U.S.
Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
This document was prepared under HRSA contract
# 250-03-0022, U.S. Department of Health and Human Services, Health
Resources and Services Administration, Office of Rural Health Policy.
Printer-Friendly
Acrobat Version (985 kb)
Contents
Foreword
Overview
Future Efforts
Introduction
Limitations
Notes about the Model
Let's get Started
Spreadsheets
Demographics
Vehicles
Building
Other Capital
Staffing
Training
Other Expenses
Budget
Rate Study
QuickBooks Easy Step Interview
Contact REMSTTAC
APPENDIX A: REMSTTAC Stakeholders'
Group
Foreword
We are very pleased to offer you
the Rural Ambulance Service Budget Model. This budgeting
and financial management tool is an important part of the financial
toolkit under development for rural ambulance services and rescue
squads that do not have the resources to purchase such tools themselves.
We recognize that rural ambulance services are an essential component
of rural health care systems. Budgeting and financial management
is but one of the many challenges facing rural Emergency Medical
Services (EMS) agencies in the United States today. Rural EMS agencies
also face such issues as recruitment and retention of qualified,
trained human resources; increasing education and training requirements;
increasing cost of equipment and increasing funding challenges,
to name a few.
With capital and operating costs increasing and
reimbursement decreasing, management of limited financial resources
is becoming a more important component of rural ambulance service
management and governance.
The Rural Ambulance Service Budget Model provides
a management tool that enables a service to enter known financial
information into a simple, yet elegant preprogrammed spreadsheet.
Once information is entered into the model, a budget is automatically
calculated that can be exported into off the shelf accounting software
and monthly budget versus actual results can be used to better manage
limited funds and plan for improved financial management of the
service.
This publication was developed by the Federal
Office of Rural Health Policy, Health Resources and Services Administration
in cooperation with the Rural Emergency Medical Services and Trauma
Technical Assistance Center. It is hoped that this Rural Ambulance
Service Budget Model will serve as a valuable tool for rural
ambulance services and provide for better informed fiscal management
in the challenging realm of out of hospital health care.
Please see the special note on the following page
concerning the ongoing availability of this document.
Marcia K. Brand, Ph.D. |
Nels D. Sanddal, Director |
Associate Administrator
for Rural Health, HRSA |
Rural EMS and Trauma
Technical Assistance Center |
A special note to the reader:
In FY 2000, Congress funded the Trauma and
EMS Program within the Department of Health and Human Services,
Health Resources and Services Administration (HRSA) to foster the
development of appropriate, modern systems of such care. Ten percent
of the funding provided for that program was earmarked for "rural"
trauma and EMS and was administered by HRSA's Office of Rural Health
Policy (ORHP). In FY 03, ORHP established the Rural Emergency Medical
Services and Trauma Technical Assistance Center (REMSTTAC). This
product represents one of the deliverables identified in the REMSTTAC
contract. Congress zeroed out the HRSA Trauma and EMS Program in
FY 05 and ORHP, therefore, lost the resources necessary to continue
REMSTTAC. However, as part of ORHP's ongoing commitment to rural
EMS, this and other products will continue to be available from
two sources. These include the Critical Illness & Trauma Foundation
(www.citmt.org) [not a government
Web site], the parent organization of the previously funded REMSTTAC,
and the Rural Assistance Center (www.RAConline.org)
[not a government Web site]
OVERVIEW
In the early stages of the development of the
Rural EMS and Trauma Technical Assistance Center (REMSTTAC) a diverse
group of stakeholders were brought together to provide input and
direction regarding how the TA center might best meet the needs
of its constituency groups. These three groups are broadly defined
as:
- Federal Agencies and national EMS, trauma,
and rural health organizations with interest in or responsibility
for rural EMS and trauma and their intersection with rural health.
- State EMS lead agencies, State Offices of Rural
Health, and similar State level organizations that relate to rural
EMS, trauma, and overall rural health.
- Local and regional EMS and trauma providers,
including rural ambulance services, hospitals, rural health clinics,
and other agencies and organizations involved in regional and
local health planning and provision.
In developing and prioritizing the REMSTTAC scope
of work, the stakeholder group recommended the development of a
financial tool kit that would provide specific financial and budgeting
tools to rural EMS agencies and organizations that may be managed
by volunteer EMS providers or others with limited experience or
training in the financial and budgeting aspects of public, private
or not-for-profit organizations. As cited in the Rural and Frontier
EMS Agenda for the Future (2005), many rural and frontier EMS services
"have no expertise or infrastructure for collecting fees or
maintaining the business functions." The need for this toolkit
has been further validated through a series of "town hall"
meetings conducted in the intermountain west and New England States
with representation from local EMS leadership.
In response to this direction, a task group
was organized within REMSTTAC to develop tools for this financial
tool kit. The task group, coordinated by a REMSTTAC staff person,
includes a business/financial consultant and representatives of:
the National Association of State EMS Officials, the Rural Health
Resource Center and the National Association of Emergency Medical
Technicians (EMTs). In addition to the considerable knowledge and
expertise of these task group members, tasks and priorities are
reviewed by the entire stakeholder group. Their input and direction
guides the work of the task group. The task group and stakeholders
identified the following priorities for toolkit development:
- A financial Chart of Accounts that identifies
common elements of assets, liabilities, revenues, and expenses
applicable to a rural EMS agency or organization
- A budget tool that assists rural EMS agencies
and organizations in developing and tracking operating budgets
and establishing fee schedules
- Instructions for using a budgeting tool and
interface with common "off the shelf" accounting software that
is readily available at low cost to rural EMS agencies or organizations.
The Sample Chart of Accounts represents
the first drawer in the Financial Toolkit. It provides a bookkeeping
and accounting framework for rural EMS services and is consistent
with generally accepted accounting principles. It is organized as
follows:
- Assets - These accounts represent both cash
and non-cash assets and include bank accounts, accounts receivable,
fixed assets such as property, plant and equipment with allowances
for applicable depreciation of such assets.
- Liabilities and Equity - These accounts represent
accounts payable, loans and lines of credit as well as earnings
and owners' equity or fund balances, depending on the type and
structure of the organization.
- Revenue - These are income accounts such as
revenues from patient billing, other revenue, subsidies, etc.
and are applicable to either cash basis or accrual basis accounting
rules.
- Expense - These accounts represent the costs
of doing business, such as payroll, fringe benefits, costs of
occupancy, repairs, maintenance, and similar expense items.
Some EMS services may not need all the items shown
in the sample Chart of Accounts. Others may find the need to add
accounts. Either way, the sample provides a model with the most
commonly used accounts in the accounting structure of a rural EMS
organization.
Sample Chart of Accounts |
Assets |
Liabilities/Equities |
|
|
|
|
1000 |
Cash |
4001 |
Patient Revenue - Medicare |
1200 |
Accounts Receivable |
4002 |
Patient Revenue - Medicaid |
1300 |
Prepaids |
4003 |
Patient Revenue - Other |
1400 |
Inventory |
|
|
1500 |
Investments |
4100 |
Grant / Subsidies Revenue |
1600 |
Property, Plant and Equipment |
4200 |
Investment Income |
1700 |
Other Assets |
4300 |
Other Income |
|
|
|
|
2000 |
Accounts Payable |
5000 |
Contractual Adjustments - Medicare |
2100 |
Short Term Debt |
5001 |
Contractual Adjustments - Medicaid |
2200 |
Accrued Salaries |
5002 |
Contractual Adjustments - Other |
2300 |
Other Accrued Liabilities |
|
|
2400 |
Long-term debt |
|
|
|
|
|
|
3000 |
Net assets/Equity - Unrestricted |
|
|
3100 |
Net assets/Equity - Restricted |
|
|
Expenses |
6101 |
Salaries-Patient Care |
6342 |
Legal Fees |
6102 |
Benefits-Patient Care |
6343 |
Collection Agency Fees |
6103 |
Medical Supplies - Patient Care |
6344 |
Software Maintenance Contracts |
6104 |
Gases (oxygen) - Patient Care |
6345 |
Consulting Fees |
6105 |
Drugs - Patient Care |
6346 |
Service Contracts |
6106 |
Laundry & Linen - Patient Care |
6347 |
Management Contract |
6107 |
Equipment Depreciation - Patient
care |
6348 |
Claim Processing Contract |
6108 |
Equipment Repair - Patient Care |
6350 |
Dues & Memberships |
6109 |
Minor Equipment - Patient Care |
6351 |
Licenses |
6110 |
Training - Patient Care |
6352 |
Donations |
6111 |
Books & Periodicals - Patient
Care |
6353 |
Food |
6112 |
Travel & Entertainment - Patient
Care |
6360 |
Printing & Publication |
|
|
|
|
6201 |
Dispatch Salaries |
6400 |
Interest Expense |
6202 |
Dispatch Benefits |
|
|
6203 |
Dispatch Supplies |
6503 |
Facilities Supplies & Services |
6207 |
Dispatch Equipment Depreciation |
6507 |
Building Depreciation |
6209 |
Dispatch Minor Equipment |
6508 |
Building Maintenance |
6213 |
Telephone |
6570 |
Building Rent |
6214 |
Radio Maintenance |
6571 |
Property Taxes |
6215 |
Radio Antenna |
6572 |
Utilities |
6216 |
Cell Phones |
6573 |
Housekeeping |
6217 |
Pagers |
6574 |
Laundry - Non Patient Care |
|
|
6575 |
Uniforms |
6301 |
Administration Salaries |
6576 |
Property Insurance |
6302 |
Administration Benefits |
|
|
6303 |
Office Supplies |
6680 |
Vehicle Registration |
6307 |
Office Equipment Depreciation |
6681 |
Vehicle Gas & Oil |
6308 |
Office Repair & Maintenance |
6682 |
Vehicle Repairs |
6309 |
Office Minor Equipment |
6683 |
Vehicle Depreciation |
6311 |
Books & Periodicals |
6684 |
Vehicle Leases |
6312 |
Travel & Entertainment |
6685 |
Auto Insurance |
6313 |
Administration Telephone |
6400 |
Interest Expense |
6320 |
Worker's Comp |
|
|
6321 |
Unemployment Tax |
6503 |
Facilities Supplies & Services |
6322 |
FICA Tax |
6507 |
Building Depreciation |
6323 |
General Liability Insurance |
6508 |
Building Maintenance |
6324 |
Professional Liability Insurance |
6570 |
Building Rent |
6325 |
Umbrella Coverage |
6571 |
Property Taxes |
6326 |
Health Insurance |
6572 |
Utilities |
6327 |
Pension Plan |
|
|
6340 |
Physician Fees |
|
|
6341 |
Accounting Fees |
|
|
The Rural Ambulance Service Budget Model (RASBM)
fills a very large drawer in the REMSTTAC Financial Toolkit. The
Budget Model is a customized Microsoft Excel® spreadsheet. Part
of the Microsoft Office® software family, Excel® is commonly
available to most computer users and is often bundled on computers
marketed in the U.S. Where Excel® is not already installed on
a personal computer; the software can be purchased inexpensively
from most office supply stores or on-line software vendors. If you
have other spreadsheet software REMSTTAC will assist you in the
conversion or importation of this template.
This tool was developed to assist rural ambulance
services in establishing an annual budget. It also helps calculate
the value of services donated to the ambulance service by another
entity and the value of donated services provided by the ambulance
staff to the community.
Why should you prepare and use a budget?
A budget is a record and forecast of all cash sources and cash expenditures.
Maintaining a budget allows you to estimate future needs and profits
and to plan for managing any discrepancies. At minimum, your budget
should track the expenses of running your service compared to the
money generated. A detailed budget will allow you to do much more
than simply track revenue and expenses; it will provide the framework
for quantifying the overall value of your ambulance service. This
becomes especially important when seeking community support, reporting
to oversight boards or committees, and in applying for grants or
loans. The Rural Ambulance Service Budget Model provides step-by-step
instructions for organizing important data regarding your service.
By simply opening this Excel® file the user can input known
or easily obtainable information into the spreadsheet. The following
tutorial provides a detailed, easy to follow procedure for obtaining
and entering necessary data into the budget model. When the worksheet
variables are filled, the model automatically calculates and displays
information that provides the user with an operating budget and
information for establishing a fee schedule (for those ambulance
services that charge for their services). The Budget Model file
consists of a series of spreadsheet "tabs", all of which
are interrelated for calculation purposes. The "tabs"
are labeled as follows:
- Introduction
- Demographics
- Vehicles
- Building
- Other Capital
- Staffing
- Training
- Other Expenses
- Budget
- Rate Study
The first step in using this REMSTTAC Budget Model
is to copy the .xls file from the enclosed CD ROM onto your computer
hard drive. This file should reside in the directory on your hard
drive where other Excel® spreadsheet files are maintained. Do
not attempt to fill in your service information on the file on the
CD ROM.
DISCLAIMER:
The rural EMS industry is widely diverse and this
budget model will not be appropriate for, nor was it intended to
serve, all ambulance services. Ambulance services are encouraged
to engage the services of a professional accountant as necessary.
Future Efforts:
The REMSTTAC Budget Model and its associated Chart
of Accounts are the first of several drawers in the Financial Toolkit
to be developed. Additional tools under consideration are:
- Cash flow management tools
- Accounts receivable management tools
- Billing and third party payer tools
- Others as identified by the Financial Toolkit
task group and the REMSTTAC stakeholder group
We welcome your feedback on the REMSTTAC Budget
Model and associated Tutorial.
You may contact us at:
REMSTTAC
300 North Willson Avenue
Suite 802-H
Bozeman, MT 59715
Phone 406-587-6370
Toll Free 866-587-6370
Fax 406-585-2741
info@remsttac.org
http://www.remsttac.org
Rural
Ambulance Service Budget Model
INTRODUCTION
Congratulations! You've taken an important first
step in deciding to use the budget model tool provided by the Department
of Health and Human Services, Health Resources and Service Administration's
Office of Rural Health Policy (ORHP). This product was developed
by the Rural Emergency Medical Services & Trauma Technical Assistance
Center (REMSTTAC) under a previous contract with ORHP.
This tool was developed to assist rural ambulance
services in establishing an annual budget. It also provides some
utility in demonstrating the value to a community for services donated
to the ambulance service by another entity (such as dispatch functions
provided free by the sheriff), and the value of donated services
provided by the ambulance staff to the community (such as the value
of volunteer labor contributions). The tool is one of a series of
"EMS Management Tools" being produced.
The model will also give you the ability to upload
our national standard EMS Chart of Accounts and the budget you develop
directly into the Intuit's QuickBooks® program. QuickBooks®
is a proprietary accounting program that can help you manage your
finances, print reports, provide payroll functions, and more. We
chose QuickBooks® to provide an interface because Intuit supports
it fully on-line and provides comprehensive help and training.
Limitations:
The rural EMS industry is widely diverse and this
budget model will not be appropriate for, nor was it intended to
serve, all ambulance services. Ambulance services are encouraged
to engage the services of a professional accountant as necessary.
Notes about the Model:
This model consists of a series of visible and
hidden rows and columns. It is designed to be completed sequentially;
however it is possible to start one section, skip part, and then
return. Green areas of the worksheet are always fine to fill in.
Yellow areas provide caution or an either/or Statement. Filling
in red sections, or any section on the budget page will override
formulas. Do so with caution and monitor the effect on the rest
of the model. These areas should be changed only by those with strong
expertise in spreadsheet design and use.
Let's Get Started:
First, print the document included in this package
called "Budget Model Worksheet.doc". Keep it handy: we'll
be filling it in as you move along in this tutorial. Next, open
the budget model by double clicking on the "Budget Model.xls"
file. The first page you see is the Demographics page.
SPREADSHEETS
(Click on Image to see full-size image)
If you are familiar with spreadsheets, skip to the next page. If
you're not, here's a little primer.
Spreadsheets are organized into columns and rows.
Columns are identified by letters (A to Z and then AA to ZZ, and
so on). Look at the words "Test Ambulance Service" above,
(they are at the top of the yellow area). The area those words appear
in is called a cell. The reference for that cell is B6. That is
because those words appear going across the top in column B and
going down to row six. The cell reference for the words "I
am preparing a budget for the year:" is A19. The words in cell
C7 are "on all subsequent worksheets".
Now look at the bottom of the graphic. Under
the number for row 31 you see a group of four arrows pointing left
or right and then seven words: QuickBooks, Demographics, Vehicles,
Building, Other Capital, Staffing and Training. (Your spreadsheet
program may display some, all, or all of these plus others.) These
are tabs. We're working on the Demographics tab right now.
To switch to the Vehicles tab, click on the word Vehicles and that
tab will be displayed.
If you need more assistance in learning about
spreadsheets, please refer to the Help function on your spreadsheet
program.
Demographics:
What this tab does: The transport and miles information
you enter on this page will become important as you get to the final
steps of the model. You will use them to help determine what you
will need to set your rates at in order to cover your costs.
(Click on Image to see full-size image)
On this tab you will enter the name and other
information about your ambulance service. In cell B15, enter the
number of emergency ambulance runs your service performed last year
that resulted in a bill being sent. Do not include responses that
did not result in a bill. In cell B16, follow the same procedure
to record the number of non-emergencies. In cell B17, enter the
total number of miles billed. Try to be accurate with these numbers,
they are important later.
STOP - IT IS TIME TO SAVE YOUR WORK.
This is the first save of your work. To save
your file to your hard drive, click on File and then Save-As. Choose
a location on your computer to save your work. Rename the file if
you would like. We'll have you save your data frequently as you
work through this tutorial, always to the same place. Also, if you
take a break, when you come back to continue working, be sure to
open the saved spreadsheet from your hard drive, not the template
version you opened to begin this tutorial.
Now it's time to move to the Vehicles tab.
Vehicles:
What this tab does: The information you
enter on this page feeds necessary information to your final budget.
For vehicles you lease, it will transfer the lease costs into your
budget. For vehicles you purchase, it will set up depreciation.
Depreciation is an important part of your final budget. By depreciating
over time, you will be saving money in the bank to replace your
vehicles when their useful life is exhausted. Since the cost of
vehicles will increase over time, depreciation alone will not produce
enough cash to meet the increased price when replacement is necessary.
You will need to supplement depreciation with either cash reserves,
or funds produced another way.
(Click on Image to see full-size image)
Let's make this friendly for you first. Click
on cell A16 and replace the words "Ambulance #1" with
terminology that is familiar to you. Call it Unit 101, Squad 54,
or whatever label will help you recognize this as your primary ambulance.
If you have more than one ambulance, replace the text in A17 through
A25 similarly.
If you are LEASING any of these ambulances, enter
the monthly lease amount in the yellow area on the same row as that
vehicle. For leased vehicles, you will not complete columns C to
G.
For all vehicles - LEASED AND OWNED - fill in
columns K (Vehicle License), L (Vehicle Registration) and M (Insurance).
In column K, fill in the amount paid in vehicle licensing fees from
your State EMS agency, if any, for all vehicles. The amount should
be an annual amount, so if the State charges you once every two
years, divide the total by two and enter that amount. Column L is
for vehicle registration and license plates from your State vehicle
licensing bureau, if any, for all vehicles. Enter an annual amount.
Column M is for one year of vehicle insurance. Fill in the annual
amount for each of the ambulances.
If you LEASE your vehicles follow the same process
as above for any non-ambulances you might have, using rows 32-36.
Then, you're done with this tab, unless you also own some of your
vehicles.
We'll use columns C to G for vehicles you OWN
(or are making loan payments). If you normally replace your vehicles
based on a specific number of years, enter the number of years in
cell G10. If you normally replace vehicles when their mileage hits
a specific level, enter the target number of miles in G11. Do NOT
put values in both cells, but also make sure you fill in one of
them. If you don't follow either of these replacement milestones,
pick one and estimate a number for it.
For each owned ambulance enter the following information:
Cell C16 (through C25) - the year the ambulance was acquired. Cell
D16 (through D25) - the cost of the vehicle the year it was purchased.
Cell E16 (through E25) - the cost of any capital equipment you purchased
with the ambulance.
Many ambulance services will purchase new stretchers,
mobile radios, defibrillators and other capital equipment each time
they purchase an ambulance. If you follow this process, enter the
total value of capital items that are purchased with the vehicle.
Capital is commonly defined as those items that cost more than $500
and have a useful life exceeding one year. It is important to keep
track of what equipment is represented in this figure. It will roll
into the total vehicle depreciation calculation; therefore, it should
not be listed again later with other capital equipment.
Cells F16 and G16 (through F25 and G25) - if you
entered a number of years in cell G10, you do not need to fill in
these numbers; your depreciation will be calculated based on the
number of years the vehicle is in service. If you entered a number
of miles in G11, then you need to complete F16 and G16. In F16,
enter the odometer reading of your vehicle at the beginning of the
previous 12 month period and the odometer reading at the end of
the 12 month period. Since you replace your vehicles based on miles
driven, depreciation will be calculated based on the total number
of miles driven last year.
Complete the same information on rows 32-36 for
all non-ambulances you own or lease.
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
Now it's time to move to the Building tab.
Building:
What this tab does: The Buildings tab will
record rent and mortgage information. It sets up depreciation for
buildings owned by the ambulance service. In addition, it estimates
the value of space donated for your use. Pay attention to donated
space for two reasons: first, it will help you understand the value
of the donation, and secondly, you can publicly report the value
of the donation.
(Click on Image to see full-size image)
Rows 7-12 are for donated space. For each category
of space, enter the number of square feet in column B. Column C
has some default square footage price estimates. If you know a specific
value for your area, you can override these numbers with actual
values.
Rows 14-20 are for lease payments made for space
you occupy but don't own. Enter your monthly lease payment for each
building.
Rows 23-28 are for buildings you own. If you know
the original cost, interest rate and mortgage term, enter those
values and the annual payment amount will be automatically calculated.
As an alternative, if you know the annual mortgage cost, you can
just type it into the red area. NOTE: for owned buildings, enter
ANNUAL information and for leased buildings, enter MONTHLY lease
payments.
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
Now it's time to move to the Other Capital
tab.
Other Capital:
What this tab does: The Other Capital
tab collects information to set up depreciation for capital items
that are not included on the Vehicles tab. Capital items are those
that cost over $500 and have a useful life that exceeds one year.
(Click on Image to see full-size image)
The Other Capital tab has 4 categories
common capital equipment: communications, patient care, mechanic
and office equipment. If you have equipment that doesn't fit into
one of these categories, you'll have to make it fit somewhere. Use
one of the "other" categories on rows 12, 17 or 25. Type
over the word "other" to remember what equipment you placed
there.
In each category, enter the purchase cost of
the item(s) purchased. Feel free to change the number of years in
the "Years Useful Life" columns. If you included your
stretcher(s) or defibrillator(s) as equipment on the vehicle tab,
do not enter them here.
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
Now it's time to move to the Staffing tab.
Staffing:
What this tab does: The Staffing
tab collects information about how you staff your ambulance service
and will estimate your salary costs for next year.
(Click on Image to see full-size image)
Let's make this friendly for you. If you have
administrative staff, type over the label Administrative Position
#1 in cell A8 with either the name or job classification for the
person filling the role. If you have more than one administrative
position (billing, secretary, etc.) do the same on A9 to A12.
For administration, you will either enter the hours worked per week
in column C and the rate per hour in column D, or you can type in
an annual amount in column E.
Whether you staff full-time, volunteer or some combination of each,
the ambulance staff section should work for you. This section is
organized around your ambulance vehicles. If you have full-time
staff or pay an on-call stipend to volunteers, you'll use columns
E and F. If you pay your staff a per-run stipend, you'll use columns
G and H. If you already know your annual salary costs, you can simply
enter those in column J.
Example: ABC ambulance service staffs one
ambulance 24 hours a day with two full-time staff. They have a second
ambulance which uses on-call staff that are each paid $2 per hour
while on call, and $20 per run. On their 500 billable runs, the
full-time staffed ambulance completes 450 and volunteers complete
the other 50.
In cell D16 enter "2" to represent the two full time staff.
In cell D17 enter "2" to represent the volunteers on call.
In E16 and E17 enter 24, to represent around the clock staffing.
In cell F16 you will enter the average
pay rate of the full-time staff. If your staff are paid different
hourly rates depending on their longevity with the service, simply
add up all of their pay rates and divide by the number of employees
and this will give you the average hourly rate. The typical ambulance
service will pay some overtime during the course of the year. Estimate
the number of overtime hours and fill in the blocks below. Use that
result as the Hourly Rate for cell F16.
|
Calculation |
Result |
Number of hours per year |
24 hours times 365 days |
8,760 |
Average hourly pay rate |
XXXXXXXXXXX |
|
Estimated annual number of hours
of overtime pay |
XXXXXXXXXXX |
|
Average hourly pay rate at time
and one-half |
Average hourly pay rate times
1.5 |
|
Annual Regular Pay |
Number of hours per year (8,760)
times average hourly pay rate |
|
Annual Overtime Pay |
Number of overtime hours per
year times average hourly pay rate at time and one-half |
|
Total Pay |
Annual Regular Pay Plus Annual
Overtime Pay |
|
Average hourly pay including
overtime factor |
Total Pay divided by number of
hours per year (8,760) |
|
In cell D16 enter "2" for the
volunteers that are on call. In cell E16 enter 24. In cell F16 enter
"2" for the $2 per hour call time. In cell G16 enter 20
for the per-run stipend and in cell H16 enter 50 - the number of
transports completed by the volunteers.
Use a similar process to enter the information for communications
and mechanic staff (if any).
STOP - IT IS TIME TO SAVE YOUR WORK.
Click on File and then Save.
Now it's time to move to the Training tab.
Training:
What this tab does: The Training
tab collects information about your ongoing education costs.
(Click on Image to see full-size image)
The amounts entered into this tab should be ANNUAL
amounts per person. Many States require certification/licensure
renewal every two or three years. If your service pays these fees
or reimburses staff for them, divide the fee paid by the number
of years the certificate/licensure is valid. See an example on the
Budget Model Worksheet for how to calculate this result. The example
is based on a State certification/licensure fee of $40 for fours
years and a National Registry fee of $25 for two years.
Use a similar process to calculate the annual
cost of refresher courses if your service pays for them. If your
service pays for conference attendance, include the average cost
of conference registration plus travel expenses in column G.
If there is other training that you pay for (for
example ACLS or PALS courses), report an average ANNUAL amount that
includes reimbursed travel costs. For example, let's say you pay
a registration fee of $150 and reimburse on average $50 in travel
related costs for ACLS. Since the refresher course is every two
years, the cost per two year cycle per person is $200. However,
you should report the ANNUAL cost per person ($100).
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
Now it's time to move to the Other Expenses
tab.
Other Expenses:
What this tab does:
This tab collects information about expenses that have not been
recorded elsewhere on any tabs.
(Click on Image to see
full-size image)
This tab requires some detective work on
your part. You will need to go through your records from last year
to determine the total amounts paid for these various categories.
The tab is organized into six different sections: patient care expenses,
dispatch expenses, administrative expenses, interest expense, building
expenses, and vehicle expenses.
DO NOT CHANGE THE ACCOUNT NUMBERS OR DESCRIPTIONS
ON THIS TAB. They are part of a national standard EMS Chart of Accounts.
If you don't see a category that matches they way you have previously
recorded your expenses, you'll need to find the best fit. If you
use QuickBooks® or some other proprietary software, you can
set-up sub-accounts to these categories later to match the way you
keep track of expenses.
On the Budget tab that follows this one, some
benefit costs will be automatically calculated for you, using an
average benefit rate of 30 percent of salary. If you don't want
to use this average rate and you know the actual costs of the red
areas in column C, fill in the actual amount in the benefits cells
under patient care, dispatch and administration in column C. Change
the (0.3) in the formula to reflect your actual benefit percentage.
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
Now it's time to move to the Budget
tab.
Budget:
What this tab does: This
tab displays the calculations and amounts entered on all previous
tabs. It also demonstrates the value of contributed items, either
by other agencies to yours, or by your volunteer staff. It uses
an inflation factor to increase your budget amounts from last year
to the current year.
(Click on Image to see
full-size image)
About the patient care section: If you elected
to fill in the red cells in the previous tab for benefits you should
make the amount in cell C11 "0." Otherwise, benefits will
be reported twice. If your total employee salaries do not equate
to at least $10 per hour for two people, cells F10 and F11 will
report an amount that volunteers contribute. This number can be
a powerful tool for you as you report the estimated dollar value
you provided to the community through the volunteers' service. Feel
free to change the Percent Inflation on any or all of the rows in
column D to match your particular circumstances. Column G is calculated
by taking the actual or estimated information in column C times
the inflation factor in column E for that row.
About the dispatch section: Many ambulance services
do not operate their own dispatch centers; the service is dispatched
by the police or sheriff's departments. If you haven't reported
an amount equivalent to $15 per hour, 24 hours a day in dispatch
salaries, this sheet will estimate the value that your dispatch
center provides to you. If you elected to fill in the red cells
in the previous tab for benefits you should make the amount in cell
C24 "0."
About the administrative section: Many ambulance
services have part-time managers. If you have not reported at least
$15 per hour for 40 hours per week in administrative payroll costs,
this sheet will report the value of the contribution to the service
by your management staff. If you elected to fill in the red cells
in the previous tab for benefits you should make the amount in cell
C36 zero.
(Click
on Image to see full-size image)
About the building section: Cell E24 will report
the annual value given to the ambulance service for donated space
that was reported on the building tab.
(Click
on Image to see full-size image)
Row 87 provides a total of your expenses from
last year, the value added to the service by donated space or dispatch,
the value provided to the community by volunteers, and budget amounts
for next year that are based on this year's budget plus an inflation
factor.
When you're satisfied the amounts are correct,
you should print this page.
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
Now it's time to move to the Rate Study tab.
Rate Study:
What this tab does:
This tab allows you to see the effect of varying base and mileage
changes, based on the percentage of collections of your service.
(Click on Image to see
full-size image)
This tab is a tool for you to estimate what your
charges will need to be in order to recoup your cost of providing
service. The number of emergency calls, non-emergency calls, and
billed miles reported on the demographics tab are displayed in cells
B10, B20 and B30. Note: in order to provide you with an example,
we have used 500 emergency trips, 200 non-emergency trips and 9,000
billable miles. When you open this sheet, the numbers you entered
on the demographics page will be displayed.
In order to use this sheet, you will need to ask
your billing clerk or billing company what your average percentage
of collections are. If you bill $100,000 annually and collect $70,000,
then your collection percentage is 70 percent. We'll use this as
an example. In this example, if you bill a $250 base rate for your
500 emergencies, you would collect roughly the amount in cell C14
($87,500). For 200 non-emergencies charged at a $250 base rate you
would collect the amount in cell C24 ($35,000). For 9,000 billed
miles at $9 per mile, you would collect the amount in cell C34 ($56,700).
Your total collections for 500 emergencies, 200 non-emergencies
and 9,000 billed miles would be $179,200.
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
You can use this sheet to test various rates and
collection percentages. We have provided space for you to add these
three collections amounts on the Budget Model Worksheet.
If you need to adjust the rates up or down for
any or each of the categories, simply change the numbers in cells
C10, C20 and C30. Each column D through M on row 10 increases the
base rate by $50. If you want to see what a base rate of $100 would
collect, change C10 to $100. Then D10 will automatically convert
to $150, E10 to $200 and so on.
STOP - IT IS TIME TO SAVE YOUR WORK. Click
on File and then Save.
Congratulations! You have finished your
own budget based on the Budget Model. We would appreciate hearing
from you about your experience using this tool, what you did with
it when you were finished, and ways we can enhance it in the future.
To provide comments, please e-mail info@remsttac.org
or telephone us at (866) 587-6370.
Unless you plan to use QuickBooks® and want to import the Chart
of Accounts and your budget, you're finished with this tool. Importing
into QuickBooks® will be covered in the next section. Printing
costs for the QuickBooks® Pro Edition ranged from $199.95 to
$399.95 at the time this document was printed.
Whether or not you export your data to QuickBooks®
you have taken a very important step in planning for the financial
future of your Agency. By exporting your data to QuickBooks®
or another off-the-shelf accounting software system, you will be
able to follow the financial performance of your ambulance service
on a monthly basis. Tracking expenditures and revenues monthly better
enables you to anticipate future needs and plan for addressing them.
Maintaining a detailed budget will also provide you with persuasive
data to share with others when you need to demonstrate the value
and needs of your ambulance service.
QUICKBOOKS
EASY STEP INTERVIEW
There is one tab in the Budget Model that you
haven't used yet. This tab contains the and budget information you've
just completed, which can be imported into QuickBooks®. This
information is formatted for QuickBooks® Pro 2006. Whether it
will import into other versions of QuickBooks® is unknown.
We will provide you with a step by step example
of importing this data that assumes you just purchased QuickBooks®
and are starting from scratch.
After installing QuickBooks®, start the program.
Follow the prompts in the program.
You will see the following screen.
(Click on Image to see
full-size image)
Fill in the appropriate information and click
Next.
Select "(No Type)" on the left side
and click Next.
Choose either the default place to save your file
or another location on your hard drive and click save.
(Click on Image to see
full-size image)
Click "Begin Using QuickBooks" in the
lower right corner.
If some Alerts pop up, click "Mark As Done"
or "Remind Me Again" if you want to be reminded.
Now go back to your Budget Model spreadsheet.
You'll see this in the lower left corner of the sheet:
(Click on Image to see
full-size image)
Just above where it says "Ready" click
the first arrow on the left side.
Then you will see the first few tabs in the spreadsheet.
Click on the QuickBooks tab, and you should see
this:
(Click on Image to see
full-size image)
We need to save this tab in a format that QuickBooks
can recognize. To do that, we're going to save a duplicate of your
budget model under a different name and format.
(Click on Image to see
full-size image)
Now change the "Save as type" in the
center on the bottom to TEXT. Also, rename the file to QuickBooks.iif.
Now click Save. You may now see two dialogue boxes,
one informing you that only the current sheet can be saved and the
other that some features of Excel may not be available in this format.
Click YES to both dialogue boxes.
Back to QuickBooks.
Click on File, then Utilities, then Import,
then IIF files.
(Click on Image to see
full-size image)
Now click on Desktop on the left and select the
QuickBooks.iif file you previously saved.
(Click on Image to see
full-size image)
Click Open. After the budget is imported you will
see the following:
Contact REMSTTAC:
Congratulations! You are finished with this tutorial.
Please refer to the extensive in-product and on-line support for
QuickBooks.
Thank you for using the budget model. We're interested
in your feedback on the use and utility of this product. If you
have comments or suggestions for improvement, please contact us
at:
REMSTTAC
300 North Willson Avenue
Suite 802-H
Bozeman, MT 59715
Phone 406-587-6370
Toll Free 866-587-6370
Fax 406-585-2741
info@remsttac.org
http://www.remsttac.org
Health Resources and Services Administration,
Office of Rural Health Policy
5600 Fishers Lane, Room 9A-55
Rockville, MD 20857
Phone 301-443-0835
Fax 301-443-2803
http://ruralhealth.hrsa.gov/
APPENDIX A:
REMSTTAC STAKEHOLDERS GROUP
Jane Ball, Executive Director
EMSC National Resource Center
Trauma-EMS Technical Assistance Center
Eli Briggs, Policy & State Affairs Manager
National Rural Health Association
Government Affairs Office
Bethany Cummings
Rural Affairs Ad Hoc Committee
National Association of EMS Physicians
Drew Dawson, Chief, EMS Division
National Highway Traffic Safety Administration
Tom Esposito, Medical Director
Rural EMS and Trauma Technical Assistance Center
Loyola University Medical Center
Blanca Fuertes, Project Officer
Department of Health and Human Services
Health Resources and Services Administration
Office of Rural Health Policy
Grant Gray, Representative
National Association of Emergency Medical Technicians
Christian L. Hanna, Rural Site Director
Children's Safety Network
National Children's Center for Rural Agricultural Health and Safety
Bob Heath, EMS Education Coordinator
Nevada State Health Division
Marilyn Jarvis, Assistant Director for Continuing
Education
Burns Telecommunications Center
Montana State University
Doug Kupas
Rural Affairs Ad Hoc Committee
National Association of EMS Physicians
Fergus Laughridge, Program Manager
Nevada State Health Division
EMS Bureau of Licensure & Certification
Tami Lichtenberg, Program Manager
Technical Assistance and Services Center
Rural Health Resource Center
Patrick Malone, Director
Initiative for Rural Emergency Medical Services
University of Vermont
N. Clay Mann, Professor, Associate Director of
Research
Intermountain Injury Control Research Center
University of Utah
Evan Mayfield, CDC Public Health Advisor
New York Department of Health
Charity Moore, Research Assistant
Cecil G. Sheps Center for Health Services Research
University of North Carolina at Chapel Hill
Carol Miller, Executive Director
Frontier Education Center
National Clearinghouse for Frontier Communities
Daniel Patterson, AHRQ-NRSA Post-Doctoral Research
Fellow
Cecil G. Sheps Center for Health Services Research
University of North Carolina at Chapel Hill
Davis Patterson, Research Associate
WWAMI Center for Health Workforce Studies
University of Washington
Kristine Sande, Project Director
Rural Assistance Center
Dan Summers, Director of Education
Center for Rural Emergency Medicine
West Virginia University
Chris Tilden, Interim Director
Kansas Department of Health & Environment
Office of Local & Rural Health
Robert K. Waddell II, Secretary /Treasurer
National Association of EMS Educators
Bill White, President
National Native American EMS Association
Gary Wingrove, Program Development
Technical Assistance and Services Center
Rural Health Resource Center
Jill Zabel, Healthcare Consulting
Wipfli LLP
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