Travis County Commissioners Court

March 20, 2012 (Agenda)
Item 16

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The medical examiner's item is number 16.
consider and take appropriate action regarding the following fee changes and information letter for the Travis County medical examiner's office, a, increase in autopsy fees, b, revised fee schedule, and c, informational letter to counties that contract with Travis County for autopsy services.

>> good morning.
I'm danny hobby and I'm the county executive for emergency services.
and also with me today is dr. David duliknack who is chief medical examiner as well as sarah scott, chief administrative officer for that office.
and what we're here today is to ask that you review and consider the increase in fees.
we do this periodically.
we were back here back in 2007 as well as 2008 we came up with a brand new agreement.
and basically we are following the recommendations from our consultant.
last November crime lab design was here and they were looking at various things in regards to the office, mainly looking at potential of a new facility.
and in doing that they looked at all the expenditures and recalculated some of the salaries, recalculated some of the formula that we have been using and so as a result of that you see before you an increase in the autopsy fee from 2300 to 2600 is the recommendation, as well as an increase in testimony fees, and then we also recommend a fee increase for external exams from 800 to $900.
along with this we also want to send out a letter, informational letter which we normally do and we have that attached as far as your backup which is in accordance with our agreement that gives them notice and allows themselves 60 days notice so they have an opportunity to adjust and get prepared for this change.
normally we do see a little spike or a little dip when we do this fee, but we are projecting that we would balance that out over time.
but here today we are before you to try to get to you approve what we think are reasonable charges based upon our expenditures and that's what we're here to do, not make revenue for the sake of revenue, but to make sure that we are adequately charging folks for what it is that we do.
the.

>> a couple of questions.
and if you can probably help me a little bit.
has there been -- I know this is, you know, setting a new rate and for the services we do render, but has there been any in the last increases that we've had as far as the fee adjustment for these particular services.
have they been pushed back where someone person we serve may want to discontinue service with us or what have been some of the comments that have been made if there's been any comments that we gathered, I guess, that have not agreed with us as far as an increase in fees? From the servicenr that we renderer.

>> I can't quote any specific comments from other counties or justices of the peace, but the last time we did increase fees, we see some counties leaving us.

>> [one moment, please, for change in captioners]

>> I'm not sure I follow the question.

>> in other words all of the services, not anything else, I'm saying even within our jurisdiction, has there been any push back in the increase in services, even within Travis County.

>> well, we don't charge for any of the services for -- for Travis County cases.

>> by law we are required to do those on Travis County residents.

>> I'm going to stay away from that.
my bottom line, though, is that if -- if we are continually -- let me ask this question.
how many counties are we serving at this point right now today without just flat outright, under the contractor that we have now.

>> 42 counties.

>> how many? 42.

>> 42.
okay.
the last deal that we did last increment time on this, how many counties did we lose? I guess came back or whatever the situation, I need to make some comments on that?

>> I think what -- I think Commissioner what I was trying to say is the history has shown that we will have a dip, but then it balances back out.
but I think the doctor just made probably a more appropriate comment and that is that it's unpredictable.
based upon the economy, based upon all of the circumstances that are now going within other counties, so we are hopeful that we would regain some of the lost cases.
however, it's unpredictable.
we started off with 45 counties.
we are now at 42 counties.
and so as you can see, since 2007, we haven't lost a lot of customers.
but again, it is unpredictable and what we're trying to do again is make sure that we are charging appropriately and based upon the formula that we have now come up with through our consultant, we feel like this is a fair way of doing it.

>> being on.
that's the final question that I have at this time.
but anyway thank you for what you are doing.
I mean, I don't disagree with you as far as this increase, I think that it's really something that's necessary and appropriate at this time.
however, I just wanted to know just wanted to lay out the resistance to what we do sometimes when we increase fees and what is the push-back on that, if any, sometimes it is, sometimes -- as you stated sometimes it's unpredictable as far as knowing what's going to happen after we make these adjustments.
thank you.

>> so if another county were to ask us in addition to your outside consultant's recommendation, what evidence do you have of the fairness of the fee increase from 2300 to $2,600, what would we say? Or what's the answer?

>> you mean in comparing it to other counties? Other --

>> no, just what justification is there? The resultant recommended it.
the consultant recommended it, our consultant.
presumably taking care of us.
the question is was there objective evidence that the consultants looked at to determine that a $300 per autopsy increase was justified.

>> the answer is yes.
in fact we put in the backup that they basically confirmed our formula that we've been using, the only difference is that there were a few added elements that they wanted to include that -- that brought the fee to where it included those items. But they were small items. But really what you saw in the recalculation was just the increase in salary since 2007.
I mean, we would continue to do that in the future and that is as our operational cost, as our staffing cost, as those increased, then we've got to increase the cost of service.
and so --

>> if we were to say --

>> dramatic change, judge --

>> if we were to say $2,600 would fairly reimburse us for what it costs us to do in autopsy, that would be true?

>> that would be where we're at with this.
is that we're just trying to be reimbursed for actual costs.

>> I would put that in a letter.
that's -- that we hinted at that, but we really don't say it.
we kind of say the consult recommended the fee increase from 2300 to 2600, if I were a smaller judge with a contract with Travis County, it would make a difference to me whether I learned that the -- that Travis County's consultant had recommended it or whether Travis County had calculated or recalculated costs and concluded that $2,600 really fully reimburses the county.
it's not like we're making significant profit.
as a result of the fee increase.
we're really just trying to reimburse ourselves.

>> that is correct.

>> yeah.

>> that's where we're trying to go with it.
we will make sure that we clarify in the letter that it is a reimbursement of costs.

>> yeah.
we have -- if we were to contact the doctor and ask him what changes the medical examiner's office has made, there's a whole lot of them that have been made recently included additional deputy medical examiners in order to keep up with the caseload as recommended by the main accreditation folks.

>> we have added several positions, an investigator, as well as a historian.

>> at substantial cost, as I recall.
any other questions, court members?

>> being on.
I was curious as --

>> okay.
I was curious as to the increase in caseload over the last several years with our population increase, but also although we have gone down to 42 counties, have we really seen an overall caseload drop from our number of out of county autopsies?

>> okay.

>> generally, we do about 1,600 autopsies a year.
but that number does fluctuate year to year.
even with a steady increase in the population in the area, assuming that, our autopsy load will -- will fluctuate along with the population on a year to year basis.
since 2007, our total autopsy load has increased about 70, up until last year.
but within that time span, almost every year it goes up and goes down.

>> so are you saying there's an average increase of about 70 autopsies a year?

>> no.
70 autopsies during that time span since 2007.

>> four or five years?

>> yes.

>> and that there's fluctuation both for our in-county autopsy number and out-of-county autopsy number.

>> so the fluctuation, as you said, it's rather unpredictable.
even though we've gone down in our numbers of counties, do we see any correlation in our overall numbers for out of county autopsies?

>> I don't think it really correlates in that manner, it's -- within a county that we serve, some of the judges may send cases to us whereas other judges send cases to other medical examiner departments.
so it's not really straightforward to predict.
I will say that with our last fee increase, our autopsy load from other counties went down about 5 percent of the following year.
it stayed low for a couple of years, then it came back up last year.
who knows what's going to happen this coming year, with or without an autopsy fee increase.

>> then with regard to sending it to other me's offices around the state, I mean, my understanding is that it sort of de facto we have how many me's offices in the state where these kinds of cases go.

>> right.
the medical examiner system in Texas consists of I think it's 11 medical examiner's offices, mainly in the big cities and the other 240 some smaller counties have agreements with those medical examiner offices to send cases on the fee for service basis as needed.
and it's -- those smaller counties, they can send cases wherever they want for autopsy.
presumably depending on the quality of -- of work and the cost.

>> uh-huh.

>> is ours the only name accredited me's office

>> [indiscernible]

>> no, most of the medical examiner offices are accredited in Texas, including dallas county, harris county, bexar county, nueces county, most of them are.

>> okay.
thank you.

>> what was the year we received our accreditation? I know we went through a period of time until we got accreditation.
and I can't recall -- in fact I was asking the county attorney here can you remember the exact date? What year was that we received accreditation.
I know we worked on it for a long time, we finally got it, though, thank goodness.

>> that was, I believe, 2009.

>> 2009, okay, okay, okay, we still -- somewhere around there.
we were close.

>> [laughter] but anyway, that's a good point to know because it is a monumental hurdle to receive accreditation.
I'm glad Commissioner Eckhardt brought that point up about accreditation and especially with the other counties, medical examiner's office, have accreditation within the state of Texas.
that's a real big deal.
I applaud Travis County, the medical examiner here for all of us who are working hard to achieve that, which is a big hurdle to cross.

>> how do we compare with the -- with this increase in fee, how would we compare with the other major metropolitan medical examiner's office fee structures? Are we at the top, at the bottom, in the middle?

>> I haven't done a -- a survey of such recently.
it's kind of comparing apples and oranges because this is a -- this is a straight out fee for all cases, no matter what type of case.
other medical examiner's offices have a base fee and then any added services are -- are added to that.
such as toxicology, x ray, evidence collection, so -- so a base autopsy might start out at a lower fee than ours, or one cost covers everything, add in other costs for the other -- for the other and some of the other offices, it could be more expensive.

>> and more administratively expensive for us, I would think, in the record keeping.

>> what we've found in the past is there is going to be some that are going to be lower, some are going to be higher, some are going to change their rate based upon the fact that we changed our rate.

>> we're probably ballpark with the fee increase, middle of the road, to maybe slightly higher.
but again this is one cost for everything.

>> uh-huh.
and do our costs figure in our need to -- our future overhead needs to -- to move to a location and construct a facility that is more appropriately sized to our numbers of autopsies?

>> no.
we will actually be coming back.
that's again part of the consultant studies, exactly how we will do that.
one of the recommendations from the consultant is that we just simply apply it to the autopsy.
however, in going out and talking with the other counties, there may be other alternatives, financial alternatives that they choose to do rather than use the individual autopsy fee, but that is certainly one that you could do.

>> what is the square footage that we're operating in currently?

>> we're a little over 1400.
14,000 I mean.

>> I was about to say, 1400 that would be very small --

>> we do need a new facility.
but even 14,000 when you look at the projections it's just not going to be there for us, so --

>> move approval of --

>> second.

>> -- 16 a, b and c and c was the revised language regarding reimbursement.

>> right.

>> second covers the whole motion?

>> yes, judge.

>> discussion on the motion? All in favor? That passes by unanimous vote.
thank you all very much.

>> thank y'all.

>> appreciate your patience.

>> thank you.

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