REVISED. April 20, 2016 REVISED. The Honorable Board of Supervisors County Administration Building 1221 Oak Street Oakland, Ca 94612

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1 ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY REBECCA GEBHART, Acting Director April 20, 2016 The Honorable Board of Supervisors County Administration Building 1221 Oak Street Oakland, Ca Agenda May 10, 2016 ADMINISTRATION & INDIGENT HEALTH 1000 San Leandro Boulevard, Suite 300 San Leandro, CA TEL (510) FAX (510) REVISED REVISED Dear Board Members: SUBJECT: ACCEPT THE SUBMISSION OF ANNUAL REPORTS FOR ALAMEDA COUNTY EMERGENCY MEDICAL SERVICES DISTRICT AND REFER THE ITEM TO YOUR BOARD S JUNE 2016 COUNTY BUDGET HEARINGS FOR CONSIDERATION AND ADOPTION OF SERVICE CHARGES FOR FISCAL YEAR RECOMMENDATIONS A. Accept the submission of the Annual Reports outlining the Fiscal Year proposed budget for the Alameda County Emergency Medical Services District, which includes a proposed 3.02% increase to the annual district special rate; the rate of $30.68 per benefit unit is proposed based on the February 2016 year-on-year change in the San Francisco- Oakland-San Jose Consumer Price Index for All Urban Consumers released by the Bureau of Labor Statistics; and B. Refer this item to your Board s June 2016 Fiscal Year County Budget Hearings for consideration of the Annual Reports and adoption of service charges for Fiscal Year SUMMARY The Alameda County Health Care Services Agency (HCSA) requests that your Board review the Annual Reports and adopt the proposed service charges at your Board s June 2016 Fiscal Year County Budget Hearings. On June 30, 2015, your Board approved a new special tax rate of $29.78 per benefit unit for Fiscal Year Due to cost-of-living increases and use of available fund balance, it is projected that Alameda County Emergency Medical Services (EMS) will not be able to maintain its current services in future years at the current tax rate. Hence, it is recommended that an adjusted tax rate of $30.68 (an increase of $.90) be adopted for Fiscal Year The proposed 3.02% increase is based on the February 2016 San Francisco-Oakland-San Jose area CPI increase data released by the Bureau of Labor Statistics.

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3 County Service Area EM Budget Unit ANNUAL REPORT FY Proposed Budget Salaries & Benefits $ 4,252,818 (Ref 1) Services & Supplies Trauma Care* $ 9,246,343 First Responder Services Unit $ 4,787,483 Dispatch Centers $ 3,281,915 Professional and Specialized Services Contract $ 200,000 Operating Expenses $ 3,297,483 Total Services & Supplies $ 20,813,224 Indirect Costs $ 155,676 Fixed Assets $ - Total Proposed Budget $ 25,221,718 (Ref 2) $ 25,221,718 FY 15/16 Beginning Available Fund Balance -15/16 Expected Use of Available Fund $ 2,409,440 (Ref 4) FY16/17 Use Available Fund Balance Budget $ 930,249 Contingency Reserve from AFB $ 1,479,191 (Ref 3) Total District Budget & Reserve $ 26,700,909 Assessments $ 18,668,808 Certification Fees $ 80,000 Ambulance Ordinance $ 70,000 Interest Income $ 10,000 Other Revenue (Ambulance Service Provider Pass-thru $ 5,332,661 Other Revenue $ 130,000 Total Revenue $ 24,291,469 Use Available Fund Balance $ 930,249 Total Revenue & Use available fund balance $ 25,221,718 Total Revenue Estimated and AFB $ 25,221,718 Contingency Reserve from AFB $ 1,479,191 (Ref 3) Total All Revenue/AFB $ 26,700,909 Calculation of District Special Tax FY Assessment Rate $29.78 Proposed District Rate Increase $0.90 $30.68 Benefit Units Per Assessor's Office (FY 15-16) 629, (Ref 5) FY Assessment Rate $30.68 Total FY Assessment Amount $ 19,319,196 $ 566,730 Less County Collection Cost (1.7%) $ (328,426) (Ref 6) $ (9,634) Net Assessment Revenue for District $ 18,990,770 $ 557,096 Notes: 1) Ref 1: Funds 30 Full Time Equivalent (FTE) positions 2) Ref 2: Proposed budget per FY MOE Request 3) Ref 3: Contingency Reserve from Available Fund Balance is equal to the total Available Fund Balance less Proposed the used of Available Fund B 4) Ref 4: Available Fund Balance is equal to FY Beginning Available Fund Balance less FY Expected Use of Available Fund Balance 5) Ref 5: Countywide number of benefit units estimated based on FY CSA Paramedic tax roll 6) Ref 6: County Treasurer collection cost * Trauma Care Detail Alameda Health System 5,266,383 UCSF Benioff Children s Hospital Oakland 1,982,480 Sutter Eden Medical Center 1,982,480 UCSF Benioff Children's Hospital Oakland ED Pediatric Readiness 15,000 Trauma Care Total $ 9,246,343 1 of 1 4/28/2016 8:11 AM

4 ALAMEDA COUNTY HEALTH CARE SERVICES AGENCY Rebecca Gebhart, Acting Director Emergency Medical Services District Travis Kusman, MPH, Acting EMS Director Karl Sporer, MD, Medical Director 1000 San Leandro Blvd., Suite 200 Main (510) San Leandro, CA Fax (510) Alameda County Emergency Medical Services District (CSA EM ) INTRODUCTION Annual Report for Fiscal Year In 1982, Alameda County held a County-wide advisory election asking voters to create a County Service Area for paramedic services and imposing a benefit assessment. Seventy-nine percent of the voters approved the measure. County Service Area (CSA) EM was created in 1983 and included the unincorporated areas and all Alameda County cities except the City of Alameda which chose not to become a member of the District. In 1989, County Counsel advised that the Board had discretion to raise the basic assessment to fund the additional cost of providing trauma services. In 2011, the City of Alameda was annexed into the District. Proposition 218, the Right to Vote on Taxes Act, approved by voters in November 1996, placed new limitations on the ability of counties and other local jurisdictions to raise revenues from assessments, taxes and fees. County Counsel determined at that time that the EMS assessment must be replaced with a two-thirds voter approved special tax. A special election was held in June 1997, and the passage of Measure C at that time re-established the paramedic benefit assessment as an Emergency Medical Services benefit tax, at a rate of $21.14 per benefit unit, adjusted annually according to the Consumer Price Index (CPI) for the San Francisco-Oakland-San Jose Area. PURPOSE The purpose of this benefit tax is to provide funding of ambulance, paramedic, trauma care, dispatch, and related services being provided by the Emergency Medical Services District, which is administered through the Emergency Medical Services (EMS) division of the Health Care Services Agency. EMS provides oversight and quality management of the County s 911 emergency medical response system, which includes administration of contracts for ambulance transport and first responder services. EMS also provides funding and coordinates data analysis and peer review proceedings for the County s three trauma centers at Alameda Health System, Eden Medical Center Castro Valley, and UCSF Benioff Children s Hospital Oakland. EMS also contracts with the Alameda County Regional Emergency Communications Center (ACRECC) for dispatch and medical pre-arrival instructions. Page 1 of 3

5 SCOPE OF SERVICES The EMS division is designated by the State of California as a Local EMS Agency (LEMSA). LEMSAs, as defined by Division 2.5 of the Health and Safety Code, have specific duties that include, but are not limited to: Certifying Emergency Medical Technicians and accrediting paramedics to practice in the county; Designating and providing oversight to specialty centers, such as trauma, stroke and cardiac receiving centers; Developing and submitting the EMS System Plan to the State EMS Authority, including annual updates; Providing physician medical direction of the 911 medical response system; Developing and updating EMS policies and procedures; Approving and providing oversight to EMS training programs and continuing education providers; Overseeing and tracking the implementation of public access defibrillation; and Planning and responding to natural and manmade disasters. SERVICE CHARGES Section of Chapter 2.20 of Title 2 of the Ordinance Code of the County of Alameda authorizes your Board to adjust by resolution the tax rate by the amount which the Consumer Price Index (CPI) for the San Francisco-Oakland-San Jose Area has increased during the immediately preceding year. The current rate, per benefit unit is $ The proposed Fiscal Year benefit tax rate is $30.68, or ninety more cents per benefit unit, based on the CPI increase of 3.02%. PROJECTS IN FISCAL YEAR During the fiscal year, EMS worked closely with Paramedics Plus, fire departments, hospitals and ACRECC to ensure a quality and efficient emergency medical services system. Overall system compliance remained above contractually obligated minimums. In addition, indicators of clinical performance continue to be excellent and are above national standards in many cases. EMS continues to be actively engaged in research in the prehospital setting, influencing the development and implementation of leading best practices within and well beyond the borders of the County. Several peer reviewed papers listing the County s EMS Medical Director as an author were published in leading journals including Prehospital Emergency Care and the Western Journal of Emergency Medicine this fiscal year. A Prehospital Care Coordinator (PHCC) and EMS Fellow were also published this fiscal year in the Journal of Emergency Medical Services. Page 2 of 3

6 Over the past several years, changes in healthcare financing have substantially impacted the ambulance service payor mix in the County EMS system. A major shift into Medi-Cal and Medicare coverage from commercial insurance, coupled with decreased reimbursement rates by commercial insurers, has resulted in an overall decrease in per-call revenue. In conjunction with contractually imposed costs, this decline in reimbursement seriously challenged the financial solvency of Paramedics Plus. This fiscal year, $4,000,000 from the EMS Trust Fund was provided as a one-time payment to Paramedics Plus to offset losses due to changes in its payor mix and to stabilize ambulance services in the EMS system. Concurrently, EMS remained engaged in long-term planning and development of a Request for Proposal designed to ensure quality emergency medical services well into the future. During Fiscal Year , EMS continued to work closely with fire service first responder and transport agencies. The use of a common reporting system enabled effective procurement and analysis of data. Fire department response time compliance was reviewed; every department was well above required minimum performance measures. EMS also established a Community Paramedicine program in collaboration with the City of Alameda Fire Department and the California Emergency Medical Services Authority; this county was one of thirteen sites chosen statewide for a pilot project. The EMS Corps program continued to provide enhanced life coaching and other services in addition to Emergency Medical Technician (EMT) training. This year, Prehospital Care Coordinators actively engaged with the EMS Corps program, serving both as primary EMT curriculum instructors and mentors. Graduates of the program continue to pass the National Registry examination with a high success rate, with many obtaining and retaining employment with local ambulance providers. Graduates are also working in other healthcare environments, including a Health Coaching program also coordinated by EMS. The Robert Wood Johnson Foundation was a major supporter of the Health Coach program. Prehospital Care Coordinators continued to manage programs in cardiovascular care including cardiopulmonary resuscitation (CPR) training and the placement of automatic external defibrillators (AEDs) in the community. In addition, they oversaw or managed trauma care, unusual occurrence investigations, quality improvement and clinical measurements, certification investigations and processing, the ambulance ordinance, helicopter utilization, contract compliance, EMS for children, disaster planning, and EMS tactical medicine. Page 3 of 3