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Home My WebLink AboutItem O3 03 BOARD OF COUNTY COMMISSIONERS COUNTY of MONROE Mayor James K.Scholl,District 3 The Florida Keys Mayor Pro Tern Michelle Lincoln,District 2 Craig Cates,District 1 David Rice,District 4 Holly Merrill Raschein,District 5 Board of County Commissioners Meeting August 20, 2025 Agenda Item Number: 03 2023-4297 BULK ITEM: No DEPARTMENT: Fire Rescue TIME APPROXIMATE: STAFF CONTACT: R.L. Colina N/A AGENDA ITEM WORDING: Monroe County Fire Rescue(MCFR) operations presentation in support of the Trauma Star Billing Rates & Collections Summer Study project. ITEM BACKGROUND: Monroe County Fire Rescue(MCFR) is presenting EMS billing rates and collections operating information as a result of a Summer Study project. PREVIOUS RELEVANT BOCC ACTION: N/A INSURANCE REQUIRED: No CONTRACT/AGREEMENT CHANGES: N/A STAFF RECOMMENDATION: Approve DOCUMENTATION: Trauma Star® FY26 Budget Summer Studies 8.02.25.pdf FINANCIAL IMPACT: N/A 3791 N F; � E-,, M �t' I I � � ;�,��. �;�� ; 4 �� °� So-M,,,�n ��,,, IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ��,�� m� � ° � liiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii wu�itatW � � +wnNnnttnv JVI � ` �- u {NttVN1\110ll11W"0 INN\\1\\� �pp9mumuNN �.'6�� Illlll�i I �� ,!,tt�M�� ttW n�� a, � VMnmvN' v�� IIIVNNllttll .� � � IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII i mryN�� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII � i Y i I��' Yw�umnaattm IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII � �� wrcpU�II�IIW�"' �Y�RH7pwuup kw u� 5 �m.� ''0 �� v��n ��m d�� 11ll�mm14W it lu,. ��' �R'kM4NNN1111Alllllllllll�'" �' yu�nu�mp uuooq d nnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnnni uumwu �� N,1111111141V16t u o00000000000000000000000000000000000000000000 I 1 �. ,� D U �, IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII rc�Nsattnm+l +!; I �V � R1lummi ' ru�uvnunt P6111IDININ°°N � Wlq I° aWMNNntttlllq Np ��t��, i,o 'i IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII --� ��. u,��t�s�,,,��u ° °�° 'iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii � „ ,��+�++yip k�,�immw+o»++u jl�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l�l i +uNNNNNN~ �� "�i+itt++vn noun IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII I YumIN111BtIN'W"" IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII �, �unNnnttttv iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii�" ttnttttnot++t�, � ?! �� iii IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIII IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ��yivnna �1V�N 7 NNE III 'Ipm�i� !Sln��i ��„ � IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII „�nmip�vma 1u�n�wi n,,, iiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiiii IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ��»�»�+ �+��t�NtN�"" ��uNMttttttu� 000iiiiiiiiii0000000000000000iiiiiiiiii00000000000000000iiiiiiiii00000000000000000000000 ;,;�� I�IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII � �ttntt�ntt+ � �� ,�,,,,,�, uuuiiiiiiiiiiuuuuuuuuuuuuuuuuiiiiiiiiiiuuuuuuuuuuuuuuuuuiiiiiiiiiuuuuuuuuuuuiiiiiiiiii �i � iii ��N ,,,,,,,,, ,,,,,,,,, ,,,,,,,,, ,,,,,,,,, wuHHHh�� l�'N u4uN� Buaattttuaw° �'� � ren6�1+ ..rcm ............................................................................................................: M1V11NINI+AIu 4raml�'�°°�u auyl�Hn W I,Y,6q, rmu �d 4anr� ,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,,, tto+o++�N" I I � �� kM11119V911) �� unNnnttttv ��d f uuuuuuuuuuum r�Natttttt NI ��IIIII �, �I � .imno'�9Vq� uuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuuu uuuuuuui�� IIIIIIIIIIIIIIIIIIIIIIIII �IuuMuriNlf�J"tt IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIIIIIII�IIIIIIIIIIIIIII i,,,, ��,�""'� nIIN ,,IVI10tNNllVIW` ry b �Vuuuuuuua�N ��° +nm '..rmuttvmu+t+»+»+»+�w � �"m��""' IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII ""�G' tin ,�� i G �� >;a �m � �� IIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIIII +� N, nttn'��u,�wM��m ray ,�� uNh��un�w"a h e�� o t r � 4�, � �i; ��:,. 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' ^ � � � ` ! \ ; `� � \� \ i a- > ; e ! ` ! m . a e ! \ � � + � � e ! ! ; ! ; � � ' & ` . � } � \� \ N i, � lR' r � �Ol�' i / , II 1 W IIII Im�� IIII o � �,; Liz Yongue From: Gomez-Krystal <Gomez-Krystal@MonroeCounty-FL.Gov> Sent: Wednesday, August 13, 2025 12:47 PM To: Ballard-Lindsey; County Commissioners and Aides; Kevin Madok; Pamela Hancock; Senior Management Team and Aides; Liz Yongue; InternalAudit Cc: Shillinger-Bob; Williams-Jethon; Cioffari-Cheryl; Livengood-Kristen; Rubio-Suzanne; Pam Radloff; County-Attorney; Allen-John; Danise Henriquez; Hurley-Christine; Rosch- Mark; Gambuzza-Dina; Beyers-John; InternalAudit; Kevin Madok; Valcheva-Svilena; Powell-Barbara; Guerra-Cynthia Subject: Item 03 BOCC 08/20/2024 REVISED BACKUP Attachments: Trauma Star - FY26 Summer Studies Presentation 8.13.25.pptx; AIS.pdf Categories: Orange Category Good afternoon, Please be advised that the agenda item backup has been revised for item 03. "Monroe County Fire Rescue (MCFR) operations presentation in support of the Trauma Star Billing Rates & Collections Summer Study project. " Sincerely, Executive Administrator Monroe County Administrator's Office 1100 Simonton Street, Suite 2-205 Key West, FL 33040 (305)292-4441 (Office) (305)850-8694(Cell) Courier Stop#1 Notary Public w.r o n r y e c_ u�n1y:�:V_e.gpy i».c z..- Y .�.. _rn groecou�_n�.Y..-.�..:.i» .Y. PLEASE NOTE: FLORIDA HAS A VERY BROAD RECORDS LAW. MOST WRITTEN COMMUNICATIONS TO OR FROM THE COUNTY REGARDING COUNTY BUSINESS ARE PUBLIC RECORDS AVAILABLE TO THE PUBLIC AND MEDIA UPON REQUEST. YOUR EMAIL COMMUNICATION MAY BE SUBJECT TO PUBLIC DISCLOSURE. 1 7 e") Monroe County Trauma Star FY26 Budget Summer Studies Trauma Star Progra Seruetces Billing Rates and Collections Ill. V IN Iwwi 14 "i! Wiwiu r ., , f (/' • a wrr r 1L ./ r war J► A� «rrw w. . .r Monroe Count Fire Rescue mission Emergency Seruices is committed to seruing our community with the highest leuel of life and property protection to meet the needs of our residents and visitors in the Florida Keys. Our mission is to relentlessly protect and preserue life by responding with speed, skill, and determination to euery emergency. I!A 0 I" IR 0 IE C 0 U IN TY 2 Monroe County Trauma StareVIEW" The Program ,NOW Trauma Star is the only Air Ambulance seruice in Monroe County prouided by a combination of resources between Monroe County Fire Rescue and the Monroe County Sheriff's Office operating from two bases in Marathon and Key West. I!A 0 I'q R 0 IE C 0 U I114 TY . r P1,10jMDA. arewwrz�""'' 3 Monroe Countyma Star Mann HNNNO Wm"" Serulces The medical air transport program prouides emergency medical scene responses swiftly, transporting patients to appropriate healthcare centers, including necessary hospital to hospital critical transfers, in a safe and professional enuironment. Consists of firefighters that are highly trained paramedics / critical care paramedics and nurses, who prouide emergency medical care during flights. The Monroe County Sheriff's Office prouides experienced administrative flight personnel, pilots and specialized auiation mechanics. l!A 0 I'q R 0 oiiE C 0 U iN TY . r F1110jWDA. 00 Monroe County Trauma Star Operations Update ➢ Helicopters & Replacements ➢ Program Staffing ➢ Historical Annual Service Demand ➢ Factors Affecting Services ➢ Flight Transport Charges & Collections ➢ Charge Recovery Limitations (\Ills I, MONROE COUNTY <Jilj F111Orzron. - 5 Monroe County Trauma Star _ Helicopter Rei)[acements -- ➢ Helicopter builds are complete, f inal stages of testing and inspections ➢ Reviews in progress by Sheriff's Off ice head Pilot and Fire Rescue's Chief Flight Nurse ➢ Helicopter delivery and local in-service training initiated by end of year (\Ills I, MONROE COUNTY <Jilj Fir�rzron. _ 6 Monroe County Trauma Star .................... Mow WON"" Prog-owram Staffing ➢ Operations are 24-7 / 365 at North and South Air Bases staffed with a Nurse, Paramedic and Pilot ➢ This year, fiue Paramedics completed flight preceptor medical program, cleared by the Medical Director and following in-service training will be rotated into operations I, MONROE COUNTY <Jilj Fir�rzron. Monroe County Trauma Star MOW • Serulce Demand bu Fiscal Year N 1400 qmwFligh s 1140 1221 1200 978 970 981 � 1000 t 856 li 800 827 798 O 4) 600 624 0 471 Z 400 382 200 0 FYI FYI FYI FYI FYI FYI FYI FYI FYI FYI FYI 8 Monroe County Trauma Star Mow - ,, 378 ,, ////////////////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%////%/////////%////%%I Lower Keys Medical ,,,��i�///////��/1 mmmmuouuouuouuouuouuouuouuouuouuouuouuouuouuoim......................................... iiiiiiiiiiiiiiiiiiiiiiiiiiiiii, t88 F ISI'IernlanS Mariners 147 On Scene/Landing Zone 0319 Cancelled Flig mp -34 -50 0 50 100 150 200 250 300 350 400 Total of 798 Flights were Billable '. M 0 114 IR 0 E C 0 U 1 in Fiscal Year 2023-24 IF a) 111 IDA, ,% 9 Monroe au�na StaTr r n WON"" Factors Affectina Serulces 14W ➢ Helicopter mechanical and maintenance issues increase with age of helicopters, including down time - New fleet will improve down time ➢ Number of trauma patients in need of flight services at the same time - New fleet will improve flight availability ➢ Reduced number of non-critical patient flights to ensure availability and readiness for more critical patients ➢ Medical services available at local hospitals ➢ Increased availability of ground transports (several new transport companies) ➢ Weather / FAA restrictions ➢ Staffing challenges in recruitment of highly specialized trained professionals for aviation ➢ Ensuring that critical care and rapid transports are provided the highest standard of care, when standard critical transport availability decreases 10 Monroe County Trauma Star WIMP" 9'I MOW Private Ground Transportation Units 14 OLIMMM kgmy w� 1 �Miiw 13 13 12 10 8 6 6 6 6 6�'�` 4 2 0 ZO�a^5 ZO�y^6 ZO�6^'l Z��1�$ ZOO$^9 ZO�9,y0 ZOZ�.y� OZ^Zp2Z ZOZZ•L3 ZOZ3.2a ZoZa.ZS Z 11 Monroe County Trauma Star Flights S Collections bg Fiscal Year . Charges . ollec„on ♦ Flights AM .10,000,000.00 L �— ,..000.00000 Monroe County Trauma Star �e �FY 28-24 Flight Breakdown bu Insurance Categoru Indigent and/or Actively Billing Inmates ,z, o.00zo> Medica.. ,zae„s> FL State Reimb Rate F-101- Can .e . ,e,.. 798 T tad / ss.ss,.sz lift off Resident Fee $42.99 per mile Indigent No"'iv`., (eB) Flights Illed Ins (157) jig 'Grorvn Arco R�prpmts sY% o/ hnrrance comme,un,ziu..nc - _.. �i � ��tlrY Medicaid (sa) .�� $ eo cc�ne,mn. FL Stat Reimb Rate I�,�Y Mo ur� ry Managed Medical Assistance� .�, ., iu,� $x n. mile Monroe County Trauma Star IN VIEW" Volow Charge Recoueru Limitations MEW Total Avg Total Estimated Max Max Allowable Reimbursement Sample Sample Recovery Reimbursement per Mile Mileage Reimbursement Possible MCFR Charges $ 12,000.00 $ 100.00 70 $ 199000.00 Medicare $ 69691 .62 $ 42.99 70 $ 99700.92 51 .1% Medicaid $ 19116.61 $ 4.47 70 $ 19429.51 7.5% Blue Cross Blue Shield $ 79829.97 $ 90.66 70 $ 149176.17 74.6% Total Estimated Average Recovery Possible 44.4% 'Note:Above Information provided as "sample"for Representatlon purposes 14 Monroe County Trauma Star MOWN ammm Charges & Collections bu Year low Fiscal Service Recovery Bonus Year Demand Charges Collections Rate Base Rate FY 14-15 382 $ 590469056.00 $ 295009113.57 50% 33.70% FY 15-16 471 $1090119690.00 $ 392969145.29 33% 33.70% FY 16-17 827 $1894289740.00 $ 595969665.79 30% 33.70% FY 17-18 978 $2292179680.00 $ 799869457.40 36% 33.70% FY 18-19 970 $2196819130.00 $ 892649479.56 38% 33.70% FY 19-20 856 $1897359510.00 $ 793339364.28 39% 33.70% FY 20-21 19140 $2595119615.20 $ 891299949.31 32% 33.70% FY 21-22 19221 $2793519100.00 $1194959095.97 42% 33.70% FY 22-23 981 $2199329600.00 $1092739227.38 �. ' . FY 23-24 798 $1796179500.00 $ 894579092.50 �. ' . FY 24-25* 624 $1299109700.00 $ 695609046.02 ' . . M 0u R 0 *lit : F ' '` /�',� r hurl Fiscal Data tu.(Di iDA. 15 Monroe County Trauma Star _ Charge Recoueru LimitationsEW" -- ➢ qRIEW Percentage of payments nary by insurance ➢ Insurance cost-sharing payment limits ➢ Indigent and/or actively billing patients ➢ Charge recovery limitations ➢ No Surprises Act instituted January L 2022 I, MONROE COUNTY <Jilj Fir�rzron. ` 16 Monroe County Trauma Star _ Charge Recoueru LimitationsRIMMI- -- No Surprises Act instituted January 21, 2022 ➢ Prohibits providers from billing the balance of air charges not paid by insurance to patients (cannot collect more than insurance allows) ➢ Cost-Sharing Limits (deductibles, copays and co- insurance) are based on the insurance plan's in- network rates, euen for out-of-network medical services Monroe County Trauma Star IN VIEW" VOWN Charge Recoueru Limitations low ➢ Current charges for Trauma Star transports are $12,000 for lift off plus $100 per mile ➢ Medicare reimburses $6,691.62 for lift off plus $42.99 per mile as mandated by the State ➢ Medicaid reimburses $1,116.61 for lift off plus $4.47 per mile as mandated by the State ➢ Blue Cross Blue Shield (BCBS), our largest commercial insurance prouider, reimburses on auerage $7,829.97 per lift off plus $90.66 per mile I!A 0 I'q R 0 IE C 0 U IN TY w 18 Monroe County Trauma Star EW" Charge Recouerg Limitations -- ➢ Mow Self Pays are difficult to collect as there is no incentive to pay * No address to bill or No insurance to bill (67 in FY25 & 225 in FY24) ➢ Indigent patients - Sometimes billed to shelters ➢ Immigrants - Border Patrol assists with patient billing ➢ Resident Fee Waivers - Any insurance collections are exhausted before qualified resident fees are waived and written off (63 in FY25 & 238 in FY24) ➢ Legal Settlements are typically insufficient as they are based upon monetary awards that are distributed amongst many providers 19 Monroe County Trauma Star Future Actions Evaluate f light activity following a f ull 12 month of operations r Delegate authority for the Director of Emergency Services to negotiate periodic reimbursement settlements r Evaluate COPCN's need capacity