CITY COUNCIL STAFF REPORT
October 1, 2024 {{section.number}}b
PUBLIC HEARING TO CONSIDER ADOPTION OF UPDATED EMS/AMBULANCE FEES FOR
THE CITY OF CORONADO FIRE DEPARTMENT
RECOMMENDATION:
Conduct a public hearing and adopt the resolution adjusting EMS/Ambulance fees to the full service costs, including an automatic annual adjustment based on the Consumer Price Index (CPI) for the San Diego region.
BACKGROUND:
The City of Coronado (City) provides Emergency Medical Services (EMS) and ambulance services through its Fire Department. These services include Advanced Life Support (ALS) and Basic Life Support (BLS) ambulance transport, among others. The current fees were last studied in 2010, with annual CPI adjustments since that time. However, operational costs have outpaced CPI adjustments, largely due to increases in salaries, equipment costs, and broader medical sector expenses.
To ensure compliance with California law, which mandates that user fees cannot exceed the cost of the service provided, the City engaged Willdan Financial Services to conduct a comprehensive Ambulance User Fee Study in 2024. The study was completed in June 2024 and recommends updating the fee schedule to ensure that users of EMS/Ambulance services bear the costs, while reducing the subsidy from the City's General Fund.
ANALYSIS:
The 2024 Ambulance User Fee Study revealed that mathematically, current fees recover approximately 22% of the full costs of ambulance services. The actual cost recovery for ALS services is estimated between 6%-14%. The gap between the true cost and actual recovery is due to increased operational costs, such as advances in equipment and technology since the fees were last updated in 2010, and changes in the healthcare system, including Medicare and Medi-Cal limitations that cap the amount of reimbursement the City will receive.
Key findings from the study include:
• The true cost of ALS ambulance transport is $6,144, while the current fee is $1,347. • The true cost of BLS ambulance transport is $5,469, while the current fee is $1,199. • Coronado’s ambulance fees are currently the lowest in the San Diego region.
For full recovery of costs, the ALS fee would need to be set at $6,144, and the BLS fee at $5,469.
This full cost recovery is recommended because of the discount on actual recovery imposed by statute and insurance program caps on reimbursement. Although billing would be at full cost recovery, the City is expected to receive 26-34% of those full costs.
Based on staff's recommendation for full (100%) cost recovery and the findings of the fee study, the proposed fee schedule reflects the full cost of providing EMS/Ambulance services. These fees ensure that the City recoups the greatest extent of actual costs while continuing to provide highquality EMS services.
CPI Adjustment:
To ensure that fees remain current and reflective of rising operational costs, staff recommends an annual adjustment based on the Consumer Price Index (CPI) for the San Diego region, effective on the first day of each July. This approach provides a proactive way to address inflationary pressures without the need for large, sudden increases in future years. Future fee studies are recommended as well for adjustments to baseline costs that may not be fully captured in CPI.
FISCAL IMPACT:
The fee adjustment is projected to generate approximately $1.4 million annually, an increase from the current recovery of $780,000. This increase in revenue will partially offset the annual operating expenses of the Fire Department, helping to maintain desired service levels while minimizing the need for General Fund subsidies.
ALTERNATIVE:
The City Council may choose to adopt a lower cost recovery rate, such as 80% or 90%, as reflected in the Ambulance User Fee Study, or direct staff to return with alternative recommendations.
CALIFORNIA ENVIRONMENTAL QUALITY ACT:
This action is exempt from environmental review pursuant to CEQA Guidelines Section 15273, as the activity involves the establishment of rates, fees, and charges.
PUBLIC NOTICE:
Legal notice of the public hearing was published in the Coronado Eagle & Journal on September 18 and September 25, 2024.
ATTACHMENTS:
1. Resolution No. 2024-61
2. 2024 Ambulance User Fee Study
Submitted By: Fire Services Department / Jayson Summers