Q & A Measures D and E
(new questions at the top)
It is Possible.
For the first year, it is doubtful due to depleted reserves. Going forward, a discount to property owners is high on the list of things our current Board of Directors has discussed as something the District could do to give back.
Our current Board of Directors has discussed this type of future break for property owners. Considered and adopted by resolution annually. If Measures D and E succeed in March you will have a newly elected Board, all property owners, all focused on stable service, not building a pot of money. We can safely say that this will be considered and implemented if we can do it and keep staffing/service stable.
TCLS is providing great service! The non-profit formed 26 years ago has worked well. We’ve protected service levels for years with efficiencies. We’ve run with a minimal overhead staff to protect patient care services. A make it work attitude has served for a long time, but we very much need your help to stabilize ambulance service and protect ambulance staff jobs and advanced life support level of care.
As a non-profit we are
- Dedicated to providing high quality care and safe transport
- Providing high quality public safety training to volunteer fire departments at costs
- Operating a deficit budget, have been doing so since 2014 to protect service levels
- Operating a shift structure that is stressful and fatiguing to medical staff
- Operating a shift structure makes it difficult to retain advanced life support staff
- Ineligible for government reimbursement of Medi-Cal shortfalls
We believe advanced life support capabilities are important for good patient outcomes in our rural area. Early recognition, advanced life support scope of practice, and proper transport destination saves brain function and heart muscle.
We have you, the patient, in our care for a long time. The responsibility is awesome. There are optional scopes of practice available here that increase this responsibility and improve patient outcomes. TCLS has become a revolving door for paramedics, train, gain experience, move elsewhere for improved shift structure. Measures D and E were created to fund this for the long-term.
TCLS is operating at a financial deficit to protect patients with the current two 24/7 ambulances. Medi-Cal and Medicare continue to pay less than it costs to provide service. California Minimum Wage mandates over the next three years will worsen deficits.
We are challended to provide consistent paramedic staffing levels, and are sometimes basic life support level on the Hayfork ambulance. This affects Hayfork and all the areas served, as the paramedic unit in Weaverville will move toward that patient to provide care if needed.
There are current reimbursement programs for Medi-Cal shortfalls that we do not qualify for as a non-profit. Formation of the district will allow direct access.
Funding of the district with the proposed parcel assessment will address funding gaps and allow TCLS to address 24-hour pay and additional staffing to fill the 48/96 shift structure, a recruitment and retention MUST, and added safety and depth for or communities and crew.
Rural services are failing because the cost of readiness exceeds what we can generate. The call volume cannot mediate a mix of high Medi-Cal and Medicare as it can in more populated and affluent areas.
The payer mix of the area served is over 70% government (Medicare, Medi-Cal) programs, These reimburse less than the cost of service. The amount of insured does not offset this. TCLS advanced life support emergency transport base rate is $2400. Patient transport miles are billine at $40/mile. Raising rates increases the co-pay of the insured.
- For 2019 the percentage of patients with stand-alone health insurance is 13%. Insurance is billed, pays the allowable charges, leaving a possible co-pay for the insured. (if a person has a Membership, balance bill is written off)
- For 2019 the percentage of patients with stand-alone Medi-Cal is 29%. Per law Medi-Cal is billed, the allowable amount is accepted as payment in full. The allowable amount for advanced life support emergency transport is $221. The allowable mileage, $3.55/mile.
- For 201 the percentage of patient with Medicare is 51%. Medicare patients frequently have supplemental insurance or Medi-Cal. Medicare is billed, the allowable amount accepted as payment in full. The allowable Medicare rate for advanced life support emergency transport is $496. Medicare pays 80% of this, with the 20% balance billed to patients, supplemental insurance, mor Medi-Cal. The allowable mileage rate is 7.62/mile. (if a person has Membership, the allowable deductible or co-pay is written off, is a person has Medi-Cal there is no balance bill) Medicare does not pay if they do not deem the care transport medically necessary.
- For 2019 the percentage of self-pay is 7%. With recent Healthcare Reform, or “Obama Care” we saw a shift from self-pay to Medi-Cal Managed Care.
Aside from the move from Self-pay to Managed Care above, these percentages have been consistent over the last 15 years, along with the population and call volume. The cost of staffing, fuel, medical supplies, insurance, etc., has increased. We have seen an increase in our ambulance transport revenues and subsidy, but it does not keep pace with expense, and will never facilitate 24-hour pay for crews.
- Partnership was explored for access to government reimbursement programs
- Trinity PUD, Weaverville Fire Protection District gave consideration
- Partnership/contractual relationship exposes those agencies fully to TCLS financial liability
- County run service was discussed and deemed financially unsustainable
- Mountain Communities Healthcare District is attaining stability, we cannot risk this
- Commitee (TPUD, WFD, County, LAFCO, TCLS, EMS Consultants) recommendation
- Form a district for access to government reimbursement programs ( Measure D)
- Ask the public for a stabilizing parcel assessment (Measure E)
- The idea of everyone sharing in the needed funding is attractive to everyone, including us
- All public safety agencies are struggling to provide the needed staffing to cover our functions
- Without the District, we leave potential government reimbursement for government mandated shortfalls untapped
- Measures D and E were arrived at as the most stable and predictable option to support needed staffing and maximize contributions from outside the County
Yes if they are on one parcel
- In studying this we looked at data in the California State Controller’s Office Parcel Tax Report, fiscal year 2016-17. www.sco.ga.gov
- We found urban areas utilized multiple tax structures with variable rates based on property use, property value, and multi-dwelling units such as apartments
- The urban areas with this type of arrangement contain luxury facilities, rare in rural areas
- We found areas similar to Trinity County had utilized the more simple assessment of one rate per parcel-which is what we moved forward with
- Initially TCLS was proposing a straight $68 for all parcels regardless of improvements
- Due to public input, we reduced unimproved to $48, which increased improved to $83
- Rural services across our County are facing same choices
- If we are to operate a balance budget, service and staffing will be less
- Without the assessment to bridge funding gaps, service and staffing will be less
- We have seen what happens in other areas when a large company takes on a rural ambulance
- Services have gaps because the cost of staffing is more than can be generated in revenue
- Patient Care would be less a priority than bottom line
- Volunteer fire departments personnel training would not be supported, would not be a priority
- Volunteer fire department personnel would be burdened with waiting for ambulances more frequently with reduced services
- You will be waiting for the arrival of advanced care and transport, detrimental to outcomes
- We are working hard to avoid this; the level and quality of the services is in the hands of the voters
For a strong local service, there needs to be local control
Membership write-offs are nearly equal to the revenue that this program brings in. Membership fees may not be collected from persons with Medi-Cal. This program cannot provide the stability needed to preserve advanced life support staffing.
- Membership provides relief from balance bills, co-pays, deductibles
- Memberships receive no balance bill in exchange for their membe
- As an example, TCLS wrote off $4,258 in Decemeber 2019
- The smallest write-off was $150, the largest $426, 17 members served
- If you have Alliance Membership, remember that while you write a check to TCLS for $150, we keeo $60 of ths, sending PHI and Reach their portion for the Membership
- We have no plan to discontinue the Alliance Membership or our ground membership
- These programs provide protection from out of pocket expense
- These programs do bring in dollars to TCLS and write-off significant balance bills
- Detail for 2019 will coon be published to our website so you can see exactly what it does
- Annual audit cost
- Elections every two years for the Board of Directors
- We expect to pay more for some product, such as software
- We will still be eligible for grants as a special district
The short answer is yes! Bullet points below. It is important that voters understand exactly what we propose, and what we are not proposing. TCLS has always had to compete with higher wages in Shasta County.
We are not proposing equitable wages with Shasta County as ambulance wages there are much inflated in comparison with the rest of the state and nation. We would not ask voters to pay for this.
We are proposing a good rate of pay, in the range of national average, and most importantly for recruitment and retention, we propose 24-hour pay for 24-hour shift
- We will move staff to a 48/96 schedule and pay them 24 hours for a 24-hour shift
- We projected a 3% cost of living increase on their initial transition
- We will add 4 medical staff to fill the 48/96 schedule
- This adds much needed depth to staffing of backup ambulances
- We would restore management hours for improved operations
- We provide a simple IRA with 3% employer match, that will increase if measures succeed
- We are not proposing PERS retirement due to prohibitive cost