5/9/2016 1 Volunteer Survival Series Nancy Magee Running Lean Running Lean Keeping Your Volunteer Agency Financially Viable Nancy Magee, AEMT MEDIC Training Solutions, LLC Volunteer Survival Series Nancy Magee Challenges Challenges Staffing Recruitment and retention Supplementary staffing Training requirements Leadership Funding Nancy Magee Volunteer Survival Series Objectives Objectives Identify financial needs and utilize assets on hand. Minimize waste and control costs. Increase revenue Decrease spending Explore grants and fundraising opportunities. Discuss how to present our case to the public in order to obtain, maintain, or increase municipal funding.
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5/9/2016
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Volunteer Survival Series
Nancy Magee
Running LeanRunning Lean
Keeping Your Volunteer Agency Financially ViableNancy Magee, AEMT
MEDIC Training Solutions, LLC
Volunteer Survival Series
Nancy Magee
ChallengesChallengesStaffing
Recruitment and retentionSupplementary staffing
Training requirementsLeadershipFunding
Nancy Magee
Volunteer Survival Series
ObjectivesObjectivesIdentify financial needs and utilize assets on hand.Minimize waste and control costs.Increase revenueDecrease spendingExplore grants and fundraising opportunities.Discuss how to present our case to the public inorder to obtain, maintain, or increase municipalfunding.
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The Business of EMSThe Business of EMSEMS has unique challenges in terms of smallbusiness operations.Ordinary small businesses can:
raise rates.cut back on hours.reduce staffing.depend on repeat business from satisfiedcustomers.
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The public has been conditioned to call 911.
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As of September 2014, 41 million Americanswere uninsured.
No one knows how the ACA will affect EMS,but realistically we can expect moretransports which will be billed at the low endof the payer mix.
From 2007-2013 10 million Americans wentfrom private insurance to Medicare.
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The Backbone of EMSThe Backbone of EMSVolunteers provide 46%of 911 EMS servicenationwide.1Rural areas depend onvolunteers 70-90% of thetime.
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How Will Your Agency Survive?How Will Your Agency Survive?The average American taxpayer believes thatEMS is tax funded.
Much of it is not.There is no Federal mandate for funding.
All Federal funding for EMS was eliminated bythe 1981 Consolidated Omnibus BudgetReconciliation Act (COBRA).
Costs are going up.Reimbursement is going down.THIS IS NOT A SUSTAINABLE MODEL.
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Doing More With LessDoing More With LessStrategies must be determined to accomplishthe following:
Increase revenueDecrease expendituresControl costs and minimize wastePlan for the future
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Fiscal and Public AccountabilityFiscal and Public AccountabilityYour agency must be prepared to present anaccurate, detailed, up to date accounting of costs.The cost of readiness must be both recognizedand understood by the community you serve.Be prepared to explain the cost of saving lives inyour service area.
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So How Do We Do It?So How Do We Do It?StrengthsWeaknessesOpportunitiesThreats
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SWOT: StrengthsSWOT: StrengthsExamples:
Years of service to the community have createdpublic loyalty to the organization.Your service will always be needed, and the needwill most likely increase.Volunteers are passionate and fiercely dedicated totheir mission.
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“The greater danger for mostof us lies not in setting ouraim too high and fallingshort; but in setting our aimtoo low, and achieving ourmark.”
~ Michelangelo
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SWOT: WeaknessesSWOT: WeaknessesExamples:
Failure to meet performance standardsComplacencyCultural stagnationLack of financial and management expertiseFailure to recognize threatsInability to attract new members
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“People are attached to theobsolete. Things that ‘shouldhave’ worked but didn’t, andthings that were onceproductive but no longer are.”
~ Peter Drucker
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SWOT: OpportunitiesSWOT: OpportunitiesLive up to publicexpectations.Educate the public onthe importance andbenefit of maintaining alocal non-profit EMSsystem.Become an organizationthat people are eager tobelong to.Implement cost savingmeasures immediately!
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“Face reality as it is, not asit was, or you wish it to be.Change before you have to.”
~ Jack Welch
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SWOT: ThreatsSWOT: ThreatsResistance to changeInadequate staffingInability to demonstrate value and benefit to thecommunityAuditsFinancial instabilityLow expectations become a self-fulfilling prophecy
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“The most dangerous phrasein the language is, ‘We’vealways done it that way’.”
~ Rear Admiral Grace Hopper
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Factors AffectingCost of ReadinessFactors Affecting
Cost of ReadinessService areaCall volumePersonnel costsOperating costsRevenue sources
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The Cost of ReadinessThe Cost of ReadinessBecause of high fixedcosts, low-volume serviceareas have higher costs pertransport.Median annual cost per call:
Nationwide: $429Rural: $800+
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Who Pays Your Bills?Who Pays Your Bills?Typical rural EMS payor profile:
And You Think We Have It Bad!And You Think We Have It Bad!California:
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Making Your CaseMaking Your CaseIn order to accurately present the cost ofreadiness for your service, you must know:
Assets on handDebt serviceOperational costsAnnual revenue from all sourcesCall volume
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Ways To Increase RevenueWays To Increase RevenueDon’t. Pass. Calls.Follow up on billing. Know your:
Payor profileCollection costsHow much is written off and whyDocumentation accuracy
QA all electronic PCRsCorrect demographics (including insurance)SignaturesDesignations (ALS or BLS)Transport destination vs mileage paid
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Explore Other Revenue SourcesExplore Other Revenue SourcesGrantsCorporate sponsorshipsEndowmentsCommunity fundraising
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Put the FUN in Fundraising!Put the FUN in Fundraising!The possibilities are limited onlyby your imagination.Ensure your agency’s websitehas a link for online donations.Engage local business ownersfor ideas.Stay visible in the community.Successful fundraising is a year-round venture.
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Give us more money…
… or people will die!
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Obtaining Municipal SupportObtaining Municipal SupportKnow your numbers!Know how much you needand why.Explain how you willutilize those funds.
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Controlling CostsControlling CostsLabor is your biggest expense.An effective scheduling program:
Helps avoid passed callsLimits overtime costs
Get the most value from your paidstaff:
TrainingStation dutiesRecord-keepingCommunity service
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Control InventoryControl InventoryPhysically inventory suppliesControl access
Keep doors lockedSign out sheets should be utilizedand reviewedQA should verify calls reflectitems used/missing
Return overstock where possibleEstablish partnerships withneighboring agencies to use upwhat cannot be returned
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Volunteers are notorious for carrying excessiveamounts of equipment and supplies.
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Downsize and De-ClutterDownsize and De-ClutterEvaluate what needs tobe kept on hand.Know what equipmentis required.Know the cost ofsupplies.Overstock:
Ties up $$Encourages wasteCreates confusion
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Downsize and De-ClutterDownsize and De-ClutterGet rid of outdated andobsolete equipment.Donate it to a 3rd worldcountry or an EMSmuseumDo not keep it at yourstation.
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Avoid “What If?” SyndromeAvoid “What If?” SyndromeStreamline your gearAvoid redundancyREALISTICALLY evaluatewhat you need.There is no need to carrythe entire ambulanceinventory to the bedside.
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Jump KitsJump KitsOften given out as a “perk” formembers.How many who have themactually respond?Contains anywhere from $300-$1,000 worth of supplies.Most of it expires or getscontaminated before it is everused.
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Apparatus CostsApparatus Costs100% of ambulance sales representativesstated that volunteers trade in their trucks asoften as two years before necessary.
Modern diesel engines have a realistic lifeexpectancy of 250k+ miles.Many are not considered adequately broken-inuntil 50k miles or more.
New ambulances are not a cost-effectiverecruiting tool or member perk.
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Other Big-Ticket ItemsOther Big-Ticket ItemsMechanical CPR devicesPower loading systemsEveryone gets an AED?Everyone gets a radio?
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Education Is Expensive…Education Is Expensive…
… but not nearly as expensive as ignorance.
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Often people with no business or managementexperience are making these choices.
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WHO IS MAKING THE DECISIONS?WHO IS MAKING THE DECISIONS?Patient-centric vsEgo-centric purchasing
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Risk Management Is EssentialRisk Management Is Essential
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Volunteer Agencies Do Get Sued…Volunteer Agencies Do Get Sued…… and fined.… and audited.
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Breakdown of Claims AgainstEMS Agencies and Providers:Breakdown of Claims AgainstEMS Agencies and Providers:
Fraud and WasteFraud and WasteFederal government has budgeted $300 milliondollars toward audits to identify billing errorsand fraud.Medicare, on average, collects $7 for every $1spent.They are highly motivated to pursue EMS.They do not care if you are “just a volunteer.”Ensure all run forms are QA’d for clinical andbilling accuracy.Triggering an audit could bankrupt your agency
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Follow Up On All Contract ServicesFollow Up On All Contract ServicesLawyersAccountantsBilling servicesFleet maintenanceStaffing servicesPayroll companies
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Fiscal ControlsFiscal ControlsAll checks written should require a minimum oftwo signatures.Itemize everything paid from “General Funds.”Petty cash should never be treated as a “slushfund.”
SummarySummaryHow will my agencysurvive in today’s fiscalclimate?
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Thank you For Your Attention!Thank you For Your Attention!
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ReferencesReferencesAn Aging Nation: The Older Population in the United Stateshttp://www.census.gov/prod/2014pubs/p25-1140.pdfNVFC EMS Cost Savings Calculator Excel Worksheethttp://tinyurl.com/qch78ooNVFC EMS Cost Savings Presentation Templatehttp://tinyurl.com/o9ltoyaEMS Workforce for the 21st Century: A National Assessmenthttp://www.ems.gov/pdf/EMSWorkforceReport_June2008.pdfGlastonbury Volunteer Ambulance Association DefendsService http://tinyurl.com/jwoyf6lIssues in Staffing Emergency Medical Services: A NationalSurvey of Local Rural and Urban EMS Directorshttp://www.shepscenter.unc.edu/rural/pubs/report/FR93.pdf
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ReferencesReferencesRural Health Network Development Planning Programhttp://www.emsgrantshelp.com/search-grants/1632092/MacKenzie, E.J., & Carlini, A.R. (2013, August).Characterizing local EMS systems. (Report No. DOT HS 811824). Washington, DC: National Highway Traffic SafetyAdministration.Misuse of the Emergency Medical Services Systemhttp://tinyurl.com/pb48e9fNational Association of EMS Officialshttp://www.nasemso.orgRural Ambulance Service Budget Modelftp://ftp.hrsa.gov/ruralhealth/AmbulanceBudgetModel.pdfVolunteer EMS: Reports From the Field, Final Report 99http://www.shepscenter.unc.edu/rural/pubs/report/FR99.pdf
