I
hope you are enjoying your weekend, Elyrians. As promised, here are
some of the questions sent to me by citizens that have arisen regarding
the Voluntary Performance Audit completed by the State, and my
responses. Again, thank you for your willingness to learn more about
YOUR city government.
Janice: What is the City doing to control health care costs?
This
is an area that all employers are struggling with, and the City of
Elyria is no different, as costs have escalated almost 13 percent
annually. To help address this, in 2012 the City re-bid the health
benefit broker contract, interviewed 11 respondents and chose a new
benefits broker that presented a case for reducing costs while
maintaining high quality services to employees. The Hoffman/Gallagher
Group was chosen and saved the saved the City $44,160 annually and
$156,620 through 2015. In 2012, working with the City Employee Health
Care Committee, the City increased employee contributions, increased the
deductibles on the medical plan, increased the out-of-pocket maximums
on the medical plan, recaptured prescription drug rebates, and lowered
the cost of the prescription drug mail program to encourage use and
lower costs. A new Employee Assistance Program (EAP) is providing more
comprehensive wellness programming and the Medical Mutual Super Wellness
program is being encouraged among employees – i.e. a new Wellness Fair
in 2012. By making these adjustments, the City has been able to
moderately increase the self-insurance reserve fund.
Fred:
Why do you and some members of City Council disagree on whether or not
the area of Emergency Medical Service should be examined?
First
let me say, that while the delivery of emergency medical care to the
citizens and visitors of Elyria has been reviewed and opinions offered
in the past, there remain many nagging issues related to the quality and
cost of care. There are many people who have strong opinions about how
EMS should be provided. My sole motivation is to assure the best
possible care is delivered at the most economical and sensible cost. I
am committed to studying the issue thoroughly and making a
recommendation to City Council that best serves our citizens. Whatever
option is recommended, everyone can be assured that it reflects a
detailed and diligent analysis.
All
members of City Council were briefed twice at City Council meetings by
the State Audit Team regarding the proposed scope of the audit. They
were given an opportunity for feedback prior to the Audit application
being submitted to the State by the Mayor’s Office. All but one member
of Elyria City Council voted to support the audit.
I
did recommend, and continue to recommend, that the City review how we
are delivering emergency medical services, for several reasons. Here
are those reasons.
The
current contract with LifeCare Ambulance is 17 years old and at the
very least, needs to be updated to address modern-day challenges and
expectations related to (1) population shifts in the city and the
location and number of ambulances available; (2) the increasing demand
of an exploding baby-boomer population; (3) modern technology that
impacts patient outcomes; (4) and the fact that the City is not getting
reimbursed for medical supplies when it is called by 9-1-1 to provide
patient stabilization; Lifecare currently receives all insurance
reimbursement. There are also additional vehicle and equipment costs to
the City that are currently non-reimbursable when providing first
responder services. If the City is to continue to provide partial EMS
back-up, or some level of EMS support, forging an updated approach will
benefit all concerned.
As
the Audit also stated, the City should also explore other business
models to determine if a revenue stream can be created to help off-set
the overall service delivery costs for both EMS and fire. Options
recommended for further exploration were based on revenue-generating
examples from other cities in the delivery of fire-based EMS or a
separate fire and EMS function. Based on comparisons with peer cities,
the audit estimated that Elyria could potentially generate $852,672 in
revenue annually for EMS response and transport. While further study is
warranted to determine if this estimate is in fact the case, adjusting
the delivery model could generate some of the revenue needed to off-set
costs of the expiring SAFER grant that funds 23 positions in our fire
department.
A
further point to consider is that the fire department staffing must be
maintained at a level that assures timely response to fires and other
emergencies; there must also be adequate manpower at each incident.
Otherwise, the citizens and firefighters can be at risk of injury or
death. Because fires and other such emergencies do not occur with great
frequency (but the threat is always there), the firefighters are
available to respond to medical emergencies in addition to the fire
calls. Employing the fire department staffing for both functions could
potentially allow us to achieve better utilization of our needed
manpower.
In
my opinion, given the current financial condition of the City, I don’t
know why we wouldn’t at least further explore revenue-generating options
that could potentially help prevent the City from having to go back to
taxpayers for a tax increase to address a serious manpower shortage in
the fire department. It is true, other remedies will also be required
to make up for the financial shortfall – including changes in the
collective bargaining agreement, changes in the command structure and
more.
In
the end, it will be Elyria City Council that makes the ultimate
decision if the City of Elyria assumes a larger role in EMS services –
not the Mayor. My role as Mayor will be to help collect information,
gather expert advice, and make a recommendation to Council. I am
interested in your thoughts on this subject. Please email me at hbrinda@cityofelyria.org.
Jack:
Overtime has been a concern across the City. How are you addressing
overtime issues in the City, and in particular, in the police and fire
departments?
As
a result of $1.7 million in cost-cutting measures to the 2013 fiscal
year budget, all departments of the city received a 10 percent reduction
in their available overtime allocation. To monitor this, the Finance
Director is now running variance reports that are reviewed by senior
management, department heads and chiefs on a quarterly basis to hold
down overtime expenses across the City. This practice will result in an
overall reduction of overtime use, with exceptions made to overtime
critical to safety, weather and natural disaster issues that arise on a
routine basis. Almost all overtime in Enterprise Fund departments are
weather related and cannot be dramatically reduced. Other significant
changes in overtime will have to be negotiated through the collective
bargaining process. Shifts are set in those agreements and the city’s
management does not currently have the ability to change shifts. Only
the Parks and Recreation Department has “off shift” workers where
management can make shift adjustments.
Specific
to the Fire Department, during the course of this audit the City
re-established three command positions through internal promotions to
help offset overtime expenses from acting officer pay and also provide
additional supervision. The majority of the remainder of overtime in
the fire department resulted from mandatory training by state and
federal agencies or emergency recalls of personnel due to emergencies.
The City will work through the collective bargaining process to address
provisions in the collective bargaining agreements that increase the
use of overtime.
In
the case of the Police Department, additional steps to reduce overtime
include reducing supervisor staffing to one and adjusting schedules for
non-patrol positions. The audit does not explain some of Elyria’s
overtime ($45,000) that is the direct result of an OVI prevention grant
from the State that funds overtime for the purpose of reducing the
number of drivers under the influence on the road. The City agrees that
overtime due to officer court time could be reduced through creative
means. It will be difficult, however, to implement the audit’s
recommendation to reduce overtime by going to more part-time officers
due to a number of factors including training and other costs equivalent
to fulltime personnel; new healthcare legislation that next year will
require employers to offer benefits to employees working 30 hours or
more per week; limitations of reconfiguring an existing workforce under
existing collective bargaining agreements; and a question about the
city’s ability to hire high quality, part-time police officers when
other fulltime options are available in the county. A practical
approach, we believe, is to address language in the collective
bargaining agreement that impacts overtime requirements.
