Suite 1100 281-405-2633 $2.34 response Houston, Texas 77060 R. E. Moulton David Frawley 6311 N. O'Connor, Suite N6 2/2/01 No Irving, Texas 75039 ~ 972-869-7630 $2 34 response x.430 ING/ReliaStar Employee Benefits Kimberly R. Cole 3555 Timmons 2/2/01 declined Suite 240 713-871-8359 $2.34 Houston, TX 77027 x.12 The Welch Company ~ g el ^ ~ i ~ ± ~ a ~ ~ ~ ~ • j, ~' ~ ~ + I U O (O I~ fh ~ ~ ~ O ~ N ~ M ~+ i i y to ~ EH fA ~ O i ~ I W i I ® i ~~ . ~ c o M ~ ~ M Y/ M i ~ ~ ~i ~i o ~ + f m ~ ~ ~ y~ ~ C ~ N ~~ ~ U O ~ U g N ^ °' rt' c L ~ I N ~ ~ ~ ~ ~ ~ +~+ ~~ a ~, o ~ c ~ ~-'~ ~ ~ V ~ W ~ Y ~ ~ ~ Q ~ ~ d 00 ~ N ar0 U O ~ CO U i I L N ~ ~ o a O ~ ~ c0 7 fl. O (!) ~ ~ r eR ~ :~ W T ~ pa~~ y ~ Z..~° • ~ ~ ~S O U N I ~ - ?i ~ N N N w- ~ ~ -Np GO ~ f0 ~ (O ~ fD ~ N N ~- I ' I + d I ~ ~ o. }~ ~ ~ - ~ a~ I ~ a~= ~, ~ W ~ S ctOO. ~ ~ m •~ ~ O Z j ~ a~°i ° rn~ ro ~ ~ ~ ~c o ~ ~ 0 ~~ a U T~ °' I i ~~ ~ o ~~ ~ ~ W --~ ~ 69 ~ tH ~» ®~ i i ~ O O O O i ' v ' I ~ I O O O O O O O O O O O O O O i N c7 ~ ~ i ~ ~ ~ +I ~ EA M EA M EA N d~ N Ef3 Ei? O to ~ I y i aci ( ~ I, '`O >. >. c ~ S.I L tA~ U I m ti I w ld'~,d d i~ a o ~ of o ~ o f i ~ w ~ w i w w ~ ; II ~ - - - ~ B • City of La Porte Emergency Medical Service Interoffice Memo Ta Joseph Sease, Director, Emergency Management Frone Chris Osten, EMS Chief Date: 01/28/02 Re: EMS Billing EMS billing is a subjed we have visited often recently. t have enclosed a new set of billing charges that I recommend council approve. The only changes made are for new drugs and procedures that our Medical Director has implemented. These changes are in color on the attached sheets. I also recommend that if council approves these changes that we put a clause in the new ordinance (a living ordinance if you will) that when our Medical Diredor implements new changes we are able to put the charges into effed immediately. I recommend we have power to esiabtish a price that Medicare accepts and we recognize as fair. ff Medicare does not recognize the charge and insurance companies do than, a charge that is one and one half times the cost of the medication and or procedure and a fair charge for time spent on the procedure. This of course would be with yours and the City Managers approval. Thank you for yourconsideration. The City of La Porte Emergency Medical Service Itemized Rate Increase Proposal for 2002 * indicates new proposed procedures and charges for 2002. Procedures/Drugs Fees Base Rate $350.00 Stand-by Rate/Hour $40.00 Milea e $6.50 Per Loaded Mile Treatment with Air Transport $350.00 Plus Su lies Treatment with Private Trans ort $175.00 Plus Sup lies * Paramedic Intercept for Mutual Aid $175.00 Plus Supplies Treatment, No Trans ort $175.00 Plus Su lies No Treatment, No Trans ort No Char e 3 Lead ECG $50.00 * 12 Lead ECG with Interpretation $75.00 External Pacemaker $75.00 Pulse Oximeter $20.00 Defibrillation/Cardioversion $75.00 E.C.G. Pads $15.00 Per Pk . of 3 * Capnography Recording $15.00 Oxygen Administration $35.00 Ba Valve Mask $50.00 ET Intubation $50.00 EOA Insertion $50.00 Retro ade Intubation $125.00 * Combitube Insertion $60.00 Sur ical Airway $120.00 Auto Ventilator $25.00 Chest Decom ression $50.00 * CPAP Treatment $75.00 Nebulizer $35.00 Suctioning $25.00 Infection Control $50.00 C.P.R. $50.00 M.A.S.T. $40.00 • i M.A.S.T. $40.00 Spinal immobilization $40.00 Banda in $20.00 Per Site S lintin $20.00 Per Site OB Kit $25.00 Glucometer $15.00 * NG Tube $40.00 Lavage Kit $150.00 IV Setu /Saline Lock $50.00 Intraosseous Cannulation $75.00 * FAST-1 / Sternal Cannulation $150.00 Blood Draw $20.00 Activated Charcoal $15.00 Adenosine $15.00 Albuterol $15.00 * Aspirin (Baby Chewable X2) $10.00 Atro ine $15.00 Atrovent $15.00 Benadryl $15.00 Bretylium $15.00 * Cordarone $130.00 Dextrose 50% $15.00 Do amine $30.00 E ine hrine 1:1000 $15.00 Epinephrine 1:10,000 $15.00 Gluca on $50.00 * Haldol $15.00 Instant Glucose $15.00 I ecac $15.00 Lasix $15.00 Lidocaine 100 mg. Bolus $15.00 Lidocaine Premixed Dri $15.00 Ma nesium Sulfate $15.00 Mannitol $ 50.00 Mo hine Sulfate $15.00 Narcan $15.00 Nitroglycerine $15.00 Sodium Bicarbonate $15.00 • • Solu-Medrol $15.00 Succinylcholine $50.00 Tetracaine $15.00 Thiamine $15.00 * Tylenol $10.00 Vasotec $50.00 Versed $50.00 t • i City of La Porte Emergency Medical Service Interoffice Memo To: Joseph Sease, Emergency Management Director Frorri Chris Osten, EMS Chief Date: 01/31/02 Re: Current EMS Transport Policy Recommendations It has recently been brought to my attention by my supervisory staff that in recent months the ability to obtain an alternate transport option (Private Ambulance Company) for emergent patients requesting to be transported to a hospital facility outside our approved facilities has become increasingly difficult. This impediment is due in part for several reasons, some of which I have listed below. 1. Default of Payment -Patients being transported by private ambulance companies at our request are simply not paying the bills that they receive from the private ambulance companies. These companies must make a profit to stay in business and unfortunately it is common knowledge that a large percentage of 911 calls for ambulance response do not end in any sort of payment due to a large portion of the patients being indigent. Inter-facility transports from hospital to hospital are considered to be guaranteed payments for privates ambulance companies due to payment and insurance verification being confirmed before the transport is received. Therefore, it is possible that in the near future we may not be able to secure any private ambulance companies to respond to La Porte for alternate transports to the Houston Medical Center. There are 80 private ambulance companies in the Houston area. They keep their fleets on the street to a minimum to keep payroll costs down. In addition, no doubt they would rather take a paying customer over an unknown (possibly non-paying customer) in La Porte. 2. Paramedic Staffing -There are fewer Paramedics graduating from colleges. The first services hit with this shortage are the private services. When we call for a private, increasingly we only get one Paramedic or at times, none at all. La Porte EMS prides itself on administering quality patient care and when a private ambulance company crew responds to La Porte to receive our patients there is no question in my mind that we are surrendering our patients to a sometimes lesser trained crew with an inferior set of patient care protocols and older less sophisticated medical equipment. 3. Statistics -Last year La Porte EMS called for a private ambulance company 67 times. The average response time for the private company in the year 2001 was just undertwenty-two minutes. The average on scene time for La Porte EMS was forty-seven minutes. This includes dispatching, making patient contact, accessing their needs, contacting the private ambulance company and waiting on their arrival. This in and of itself seems to me to be defeating the original goal of keeping our EMS units more available to our citizens when they are sitting on scene awaiting a private ambulance that may or may not materialize. 4. Delay in Appropriate Care - Many of our citizens have special needs and regiments of treatment started at other hospitals. Some examples are cancer patients receiving treatment from M.D. Anderson, Heart patients at St. Luke's and Memorial, and numerous pediatric problems that are treated at Texas Children's. When we transport these patients to a local hospital often, the local hospital will just arrange transport to the hospital of their (patient} choice resulting in an overall delay in appropriate patient care. • • 5. Hospital Closures - Wrthin the last few years we have lost five local hospitals in our transport area due to facility closures. We have replaced them with only one. It is no secret about how often hospitals go on drive-by. Furthermore, when we do transport to our approved local hospitals, the waiting time for a bed has increased overthe last couple of years. Ourtumaround time is increasing monthly because we are waiting for available beds to become open. In closing, we may be doing our citizens a great disservice overall by not transporting them to the hospital of their choice to include the Houston Medical Center. The twenty plus minutes we spend on the scene waiting for a private ambulance company delays patient care by a physician. The private ambulance companies more often than not are not staffed or equipped to deliver the level of care during transport to the hospital that La Porte EMS provides. I believe that most of the 67 transports last year were our citizens with special needs. I see little burden on our service with an increased turnaround time of an additional 20 to 40 minutes (transporting to the Houston Medical Center} depending on the time of day. Lastly, we always have a supervisor in the city with all the equipment that our ambulances have and a competent Fire Department to back them up. I recommend that we change our transport policy to include the downtown Houston Medical Center. • Page 2 • ~ U • ,--~ O w p~ N O a ~, O c~ ~ ~ H 0 0 0 0 .~ U . r.., O ~--~ N N C~ ~--~ • ,~ C/] C~ U O O c~ c~ N N ~ ~ ~ N -- ~ ~ C~ C~ ~ C~ ~~-i ~ l V • • V1 • r~ ~~ • ~.~ r~ • r~ U O .~ ~ .~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ °' a~ ~ o ~ ~ o ~ ~ ~ ~ ~ ~ c~3 p ~ ~--~ ~ c~ ~ ~ ~~~~ ~~p~~ a~ ~ I I i ~ ~ ~ ~ • • .o a~ ~ ~ ~ o a~ ~', ~ ~ r • r~ '~ • ~~ ~~ • r..~ U O ~ ~ ~ ~ ~ .~ ~ ~ ~ ~ ° o 0 0 ~ ~ ~~ ~ ~ ~ ~ ~ ~ ~ ~ ~ o ~ o ~, ~ ~? , ~ ~ ~ ~ ~ c~ ~ ~ o ~ ~ ~ ,-~ ~ c~ W ~ ~ ~ ~ ~ I I I I ~ ~ P~ ~ ~ • 0 a~ +~ ~ ~ ~ ~ ~ ~ ~-' o ~ ° 3 ~ ~ a~ a' °~ o ~ ~ O O ~ O °~' .~ .~ ~ ~ ~ a.{ a., a '~ c~ O ~ U . ~ O ~ ~ c~ ~ ~ ~--~ O ~ . ~ 4J ~ ~ ~ . r..~ ~ ~ ~ U ~ ~ ~ ~ ~ ~ c~3 '~ 4J ~ ~ ~ ~~ ~ ~ '~ v~ ~"' ~ O cc3 ~ ~ ~ ~ ~ p ~ ~ ~ ~--' ~-' ~ bfJ ~ ~ ~ ~ ~ ~ ~ . ~~ ~ ~~ ~ ~ ~ ~ ~ .,~ ~ ~ ~ ~ . ~ o ~ ~ ~ ~ ~ VJ C~ 4~ d N O ~~ (~ O ~ •~ v H . ~, d~ O O N -~ . r..~ 0 i N bA a3 N 4~ .~ O N .~ ~ a ~•~J .~ 4J 4~ .~ U 4J .~ .~ ~~ U O Q .~ 4~ O O c~ 3 J--~ .~ Q c~3 O U O c~3 N • ~ ~ ~ c~3 ~ c~ ~ n ~ • W a~ ~, 0 a • L/~ L/~ C/~ I-~ an • ~~ r~~ ~~ • ~~ Aa • L/~ L/~ M--I bn .~ .~ A~ W ^~~ ?~ r~ 1 . r..~ CC3 -~--~ -~-~ 4~ U 4~ ~--~ ~--~ .~ 4J c~ c~ • .~ • ~' 1 0 '~ -~--~ ~ ~ U ~ ~ ~ ~. -~ H . ~ ~ ~ ~ ~ ~ ~ ~ i r"'' U 4J '.~ ~ ~ ~ ~ ~ H ~ ~ W c~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ o . ~ ~ ~ ~ ~-, N c~ 4 ~ ~ ~ ~ ~ ~ . • • ~ o N ~n ~ ~ ~ ~ ~ .O ~ ~ '''' ~ ~ ~ ~ ~ U o ~ W ~ v~ a~ E~ ~ ~ w r~ 1 ~~ N c~ 4J ~ O M ~ r--~ ~ ~ O R3 ' _~ '-~ ~ ~ ~ ~ ~ ~ ~ .~ ~ ~ O '-~ ~ O ~ '~ '~ '~ 4~ ~ O ~ ~ ~ ~ H • . • • . r..i ~--~ ~}--~ ~-1 ~"~ ~ b~ ~ ~ ~ ~ ~ ~ o ~ ~ a~ ~ ~ ~ ~ Q ~:Q ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ ~ O ~ ~ •~ ~ O O 4) ~ O 4~ .~ ~ ~ ~ ~ a~ ~ ~~.~..~ . ~ ~, Q W ~ ~ . r..~ ~ ~ ~--~ ~ • ~ ~ ~ ~ ~ N r--a ~ U O 4~~ O • ~ ~ ~-+ O ~ 4~ ~ '~'' U ~ ~, ~' ~ ~ ~ ~ ~ o ~ ~ ~ o ~, ~ U ~ ~ ~ ~' ~ ~ ~ ~ c~ O U ~ U ~ . r, O ~ ~ O ~ ~ ~ ~~ ~~' o a~ ~~~ ~ ~ o ~ ~ Q~ ~; °•.~ ~ ~ ~ ~ ~ ~ ~ ~ O ~ 4~ ~ ~ ~ ~ ~ c~ c~ U c~ 't~ N O a~ U O • •