ASTM_F_1493_-_93_2003.pdf

Designation:F 1493 93(Reapproved 2003)Standard Guide forFinancing and Financial Accountability of MedicalTransportation Systems1This standard is issued under the fixed designation F 1493;the number immediately following the designation indicates the year oforiginal adoption or,in the case of revision,the year of last revision.A number in parentheses indicates the year of last reapproval.Asuperscript epsilon(e)indicates an editorial change since the last revision or reapproval.1.Scope1.1 This guide establishes guidelines for understanding thefinancing of medical transportation systems.It identifies fac-tors affecting financing,system design and performance re-quirements,revenue sources,financial accountability and man-agement,and requirements for financially efficient systems.2.Referenced Documents2.1 ASTM Standards:F 1177 Terminology Relating to Emergency Medical Ser-vices23.Terminology3.1 Definitions of Terms Specific to This Standard:3.1.1 patient transport pricedetermined by summing allcosts related to patient transports,to include all non allowedcharges and contractual allowance and adjusted by any revenuegenerated by any subsidies,contributions and subscriptionfees.The resulting amount is divided by the total number ofpatient transports to determine the patient transport price.3.1.2 medical transportation system(see TerminologyF 1177 for the definition of this term.)3.1.3 medical transportation services(see TerminologyF 1177 for the definition of this term.)4.Significance and Use4.1 ManagementSound fiscal management is essential forall medical transportation systems.Without sufficient financialresources,a system will fail to consistently achieve its objec-tives.Therefore,finance is a primary responsibility in allsystems;be they hospital owned/operated,private,public orvolunteer organizations,or any combination thereof.4.2 Cost DeterminationThis guide is designed to accu-rately determine actual and imputed costs of providing ambu-lance service.It provides methodology for understanding thevalue of services rendered and a basis for realistic industry-wide comparisons.4.3 Cost AccountingIt is recognized that medical trans-portation services frequently are a part of a larger organization.However,the proper use of this guide mandates that all costs,real and imputed,directly or indirectly related to providingambulance service,regardless of organizational structure,betotally and accurately accounted for through the use of gener-ally accepted accounting principles.4.4 ApplicationThis guide,as part of the ASTM Stan-dards and Practices,shall apply in its entirety whenever theentire document,or any part thereof,is used by any govern-mental authority to establish,operate,manage or regulate thedelivery or payment for medical transportation services.5.Environmental Factors5.1 Several significant factors of a given service area affectits systems resources and related costs.They require carefulexamination and analysis.Understanding these factors willenhance the ability of those who direct,administer,manageand/or regulate medical transportation systems to more accu-rately determine anticipated needs and evaluate actual costs.5.2 TerrainAreas with mountains,valleys,waterways andbridges,and so forth,will usually be less accessible and requiremore resources resulting in reduced efficiency and a higherpatient transport price.5.3 Roads and HighwaysOutdated and dangerous designof roads create hazards.These hazards create more demand forservice and thus require a greater concentration of resources.The extra resources increase system costs.5.4 WeatherSystems subject to extreme weather condi-tions(that is,cold and snow,heavy rain and rock/mud slides,hurricanes,heat and dry conditions,wild/forest fires,and thelike)will need seasonal or periodic plans to meet area needsduring such extremes.Maintenance of proper response plansand participation therein is a cost factor to the system.Duringsuch times maximum resources are required and systemefficiency is reduced resulting in higher overall patient trans-port costs.5.5 Population DensityAreas of high population densitygenerate higher call volume and allow greater flexibility inutilization of resources resulting in lower overall patienttransport costs.5.5.1 DemographicsAreas with population characteristicswith high concentrations of the elderly and economically1This guide is under the jurisdiction of ASTM Committee F30 on EmergencyMedical Services and is the direct responsibility of Subcommittee F30.03 onOrganization/Management.Current edition approved Sept.10,2003.Published October 2003.2Annual Book of ASTM Standards,Vol 13.02.1Copyright ASTM International,100 Barr Harbor Drive,PO Box C700,West Conshohocken,PA 19428-2959,United States.disadvantaged,or both will result in higher call volume and agreater demand on resources to meet the needs of theseportions of the total service area.5.6 Natural/Man Made DisastersSystems subject to un-predictable events of extreme consequences(for examp