l`i~
COMMISSIONERS' COURT AGENDA REOUEST
G3.~~o~/.!6
PLEASE FURNISH ONE ORIGINAL AND TEN COPIES OF THIS
REOUEST AND DOCUMENTS TO BE REVIEWED BY THE COURT
MADE BY: H.A. "Buster' `"~ OFFICE: Commissioner, Pct. I
MEETING DATE: March 27, 2006 TIME PREFERRED: ~ ~ -3~'
SUBJECT: EMS Ad-Hoc Committee Final Report.
EXECUTIVE SESSION REQUESTED: (PLEASE STATE REASON)
NAME OF PERSON ADDRESSING THE COURT: Commissioner, Pct. 1
ESTIMATED LENGTH OF PRESENTATION:
IF PERSONNEL MATTER -NAME OF EMPLOYEE:
Time for submitting this request for Court to assure that the matter is posted in
accordance with Title 5, Chapter 551 and 552, Government Code, is as follows:
Meeting scheduled for Mondays: 5:00 P.M. previous Tuesday.
All Agenda Requests will be screened by the County Judge's Office to determine if adequate
information has been prepazed for the Court's formal consideration and action at time of Court
Meetings. Your cooperation will be appreciated and contribute towazds you request being
addressed at the earliest opportunity. See Agenda Request Rules Adopted by Commissioners'
Court.
THIS REQUEST RECEIVED BY:
THIS REQUEST RECENED ON:

EMS ADHOC COMMITTEE
FOR
KERR COUNTY COMMISSIONERS COURT
FINAL REPORT
Mazch 27, 2006
EMS ADHOC COMMITTEE
KERB COUNTY COMMISSIONERS COURT
INDEX
A. BACK GROUND
A.I. The Committee .............................................................. page 3
A.2. Committee Charge .......................................................... page 3
A.3. Procedures Used ............................................................ page 3
A.4. Those Contacted ............................................................ page 3
A.S. Information Obtained ...................................................... page 4
B. COMMITTEE CHARGE
B.I. Assess Function and Viability of an ESD
B.l.a. Countywide ESD ................................................. page 4
B.1.b. Countywide ESD excluding The City of Kerrville............ page 5
B.l.c. County Wide ESD excl/incl other ESDs in the County...... page 5
B.2. Review EMS Operations
B.2.a. Billing System ..................................................... page 6
B.2.b. Collection System ................................................. page 6
B.2.c. Funding Formula .................................................. page 7
B.2.d. Other ................................................................ page 8
B.3. Recommendations
B.3.a. Billing .............................................................. page 8
B.3.b. Collections ......................................................... page 9
B.3.c. Equitable Funding Formula ..................................... page 9
B.3.d. Quality of Service ................................................. page 10
B.3.e. Adjacent Counties ................................................. page 11
C. CONCLUSION ........................................................ page 1 I
D. OPTIONS ............................................................. page 12
ATTACHMENTS
2
EMS ADHOC COMMITTEE
KERR COUNTY COMMISSIONERS COURT
FINAL DRAFT REPORT
Februazy 27, 2006
A. BACK GROUND
A.1. The Committee
The EMS Ad-hoc Committee was appointed by the Commissioners Court consisting
o£ Two (2) former city council members -Jim Murphy and Joe Hemng, Jr.; Two (2)
former commissioner court members -Gordon Morgan and Ray Lehman; and Walter
Schellhase as chairman.
A.2. Committee Charge
The Committee was charged with the general tasks of looking into the over all EMS
operation as related to the City and County. In addition, the Court provided the
Committee some specific task, as detailed on Attachment "A".
A.3. Procedures Used
In order to achieve the tasks as outlined in attachment "A", the Committee conducted
numerous interviews, committee meetings, phone conservations and other meetings
to review documents and compaze data. This process produced numerous details with
regazds to the EMS operation, documents used, computer hook up, general paper
process, billing process, collection procedure and the budgeting process. In addition,
several meetings were held with County Commissioners' from time to time to receive
input and bring them up to date on the Committee's progress.
A.4. Contacts
The Committee has made many contacts with a number of individuals in the process
of collecting the data for this report. In all cases, the Committee was given full access
to all City employees and data requested. City individuals contacted were: The City
of Kemille's Fire Chief, Raymond Holloway; Assistant Fire Chief, Mark Beavers;
EMS Coordinator, Eric Maloney; EMS Billing Clerk, Cindy Zachary; City Financial
Officer, Mary Sekula; City Assistant City Manager for Finance, Brian Brooks; City
Manager, Paul Hofmann and Former Interim City Manager, Don Davis. All of these
individuals have bent over backwards to assist the Committee in their data collection
process and in all cases the personnel have been most helpful and supportive of this
effort.
3
The Committee has: 1) met with Paula Rector to obtain data regarding tax base and
projected rates required to support any proposed ESD, 2) discussed with Barbara
Nemec, County Treasurer, the payment of EMS budgeted item to the City, and 3)
Contacted adjacent county EMS Directors to compaze operations.
In addition the Committee met with SPMH personnel (Ron & Betsy) regazding
Medicare and ESD procedures.
A.S. Information Obtained
The Committee has been provided numerous documents to assist in the reseazch to
accomplish the tasks assigned by the Court. The documents consisted o£ budgets,
billing rates, trip reports, computer generated reports, quarterly reports, previous
years actual expenditures, the budget process, a break down of calls made, transfers
and mileage run.
In addition, the Committee was given a crash course on Medicare rates, billing and
problems associated with Medicare and the EMS.
B. COMMITTTEE CHARGE
B.1. Assess Function and Viability of an ESD
B.l.a. County Wide EDS Including the City
The function of a Countywide ESD would be to provide Emergency Medical
Service throughout the County. Such an ESD could be established with
relative ease, as the law is simple and straightforward. However, this action
would require the cooperation of the City of Kerrville, the City of Ingram,
ESD #1, and ESD #2. The City of Kerrville would have to be willing to give
up a very professional and effective EMS Department or the City would have
to enter into a contract with the new ESD to provide EMS to the entire county.
Hence, there is no reason the County could not proceed with a countywide
ESD if the City concurs. However, there is not a lot of support on the City's
part to get involved with an ESD at this time. There aze many variables
involved with such action and questions to be answered.
At present, the City EMS operates countywide, with the exception of the
northern part of the county being served by Junction, a small area in the
southern part of the county serviced by Bandera, and the Falling Waters area
served by Kendall with about a $300,000 to $400,000 annual shortfall.
Therefore, a countywide ESD would have to have a tax rate of at least $0.010
to $0.015 per $100 of evaluation to raise this amount of money just to cover
the current short fall. In turn, the County would be obligated to reduce their
tax rate by at least 1.5 to 2 cents or the amount of the ESD tax, in order to
assure
the Kerr County citizens would not have a tax increase to support a
countywide ESD.
A newly created County ESD Boazd could contract with the City to provide
EMS through out the county just as being provided now. The ESD tax would
apply to ail citizens of Kerr County. See attachment "B".
An ESD board would have to be appointed by the Court. The Boazd would
then have to enter into a contract with the City to provide the countywide
service or purchase the City EMS Department and run the Department
themselves including all billing, collections, maintenance, etc. and do all other
activities such as participating with dispatcher, etc.
The Viability of a Countywide ESD including all taxing entities in the County
is not likely until such time as all of the numerous tasks and details have been
fully explored and worked out. There would have to be many agreements
reached between all of these taxing entities before such an ESD could be
formed.
B.l.b. Countywide ESD Excluding the City
The function of a countywide E5D excluding the City of Kerrville would
provide EM Services throughout the County but not within the city limits.
The City would have to agree for the new ESD to provide EMS in the ETJ. A
countywide ESD that does not include the City could be established with little
difficulty. The laws governing such action are simple and easy to accomplish
Again, the Court would need to appoint an ESD Board. The Board would
need to enter into a contract with the City to provide EMS through out the
County just as the Court does now. The ESD Board would need to set a tax
rate to pay the City contract plus provide the cost of Board operations
including provisions for long range planning. With this arrangement there
would be no change in the current day-to-day operation.
Or, the County could set up their own Emergency Medical Service system
including equipment, buildings and staff. This would be a total duplication of
what the City is doing -billing, collections, etc. Keeping in mind that the
ESD tax district would not include the population within the city limits.
Possible funding for a new ESD is shown on attachment "B"
Again, the viability of such a district is not likely until the many details are
worked out and agreed to by all involved.
B.1.c. Countywide ESD Including/Excluding existing ESDs in the County
Any ESD created within the county would have to either include or exclude
the existing ESDs now operating within the county. At present there aze two
5
ESDs in the County -ESD #I (Ingram) and ESD #2 (Mountain Home). If
they are excluded, the new ESD would simply not include the geographical
boundaries of those ESD and any new ESD tax would not affect those
citizens. However, if the existing ESD were included in the new ESD, ESD
#1 & #2 would have to be dissolved or double taxation would occur.
The Viability of accomplishing such an ESD at this time would require
agreements on the part of all existing ESDs and an agreement with the City to
provide ETJ service. All of such agreements would have to be worked out
well in advance of forming such an ESD. The possible tax base for such an
ESD is shown on attachment "B".
B.2. Review EMS Operations
B.2.a. Billing
At time of service, EMS personnel fill out a billing sheet (paper form or
by computer) for each call made providing all the data regarding the
service provided. This data is used to prepare the invoice using the "rate
schedule" as shown on attachment "C".
EMS has four avenues for billing -CMS (Central Medicaze/Medicaid
System), Veterans Administration, Private Pay and Self Pay.
CMS is billed the entire cost of service provided although CMS only pay
80% of what Medicare/Medicaid approve. The difference in what is billed
and what is paid is classified as aon-collectable. If the patient carries a
secondary insurance coverage the remaining 20% of the
Medicaze/Medicaid approval will be paid by the secondary carrier. If the
patient does not carry a secondary insurance and does not pay the 20% it
becomes a bad debt.
The VA is invoiced the entire cost of service provided and pays the same
as CMS but very slow. In most cases, there is no secondary carrier.
Private Pay patients generally do not have Medicaze/Medicaid, but carry
their own private insurance and in some cases a secondary carrier. These
patients are billed the full cost of service. The amount paid is based on the
type of coverage the patient carries such as 80% co-pay. In this case,
EMS has to look to the patient to pay the 20%. This 20% is billable, but
EMS must look to the patient to pay. If it is not paid it becomes a bad
debt. In some cases the patient may have insurance but chooses to file his
own claim and then pay the bill once insurance claim is paid. If the
patient does not pay this bill after being reimbursed by the insurance filing
this becomes a bad debt.
6
Self Pay is when the patient has no insurance coverage and handles the
payment of their own bill. In the event these invoiced are not paid they
become a bad debt.
In that EMS is a Medicare Provider, all payments aze basically capped by
what Medicaze approves. Therefore, raising prices would not have a
significant impact on the total amount collected due to the Medicare cap.
It appears the billing department of EMS is making an effort to see that all
services provided aze accurate and processed timely.
There are numerous runs that EMS make that cannot be billed. If EMS
goes to a residence based on a legitimate call and the patient refuses
service, this run cannot be billed. The patient refusing service must sign a
document declaring that EMS is refused. If EMS goes to a highway
accident and the wreck victim refuses service, this call cannot be invoiced.
If some medical service or supplies are provided at the scene there is a flat
fee that can be billed but mileage cannot be charged unless the individual
is actually transported to the hospital.
B.2.b. Collections
According to the EMS coordinator Eric Maloney, the Kemille EMS
overall collection rate was 77.7% in 2004-5 with a net collection rate of
57.2%. 26.4% of that is non-collectables and 24.3% is bad deb s. The
bad debt part of this unpaid is referred to a collection agency for
collection after 90 to 120 days. The collection rate for bad debt in 2004-5
was 8.4%. EMS recently changed collection agency and has seen an
increase in the collection of bad debts based on information provided.
See revenue collection. breakdown on attachment "D".
B.2.c. Funding Formula
At present there is no standazdized funding formula used to determine the
County's participation in the EMS budget.
The City approach, as reflected in the 2005-6 budget, is to budget the
County for a portion of the Medical Director, Lease, and Medical
Coordinator and then split 50/50 the remaining subsidy that totals
$189,377. The deficit for 2005-6 is projected at $130,201 and will be
rolled into next yeaz's budget numbers.
This 50/50 split has never been based on any particulaz formula. It was
simply a means of sharing the subsidy. This 50/50 may have originated
for the 50150 split used with the Library funding. There is some
speculation that the 50/50 split is based on the number of runs being made
within the County outside of the City limits. There is no track record to
reflect this being the case. See attachment "E" for an actual break down
of the runs within the city limits and outside the city limits. In addition,
7
the County has always paid the total cost of First Responders. As can be
seen from attachment "E" the run percentages are: 65% City, 6% Ingram
and 29% in the balance of the county.
In previous years the City has budgeted the COUNTY'S PARTICIPATION
at the following amounts:
	2003-4	2004-5	2005-6
Medical Director	$ 9,898	9,040	9,040
EMS Lease	9,444	6,000	6,000
Subsidy Operation	-0-	-0-	136,837
Equip Replacement	-0-	-0-	37,500
TOTAL SUBDISDY	19,342	15,040	189,377
First Respond	9 675	10,780	10,780
TOTAL	29,027	25,820	200,157
The actual amount paid by the County to the City for EMS has been:
2003-4 2004-5 2005-6
29,027 23,700 (200,257)6adgeted
During the same period the City has budgeted the CITY'S PARTICIPATION
as:
	2003-4	2004-5	2005-6
Medical Director	$ 9,040	9,040	9,040
EMS Lease	6,000	6,000	6,000
Subsidy Operation	-0-	129,645	136,837
Equip Replacement	45,137	-0-	37,500
TOTAL SUBSIDY 60,177 144,685 189,377
The actual deficit for the same three-year period was:
2003-4 2004-5 2005-6
(147,771) (146,107) (130,20])*
* The actual deficit at the end of [he year is rolled over into the next year's budget
B.2.d. Other
In the review of EMS operations there was nothing noted that might
drastically affect the quality of service, cost effectiveness or other matters
that may improve EMS service. The current EMS operated by the City is
efficient and appears cost effective. The Bandera EMS, for example, has
one individual that works as a liaison between the medical provider,
individual doing the input, the paper work and the billing service to make
sure ail services provided are billed and proper coding for Medicare
payments. We could not identify any individual that performed such a
service with EMS.
B.3. Recommendations
The Committee is charged with making recommendations in several specific areas
of the EMS operation. This report will address these areas as well as presenting
conclusion that were noted and options that developed as this review process
developed.
B.3.a. Billing
There seems to be no required significant changes in the billing process.
The billing process performed by the EMS staff appears to be efficient,
timely and professional. If the County chooses to continue to be a
customer of EMS, the Committee recommends no changes required in this
area with the exception of that noted in section B.2.d.
The Committee did discuss the possibility of the City referring all calls
outside the city limits to the County for billing and collecting. This would
require a complete duplication of clerical operation. Therefore, this does
not seem to be a viable option. In addition, who in the county would
perform such a function?
B.3.b. Collections
There should be no significant changes in the collection process.
According to the EMS staff the collections are better than the area
average. The fact that billing is always greater than Medicaze approves
means there will always be a given amount of un-cohectables and hence,
bad debts. There are also bills that are just not paid for one reason or
another: bad checks, refusals to pay, cannot afford to pay and out of town
and hard to fine, bad addresses, etc. In general, after 90 days they are
turned over to the collection service. Although, the current Collection
Agency has been employed only a few months, EMS staff report that
recent changes made in the collection of bad debts have shown some
improvements according to Cindy Zachary. The Committee recommends
no changes in this area.
B.3.c. Equitable Funding Formula
The Committee is presenting several options the Court should consider as
possible funding formula:
B.3.a1) The Committee is recommending a three-person budget
committee -one representing the County, one the City of Kerrville
and one representing the City of Ingram. This three-person
9
committee would work with the City of Kerrville in developing the
EMS budget each year and sign on the legitimacy of the budget
and agree to include the anticipated subsidy & deficit in the
budget of the respective entities budgets.
B.3.c.2) In that all citizens aze residents of the county and pay the same
taxes, the County might consider paying the total EMS subsidy and
deficit each year. The Committee recommends this action.
As an example, for the current funding year (2005-2006) there is a
total subsidy of $378,754. $189,377 is being budgeted by the City
and $189,377 is being budgeted by the County. In addition, there
is a projected carry aver of $130,201 for a total of $508,955.
The Committee is "NOT" recommending that the County pick up
all of this subsidy this year or the next, but we are suggesting the
City and County should work out a way to phase into this
arrangement.
Again, the Committee is recommending that the County and City
should work together, along with the three-person committee, to
develop a budget that reflects a true minimum subsidy with out a
carry over deficit. The deficit & subsidy requirement may be
inherent in the level of care provided. In the event EMS would
operate without a deficit in any given yeaz, that savings should be
rolled over into the following years EMS budget and not go into
the City's General Fund.
B.3.c.3) A funding formula could be developed based on runs actually
made the previous year for each entity. For example, the 2004-5
percentage of runs were 65% Kerrville, 6% Ingram and 29 % for
the balance of the County. The County would pay the total cost of
First Responders but would share all other cost (EMS Medical
Director, EMS Coordinator, lease, Equipment and Subsidy) based
on the % figure of runs made. Attachment "E" shows 4,910 total
runs during 2004-2005. There were 3,933 total runs within the
county without the 977 transfers. Therefore, 2,559 (65 %) runs
in Kerrville, 216 (6 %) runs in Ingram, and 1,158 (29 %) runs
outside the city limits. See attachment "F" for mileage run recap
for 2004--2005.
B.3.c.4) A funding formula could also be developed based on the
population. The most recent population figure for Kerr County is
45,675, 1,817 for Ingram and 21,477 for the Kerrville. There are
22,381 citizens living out side of the city limits. Therefore,
Kerrville has 47 % of the population, Ingram has 4 %, and the rest
of the County has 49 %. In this scenario, the County would pay
the total cost of First Responders but would share all other cost
10
(EMS Director, EMS Coordinator, Lease, Equipment, and
Subsidy) based on the % of population shown.
If the City is agreeable to continue the percentage split of the subsidy and
deficit based on runs, mileage or population it is the Committees
recommendation that the County accept the arrangement.
B.3.d. Quality of Service
The "Quality of Service" now being provided by the City has been noted
on more than one occasion by leadership in both the County and City is
excellent and has never been an issue of contention during this study.
B.3.e. Adjacent Counties
See Attachment "G" to review the EMS operation in counties adjacent to
Ken County & Attachment "H" for those contacted in adjacent counties.
C. Conclusion
C.1. A Countywide ESD is the obvious solution to EMS (and Fire Service) throughout
the County. However, there are many hurdles to jump and numerous agreements
that would have to be reached prior to the development of any ESD countywide.
A joint effort between the City of Kenville and the County should be started at
this time to work towazd that aim. Bandera and Kendall operate their own EMS
system countywide and Kimble is a countywide ESD. Therefore, an in-depth
study of these bordering counties EMS operation would be beneficial to Kerr
County.
C.2. The County has had an equitable and in some cases more than fair arrangement in
the past with minimum financial participation. The 50150 split for the current
yeaz ('OS-'06) is fair and equitable on the part of the City. It would appear that
the basis of the conflict between the City and the County has been a lack of
effective communications. There seems to be a sincere effort on the part of the
current City Administration to see that this is corrected.
C.3. The Committee concludes that the Kerrville EMS is doing an excellent job. There
seems to be no major complaints of any sort regazding the service provided the
citizens of Kerr County.
C.4. With out a question the County & City aze getting the benefit of a well run EMS
Deparhnent that has the ability to work jointly with the Kerrville Fire Department.
C.S. In no case did the Committee find where the City is using any funds from the
EMS budget to support the City General Fund. The cost of two dispatchers
projected at roughly $72,000, is moved from EMS budget to the General Fund to
pay for these dispatchers. This item seems to draw the most attention in that the
11
budget entry is called "Transfer Oixt". However, this is a simple way of paying
the cost of the dispatchers without having dispatchers on the EMS payroll.
C.6. The City should provide the County the proposed budget as early as possible in
the budgeting process. A member of the County staff should participate in the
budget preparation.
C.7. The County should have a specific person to receive all monthly, if available, and
quarterly expense and income reports from the City, track the budget payments
and assist in the budget process. These reports and payments should be evaluated
monthly and the evaluation reported to the Court on a regular basics. If there are
irregularities they should be corrected timely. The Committee suggests that the
County Auditor should have this responsibility.
D. OPTIONS
D.1. Establish a Full Countywide ESD including The City of Kerrville and existing
ESDs
D.2. Establish a partial Countywide ESD without the City of'Kerrville and
include%xclude the existing ESDs.
D.3. Agree to a joint funding of the Cities service costs on a % basis.
D.4. Establish a separate fund for revenue and expenditures to finance the total EMS
Subsidy and Deficit of Operation
Approved this 27th Day of March 2006.
Dr. Gordon Morgan
Fo er Kerr Counnty Commissioner
Vv
Jim 1 urphy
Former Kerrville City Counci] Me btti er
p.""'11W..~ '.'.iN.M~'~.'~
Ray nond Lehman d' ~'°~~
Former Kerr C-o7unty Commissioner
~~ `w~i/
Walter Schellhase, Chairman
ATTACHMENTS
"A" -County's charge to the Committee
"B" -Recap of County Values and tax rate samples
"C" -EMS rate fee schedule
"D" -Revenue Collection Breakdown
"E" -Recap of runs made in 2004 - OS
"F" -Recap of mileage for 2004 - OSCity
"G" -Recap of data from Bordering Counties
"H° -County EMS Directors Contacted
"I " - Fund 30 2003-04, 2004 - O5, 2005 - 06
"J" - EMS Equipment Recap
"K" -Payee Types and Revenue Analysis
12
A
Proposed members for EMS Study Committee:
1. James A. Murphy 2. Gordon Morgan
3. Joe Herring, Jr. 4. Ray Lehman
5. Walter Schellhase
Statement from Kerr County Commissioner's Court:
Kerr County Commissioners Court desires to maintain a very high standard of medical
care and service in Kerr County. The Commissioners Court further believes, to the extent
possible and practical, that the EMS service grovided in Kerr County should strive to be
financially self sustaining. With these goals in mind an assessment of the following
items by the above appointed committee will be of great service to the residents of Kerr
County.
1. Assess function and viability of an Emergency Service District (ESD)
a.) County-wide ESD including the City of Kerrville.
bJ County-wide ESD excluding the City of Kerrville.
Note the two current ESD's in the county may be excluded under either scenario
2. Review and make recommendation on the billing system and rate structure under the
current EMS contract with the City of Kerrville.
3. Review and make recommendation on collections system undeP the current EMS
contract with the City of Kerrville.
4. Review and make recommendation on an equitable funding formula between the City
of Kerrville and Kerr County for funding any financial shortfall under the cun~ent EMS
contract.
5. Review and make recommendation on other EMS issues that affect quality of service,
cost effectiveness or other matters that may improve EMS service in Kerr County.
Committee to report back to the Commissioners' Court not later than March 1, 2006 with
its fmdings.
Kerr County hopes the City of Kerrville will join in approval of this committee to help
develop a long range plan for the continued high quality of EMS service throughout Kerr
County.
~-
KERB COUNTY
TAXABLE VALUES
2005
CERTIFIED NET TAXABLES -INCLUDES FROZEN
TAXABLE VALUES - 2005
County	$2,840,108,495
City	1,324,805,483
Ingram	54,479,617
ESD #1	353,058,479
ESD #2	63,106,768
**~**~*ss:rs*****r:a*a*~*~r***~s*r~**~ss~ss*ss~r~**-ersan~~~~+~srr*~s*:vs**er~**te
COUNTY $2,840,108,495 @ $0.02 on $100 of value = $568,022
COUNTY wlo KERRVILLE $1,515„303,012 @ $0.02 on $100 of value = $303,061
COUNTY w/o KERRVILLE,
INGRAM and ESD #1 & #2 $1,044,658,148 @ $0.02 on $100 of value = $208,931
Counties 2005-6 Participation $2,840,108,495@ $0.00675 on $100 of value = $191,707

2006 APPROVED FEE SCFtEDULE
FEE
EMS:
Basic Life Support	331.22
9asic Life Support (Emergency)	331.22
Advanced Life Support 7	447.58
Advanced Life Support I (Emergency)	447.56
Advanced Life Support tl	632.50
Specialty Cara Transport	632.50
Aid Gnly, No Transport	100.00
Dedicated Standby	
Fnrfirst two hours (per hour)	100.00
Par hour after fir;d two hours	75.00
Response Fea	55.00
Local Transport (NO Supplies)	100.00
Return (NO Supplies)	100.00
Mileage {per loaded mile)	9.35
SupplylProcedura Charges:	
SplintinglTraction	33.00
Burn Cooled/Drassed	28.40
Neck/Spine	38.50
Emergency Chiltl Birth	33.00
Shock Management	38.50
Suction	22.00
Puise Oximetry	55.00
Dextrose Stix	27.50
Extra Attendant	100.00

KERRVILLE SIRE DEPARTMENT
Revenue Collections Breakdown
Fiscal Year04/05
Gross Service Charges
9ncluoea T; ansters
Charges Disallowed 26.4°10
Net Service Chargtss
Sent to Collections 24.3°i°
Revenue from Collections 8.4°~
Total Cash Revenue
Ovetatl Gross Collection Rate
Net Collection Rate
rooes rot include the Charges Dis°gowed
$ 1,939,525
$ _ (511,915)
$	1,42$,414
$	(347,728)
$	29,090
$	1,109,772
57.2°~
71'.7°~
City of KertvfHe C~deMlial 2/23/20pt, Page 2
E flEppRSME~T
KERRVILLE FIR
Requested EMS Report
punt
~'a
Transfers
Ci~Y
CauniY
i~gram
~iltab1e
patient C G gEp
AR APR MAY J~5 J05 A05 05
V ipEG JAN FEB 05 05 05 69 79 85 221 . n.5 5 0 3q 33 ` Z4 /s
OCT NO 04 05 ~ 97 78 95 220 201 212 ~ 1 ~ ° y (~ fu
04 04 Z2 63 92 214 227 111 111 143 2~ ~
89 216 1Q2 19
2 2 186 223 296 206 a4 122 96 17 22 ~ 7 423
97 72 14 23 ~ 435 408 413
1
22 ~ 385 378 387 416 437 38 333 366 ~ ~ ,~,~
424 387 374 369 3
313 327 355 354 '.
367 336
~1¢ i~>,S
3°~~'~
Page 1
1131(2
v..~ille GOT~dent+2a

KERRVILLE FIRE DEPARTMENT
Requested EMS Report -Mileage
Fiscal year 04/05
Total Miles traveled
Transfer Billable (loaded) Miles
Non-Transfer Billable Miles
City
County
Ingram
Total Billable (loaded) miles
Note:
120,970
37,537
Miles
4, 907
6,724
1,127
12,758
Percent
38.46%
52.70%
8.83%
100%
1. This report does not include any miles traveled from Refusals.
Example - if an ambulance travels to Mo Ranch for a sick call and
the patient refuses transport, no miles are billed or logged.
2. This report does not include all the miles traveled for Air Medical
Transports. Example - if an ambulance travels to Mo Ranch for a
sick call and transports the patient to San Antonio via Air Medical
Transport. Only the miles traveled from the scene to the Landing
Zone are billed to the patient.
3. These two examples would significantly increase the number of
miles added to the County. Unfortunately, there is no way to track
the actual miles traveled without pulling every Refusal and Air
Medical Transport report.
4. This report only reflects the Billable (loaded) miles and does not
include non-billable miles. Example -noted in #1 and #2, to any
emergency scene, or miscellaneous travel around town.
City of Kemille Confidential 1/31!2006 Page 1
EMS AD HAC COMMITTEE
KERB COUNTY
BORDERING COUNTY REVIEW
COUNTY KERB	BANDERA	GILLESPIE KENDALL KIMBLE
		
OWNER OF EMS City of Kemille	County with units	City & County County Run Countywide ESD
with units located	located in Bandera,	share equally 100% County Tax Rate %x cent
at 2 fire stations	Pipe Creek, and Northern	fmanced
	part of county	
'OS-`06 BUDGET $2,081,785 $707,000 not provided $900,000 $300,000
75% service/5% grants
'OS-'06 SHORT FALL $389,534 -0- if there is one it will not provided 25 to 30% about 20%
be paid by county tax ($225 M to $300 M
# PERSONNEL 21 3 Full Time 12 full time 12 full time 1 full time/13 part time
30 Part Time I S part time paid per call
36 Volunteers
PERSONNEL BUDGET $1,165,392 $500,000 not provided $400 to 500,000 M $82,000
BILLABLE RUNS-2004-5 4910 1300 to be provided 2090 441
TRANSFERS-20045 974 -0- (911 only) not provided emergency only 21 % (93 runs)
WHO DOES BILLING City of Kemille BMC Billing not provided Houston Firm San Antonio Firm
in house Mike Naughton
210-355-5986
COST PER BILLING not provided $17,75 not provided 12% 10%
COLLECTIONS City of Kemille By County By City Employees Houston Firm San Antonio Firm
68 to 75 % per Cindy % Unlmown 45% is Medicare/Medicaid
BAD DEBT Company in Dallas	Municipal Service	Farmed out Houston Finn	Forgives -does not
20% of collections	20% of collections	12 % & uses	pursue those that cannot pay
	800-568-7004	credit cazds	
AREA SERVED Ken County less the	Bandera County plus	not provided All of Kendall &	Kimble County plus
northern part & southern tip	southern tip of Kerr	Falling Water in Kerr	northern Kerr
/'~
W
EMS AD HAC COMMITTEE
KERR COUNTY
EMS CONTACTS
%ERR COUNTY Eric Maloney, EMS Coordinator 830-257-5333
BANDERA COUNTY Cindy Martin, EMS Coordinator 830-796-4282
210-364-0613 (c)
Christy, City Halt 830-796-3765
KENDALL COUNTY Jeff Fincke, EMS Manager 830-249-3721
Boerne City Halt 830-249-9511
GILLlSPIE COUNTY Waltace Britten, EMS Director 830-997-7521
Commissioners Court 830-997-7503
County Judge 830-997-7501
EDWARDS COUNTY Becky Kott, EMS Manager 830-683-3305
Tue/Thu/Fri Only
Rocksprings City Hall 830-683-4105
Sheriff's Dispatch (Misty) 830-683-4104
REAL COUNTY Leakey City Hall 830-232-6757
Tue/Wed/Thu Only
BIMBLE COUNTY Ted Sandlin, EMS Director 325-446-3300
Junction City Offices 325-446-2622
Commissioners Court, Mr. Torres 325-446-3353
,,,8,2!)!)8 x
9:20 AM
EMERGENCY MEDICAL SERVICES FUND
BUDGET SUMMARY
FUND 30
AMENDED PROJECTED REQUESTED
	ACTUAL	BUDGET	BUDGET	BUDGET
	2003-04	200405	2004-05	2005.06
BEGINNING CASH BALANCE	($189,099}	($129,757)	($147,771)	($146,107)
REVENUES:				
Operating Revenues'	$1,650,083	$1,659,070	$1,560,712	$1,692,251
Operating Transfers in	0	578	1,880	0
City Subsidy - Medicgl Director	9,040	9,040	9,040	9,040
County Subsidy -Medical Director	9,898	9,040	16,595	9,040
City Subsidy -EMS Lease	0	6,000	6,000	6,000
County Subsidy -EMS lease	9,444	6,000	6,000	6,000
City Subsidy -Operations	0	129,645	129,645	136,837
County Subsidy -Operations	0	0	0	136,837:
City Subsidy -Equipment Replacement	45,137	0	0	37,500
County Subsidy -Equipment Replacement	0	0	0	37,500
County First Responder Program	9.675	10.780	10 0	10.780
TOTAL REVENUES	1 7 ' 77	$1.830.153	$1.740.651	$ 82.0 1.785
				
TOTAL FUNDS AVAILABLE	$1,544,178	$1,7D0,396	$1,592,880	$1,935,678
EXPENDITURES
Operating Expenditures	$1,571,452	$1,690,959	$1,668,477	$1,755,680
Equipment Replacement	63,280	0	0	150,000
Operating Transfers Out	57,217	70.510	7 0	7 36
TOTAL EXPENDITURES	691 50	$1.761.489	51.738 987	$1.978,096
ENDING CASH BALANCE
5% FUND BALANCE REQUIREMENT
($147,n1) ($s1,D73} ($1as,1D7) ($42,a1a>
$87,783
DIFFERENCE TO FUND BAWNCE REQUIREMENT {$130,201)
J
KERRVILLE FIRE DEPARTMENT
AMBULANCE BREAKDOWN
Medic 2 -- 24/7 Primary response unit at Station 2 (Coronado Dr. )
Currr:nt Mileage 91,b76
Medic 3 - 2417 Primary response unit at Station. 3 (Legion Dr.).
Current Mileage 114,273
Medic 1 - Backup ambulaace which is net manned. [n case of an emergency or we are
out of ambulances it is manned by Fire Company personnel if available, or by
off-d'uty personnel. This unit is located at Central Pire Station (Water Str.)
Currr;nt Mileage 124,734
Medic 6 -Backup ambulance which is not manned. In case of an emergency or we are
out of ambulances at can be manned by off-duty personnel, which is located at
Station 3 (Legion Dr.). This unit is going to be replaced this year.
Currant Mileage 190,548
Medic 4 -Primary Transfer unit that is on duty Monday thru Friday 7:30 to 4:30p at
Admin Office (Coronado Dr.); Secondary response unit for 911 emergency
calls.
Cun•<:nt Mileage 120,381
Medic 5 -Primary Transfer unit that is on duty Monday Lhru Friday i O OOa to 7:OOp at
Admn Office (Coronado Dr }; Secondary response unit for 9 ] 1 emergency
calls.
Content Mileage 42,306
In Summary, the Kettvillc Fire Department has a total of six ambulances in the
fleet; two primary ambulances are manned 2417 for all 911 calls within Kerr County,
These units alsc+ make transfers after 7:OOpm and on weekendsv if necessary. The two
primary transfer ambulances are manned for 8 hours Monday tl-iru Friday and can
respond to 911 +alls in the county They also are on call over Ute weekends on a rotating
basis to make transfers. The two secondary reserve ambulances are .not manned and can
respond only if the primary units are not available. However, these reserve units must be
manned with fire engine personnel if available. Let ma explain what 1 mean about fire
personnel being available. We run minimum manning on shift When we are at this level
we wil I not be able to maa an ambulance. To man an ambulance we must have two
medics available. If we take them ofP of a fire truck this would cause an engine company
to beout-of-service or we would call to ofT duty personnel to man the ambulance. The
1Genville Fire Department plans to replace or remount one ambulance per year at a cost
of $l SQ,000 for a replacement and $75,000 for a remount. Currently, because of budget
shortfalls, we arc behind schedule, We are replacing one ambulance this year and need to
remount twn ambulances next year.

KERRVILLE FIRE DEPARTMENT
Requested EMS Reports
December 1, 2004 to July 31, 2005
Pavee Tvpe -Transports Percent
Medicare 60.7%
iNedicaid 7.1 °h
VA 9.
Totals 77.2%
Other Insurance 10.5%
Private Pay 12.3%
EMS Location Code Analysis Report
!Fiscal year 04/06
CSI ,, ocatian	Patients	P		evenu	Rev. %
City	2560	64.8%	$	763,050	63.2°•6
County	1165	29.5%	$	370,136	30.7%
Ingram	217	5.5%	$	69,846	5.8%
Gut Of County	$	0.2%	$	3,826	0.3°k
Totals	3950		$	1,208,858	
Ciry of KerrvlN° CoxMdenNal 2/2312006 Pege 1