1. or YOU CAN’T HAVE A CAVIAR SYSTEM ON A PEANUT BUTTER BUDGET
A Tale of Two Cities or
YOU CAN’T HAVE A CAVIAR SYSTEM ON A PEANUT BUTTER BUDGET

2. System Needs Drive System Design
AP Triton Consulting, LLC
System Needs Drive System Design
Populations – age, economics, density
Geography – natural and manmade barriers
Hospitals – locations, distance, saturations

3. System Design Drives System Cost
AP Triton Consulting, LLC
System Design Drives System Cost
Dispatch, call taking, EMD
Response – type, level, mode, TIME
Transport type and location
Surge capacity

4. System Costs Drive System Design
AP Triton Consulting, LLC
System Costs Drive System Design
FACTORS:
Payer Mix
Dispatch / Response Policy
Surge Capacity

5. System Value Finite amount of system revenue
AP Triton Consulting, LLC
System Value
Finite amount of system revenue
Call volume
Payer mix
Call type
Rates for service
No one has an advantage over the others

6. Matching System Design to System Value
AP Triton Consulting, LLC
Matching System Design to System Value
Determine the “value” of the system
Payer mix to rates = System Value
Determine the cost for service
How many units or unit hours are needed

7. Matching System Design to System Value
AP Triton Consulting, LLC
Matching System Design to System Value
Determine the cost for service
Response times
ALS vs BLS
Tiered response
Maximum UHU / TOT

8. Matching System Design to System Value
AP Triton Consulting, LLC
Matching System Design to System Value
Objectives:
Determination of value
System design
Determination of costs

9. Matching System Design to System Value
AP Triton Consulting, LLC
Matching System Design to System Value
Options:
Increase rates (political decision)
Modify deployment (measure against needs)
Combination of both (usually the best)

10. AP Triton Consulting, LLC
NOW WHAT?

11. Comparison of Bids and Types
AP Triton Consulting, LLC
Comparison of Bids and Types
FFS – Traditional bid (stipulated rates)
FFS – Traditional bid (proposed rates)
Fixed cost subcontract (hours, transport, system)

12. City A Wants Unit Hour Bid
AP Triton Consulting, LLC
City A Wants Unit Hour Bid
Seven 24-hour units / 365 days a year
Two EMTs
Total unit hours = 61,320 per year

13. City A Wants Unit Hour Bid
AP Triton Consulting, LLC
City A Wants Unit Hour Bid
Salaries: $2,530,000 ($41.26 / hour)
Benefits: $885,500 ($14.44 / hour) – 35%
Other costs: $1,713,723 ($27.95 / hour) - 33%
TOTAL UNIT HOUR COST: $83.65

14. City B Wants Unit Hour Bid
AP Triton Consulting, LLC
City B Wants Unit Hour Bid
Six 12-hour units / 365 days a year
One EMT / One Paramedic
Total unit hours = 26,280 per year

15. City B Wants Unit Hour Bid
AP Triton Consulting, LLC
City B Wants Unit Hour Bid
Salaries: $2,679,000 ($ / hour)
Benefits: $451,000 ($17.16 / hour) – 17%
Other costs: $1,970,000 ($74.96 / hour) - 38%
TOTAL UNIT HOUR COST: $ ($198)

16. A Tale of Two Three Cities

17. City C Wants Unit Hour Bid
AP Triton Consulting, LLC
City C Wants Unit Hour Bid
Two 24-hour units / 365 days a year
One EMT / One Paramedic
Total unit hours = 17,520 per year

18. City C Wants Unit Hour Bid
AP Triton Consulting, LLC
City C Wants Unit Hour Bid
Salaries / Benefits: $1,862,572 ($ / hour)
Rolling Stock: $146,605 ($8.37 / hour)
Other costs: $502,294 ($28.67 / hour)
TOTAL UNIT HOUR COST: $143.35

19. AP Triton Consulting, LLC
City A – Acme Ambulance* $83.65 / hour City B – Acme Ambulance* $ / hour City C – Fire Department $ / hour * non-union

20. A Tale of Tangled Webs Establish your System Value
AP Triton Consulting, LLC
A Tale of Tangled Webs
Establish your System Value
Chances are your City and/or your County will have no idea
Challenge your LEMSA’s “expert” consultant (CoCo)
Determine your system needs (deployment)
Lower response times, more units
Increased and better patient outcomes
Never assume anything
Firefighter based ambulances may be cheaper
Increase in revenue to your agency

21. Don’t let the “tale” wag the dog!
AP Triton Consulting, LLC
Don’t let the “tale” wag the dog!

22. Thank You. Kurt Henke 707.266.4309 KHenke@APTriton.com