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HomeMy WebLinkAboutMINUTES - 08142012 - C.77RECOMMENDATION(S): Accept recommendation from the Emergency Medical Services (EMS) Director regarding revising funding process as outlined in the Contra Costa Fire-EMS Measure H Distribution Efficiency Proposal and direct EMS to implement an efficient funding process for distribution of Fire Measure H Funds. FISCAL IMPACT: No general fund impact. BACKGROUND: CSA-EM1 (Measure H) funding associated with first responder equipment and the Fire Paramedic Fund through Measure H is predictable from year to year, yet the actual funding process is unnecessarily complex. The current distribution procedure for Measure H Fire First Responder Paramedic and Fire Equipment Funding was established in 2004 and specifies that funds be distributed quarterly. The recommendation is to move to a reliable once-a-year distribution procedure. The new process would save over 118 hours of Fire and EMS staff time, equivalent to $5,293 per year, while reducing the risk of potential delays that could adversely impact support for Fire Paramedic and APPROVE OTHER RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE Action of Board On: 08/14/2012 APPROVED AS RECOMMENDED OTHER Clerks Notes: VOTE OF SUPERVISORS AYE:Candace Andersen, District II Supervisor Mary N. Piepho, District III Supervisor Karen Mitchoff, District IV Supervisor Federal D. Glover, District V Supervisor ABSENT:John Gioia, District I Supervisor Contact: Pat Frost, 646-4690 I hereby certify that this is a true and correct copy of an action taken and entered on the minutes of the Board of Supervisors on the date shown. ATTESTED: August 14, 2012 David Twa, County Administrator and Clerk of the Board of Supervisors By: STACEY M. BOYD, Deputy cc: Tasha Scott, Demetria Gary, Juliene Latteri C. 77 To:Board of Supervisors From:William Walker, M.D., Health Services Director Date:August 14, 2012 Contra Costa County Subject:ACCEPT Recommendation by Emergency Medical Services (EMS) Director on Contra Costa Fire-EMS Measure H Distribution Efficiency Proposal BACKGROUND: (CONT'D) First Response Agencies. This alternative distribution process is supported by the Contra Costa Fire Chiefs Association. The new process represents a 93% savings over the current quarterly payment practices. Under the new process distribution would occur during January/February of each fiscal year. CONSEQUENCE OF NEGATIVE ACTION: Cost and time savings would not occur. CHILDREN'S IMPACT STATEMENT: Not applicable. ATTACHMENTS G:\NON CONTRACTS\Sorted by year\2012\EMS Budget Streamline Project - Report.docx G:\NON CONTRACTS\Sorted by year\2012\Letter Fire Chiefs Assoc 7-16-12.pdf Contra Costa Fire-EMS Measure H Distribution Efficiency Proposal Submitted by Pat Frost, Director Emergency Medical Services January 24, 2012 – Pfrost – rev 7-20-12 Problem: Current mechanisms of processing funding for Measure H Fire Reimbursement are unnecessarily complex, inefficient, costly and prone to errors. Opportunity: Create a reliable, efficient and cost-saving funding process for Measure H funds based on current CSA-EM-1 Fire Provider Agency appropriations, as specified by 2004 Board Order. Background: County Service Area (CSA) EM1 was established by the Board of Supervisors in 1989 following a November 1988 countywide vote supporting a benefit assessment of up to ten dollars annually per single-family residential parcel or benefit unit to support enhancements to the County’s emergency medical services (EMS) system. The ballot measure (Measure H) specifically referenced expanded paramedic services, EMS communication and fire service medical training and equipment as enhancements that could be funded through parcel charges. A major impetus for establishing CSA EM-1 was the countywide expansion of paramedic ambulance service which has been in place under the AMR contract approved in 2004. The benefit assessment also helped establish a “First Responder Paramedic Fund” supporting Fire first responder engine based paramedic service and first responder equipment. The First Responder Paramedic Fund approved by the BOS in 2004 was based on an “illustration” from the EMS System Design Study conducted by Fitch and Associates. Subsequently this illustration was used to create a contractual distribution process that relied on all Fire agencies to generate and submit their own invoices to EMS. EMS would then be responsible for submitting invoices to the Health Services Finance Department, which in turn would be paid by the Auditor-Controller’s Office. Initially this complex process may have been required to appropriately determine Fire funding which varied substantially during the implementation phase of Fire Agency’s First Responder Paramedic Programs, however these programs are now mature and predictable, giving all parties an opportunity to create efficient funding processes. Recommendation: Simplify the reimbursement process into a single lump sum reliably distributed by EMS to Fire Agencies in January/February of each fiscal year. Benefits: • Reduction in billing and accounting errors that add unnecessary cost and time to managing the Paramedic First Responder Fund. o The current process relies on numerous individuals and groups to be involved in the submission, processing and oversight of each funding transaction. These include the Fire Chief, Fire EMS Chief, Fire Admin Staff, Fire Finance, EMS Admin Staff, EMS Director, Health Services Finance Staff, CFO Health Services, Board of Supervisors’ Staff, the Board of Supervisors and the Auditor-Controller’s Office. o With every transaction the potential for error is incredibly high due to the current complicated process which has the unintended consequence of substantially increasing the due diligence required for appropriate oversight. Examples include errors in billing submission and misallocation to appropriate subaccounts. o The error rate of the current process is estimated by EMS to be approximately 50%, primarily occurring in the processing of Paramedic quality oversight and engine reimbursement. This results in unnecessary delays that disrupt timely payment critical to Fire Agency budget planning. Smaller Fire Agencies are most seriously affected by these disruptions. • Efficient cost-effective workflow: Cost and complexity of processing transactions will be significantly decreased for all parties: Health Services Finance, EMS Staff and Director, County Auditor-Controller, Board of Supervisors, and Fire Admin/Finance Staff, Fire Chiefs, Fire EMS staff o Time on transaction costs: Time is money. The current process wastes both when the fiscal environment demands efficiency. o Staffing reductions in all agencies have affected all parties’ ability to follow-up and track timely payment. Contra Costa Fire-EMS Measure H Distribution Efficiency Proposal Submitted by Pat Frost, Director Emergency Medical Services January 24, 2012 – Pfrost – rev 7-20-12 o The current process is unnecessarily complex requiring duplicative accounting practices to assure allocations have been distributed correctly. • The effected Measure H allocation for the First Responder Paramedic Fund is $1,845,760 per 5/18/2004 Board Order. The new process would retain the board ordered allocations of: o Paramedic Engine: current allocation is based on a formula of $30,000/paramedic engine o Paramedic Program Oversight (RN/EMT-P): current allocation is based on a formula of $4,919.20/engine o First Responder Allocation: $300,000 (less Zoll ePCR support charges) split between all eligible agencies o Paramedic Medical/EMS Agency Oversight: $102,729 split between all eligible agencies Illustration of Current and Proposed Streamlined Process Table A Fire-EMS Funding Current (quarterly billing) Proposed (New) (annual billing) Number of transactions 31 9 Number of individuals required to process each transaction 11 6 Total transactions per year (# of transactions x # of individuals) 341 54 Time in hours to process (10 minutes per person/per transaction) 56.83 9 Estimated average salary per hour $40 $40 Total cost to process transactions (hours x salary) $2,273 $360 Number of incorrect or delayed transactions (50% based on review) 170.5 (50% based on review) 2.7 (5% estimated due to reduced complexity) Time in hours to research/correct (30 minutes per person/per transaction) 82.25 1.35 Estimated average salary per hour $40 $40 Total cost to research/correct transactions $3,410 $54 Total cost per year $5,683 $350 Time Savings (in hours) 118.73 Cost Savings $5,269 (93%) Risks: The EMS Agency can identify no significant risks to this arrangement. Proposed Implementation Timeline January 2013: EMS Agency reviews previous fiscal year CSA-EM-1 final budget report and determines allocation for each fire department eligible for funding based on 2004 board order. EMS Agency then processes appropriate funding to fire agencies. February 2013: Fire agencies receive full funding in annual lump sum improving budget planning. Conclusion: Redesign of distribution of the First Responder Paramedic Measure H funds reduces time on task and reduction in billing errors for substantial cost and time savings for all parties responsible for the distribution and oversight of these funds.