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56 <br /> Fee Study Review — Emergency Medical Services <br /> Staff Recommendations <br /> • Costs can be increased incrementally to regional peer averages. This will not dramatically improve cost <br /> recovery due to constraints from Medicaid reimbursement and self-insured low payment rates. <br /> • County cost to run this service is high, and based on current CIP & Operating model, county subsidy will <br /> increase in future years. While County has limited ability to offset these investments, the County can <br /> communicate the need for these investments during budget process. <br /> • CIP includes significant investments in EMS services that will drive increases to debt service. These <br /> include a robust EMS vehicle replacement schedule, new CAD software, and two new EMS <br /> substations that will add staff and vehicles. New ES headquarters and VIPER radio towers are also <br /> significant capital investments in next 5 years. <br /> • County currently uses grant funding to cover new EMS programs like PORT and CARES, that will <br /> eventually need to rely on county funding if they are maintained. <br /> • One component for future review is external collections. County currently has staff in Tax Office collect <br /> EMS fees. All peer reviewed counties use external collection services. County added an FTE in Tax in <br /> 2025 to improve collection recovery. Staff will review alternative models and reach out to peer staff which <br /> use external collections. <br /> ORANGE COUNTY <br /> 21 NORTH CAROLINA <br />