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13 <br /> The EMS model focuses on ambulance transport services, including advanced life support and <br /> basic life support responses and associated mileage. Using call volume,transport mix, payer <br /> mix, and cost allocation data,the model estimates that EMS transport and mileage services <br /> cost approximately $16 million per year. At current ALS and BLS base rates and mileage charge, <br /> projected revenue is approximately $4.5 million annually,which equates to roughly 28% cost <br /> recovery and a remaining subsidy of about $11 million. Please note that our model uses <br /> conservative volume estimates; actual revenue and recovery rates may be higher. <br /> This gap is driven by external constraints. Federal and state reimbursement schedules, <br /> commercial insurance contracts, and limited collection rates for self-pay accounts place a <br /> ceiling on what EMS can realistically recover through user fees. Full cost recovery for EMS is not <br /> feasible under current reimbursement policy and would be inconsistent with the County's public <br /> safety goals. The recommended rates move EMS closer to regional norms, improve cost <br /> recovery within those constraints, and still rely on County contributions and other funding <br /> sources to support most EMS operating costs. <br /> Peer Comparison Analysis <br /> MGT collected peer data from several agencies to compare the County's current fees against <br /> others. Based on the information gathered, EMS rates charged by Orange County are generally <br /> lower than those charged by peers, with the exception of Advanced Life Support-2 (Emergency) <br /> and Advanced Life Support-2 (Non-Transport). When comparing payment collection <br /> mechanisms, MGT found that most peers use a third-party billing system,while Orange County <br /> handles billing in-house. Orange County also offers hardship assistance, while none of the peer <br /> agencies reviewed provided such assistance. Please see Exhibit B for the complete listing of <br /> peers and fees MGT collected data for. <br /> Special Event Coverage Fees <br /> As part of the user fee study, Emergency Services computed hourly rates for use in Special <br /> Event Coverage fees. These are intended to help cover the cost of providing staff and <br /> equipment at events like concerts. The hourly rates are presented in Exhibits 2 and 3. The <br /> County sets the rate for all parties in the County to provide this service. The County does not <br /> provide this service itself, due to lack of staff capacity. As such,this fee would initially benefit <br /> other providers, primarily South Orange Rescue Squad. If the rates are set too low and other <br /> providers no longer offer this service,then the County would need to hire additional staff to <br /> provide this service itself. Setting the rate at the amount required for the County to provide this <br /> service is useful as a cost avoidance measure. <br /> Exhibit 2:Special Event Fees, Per Hour <br /> Special Event Coverage Fees <br /> Standby Position Current Fee(Per Hour) Proposed Fee (Per Hour) <br /> Additional EMT $40.00 $45.00 <br /> Ambulance with 1 Paramedic and 1 EMT $120.00 $220.00 <br /> Ambulance with 2 EMTs $110.00 $210.00 <br /> Clerical Staff $20.00 $30.00 <br /> EM Senior Officer $40.00 $60.00 <br /> EMS Command Staff $60.00 $60.00 <br /> EMS Physician $85.00 $85.00 <br /> Paramedic $60.00 $60.00 <br /> Telecommunicator $40.00 $50.00 <br /> MCIT PAGE 9 <br />