HomeMy WebLinkAboutMINUTES - 10212014 - D.4RECOMMENDATION(S):
1 . ACCEPT report on September 17, 2014 Emergency Ambulance RFP Development Workshop from EMS Agency
Staff and RFP consultants Fitch and Associates LLC.
2 . DIRECT the Emergency Medical Services (EMS) Agency, with the assistance of Fitch and Associates, to prepare
for Board of Supervisors approval a draft request for proposal (RFP) for emergency ambulance service covering
those areas of the county currently served by American Medical Response (all of Contra Costa County except the
areas of the Moraga-Orinda and San Ramon Valley Fire Protection Districts) to include two service options and
stipulate that proposers must include service plans and pertinent financial information to meet each of the two options
as described below:
Option A: would meet most of the existing service standards except that east county response zone would be
combined with Discovery Bay included in the 11:45 minute/90% urban area response, the requirement for Quick
Response Vehicles would be eliminated, and the special Richmond area response requirement would be changed from
10 minutes/95% with two paramedics to 10 minutes/90% with single paramedic staffing as required in other areas of
the county.
APPROVE OTHER
RECOMMENDATION OF CNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
Action of Board On: 10/21/2014 APPROVED AS RECOMMENDED OTHER
Clerks Notes:
VOTE OF SUPERVISORS
AYE:John Gioia, District I Supervisor
Candace Andersen, District II
Supervisor
Mary N. Piepho, District III
Supervisor
Karen Mitchoff, District IV
Supervisor
Federal D. Glover, District V
Supervisor
Contact: Patricia Frost,
925-646-4690
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: October 21, 2014
David Twa, County Administrator and Clerk of the Board of Supervisors
By: June McHuen, Deputy
cc: Pat Frost, T Scott, C Rucker
D.4
To:Board of Supervisors
From:William Walker, M.D., Health Services Director
Date:October 21, 2014
Contra
Costa
County
Subject:Report on Emergency Ambulance Request for Proposal (RFP) Development Workshop
RECOMMENDATION(S): (CONT'D)
Option B: would be based upon modified response standards as recommended in the EMS Modernization Study prepared by Fitch and
Associates.
Both options would include a paramedic inter-facility (hospital transfer) response standard not included in the existing ambulance contract.
The County would be able to choose which of the two options the successful ambulance proposer would be required to implement, and
would further be able to change its preferred options at any time during the contract period.
FISCAL IMPACT:
No fiscal impact.
BACKGROUND:
The Fitch EMS Modernization report provides a number of recommendations, some controversial and some not so, for moving our EMS
system forward in the years ahead. These recommendations need to be carefully considered and reviewed by the EMS Agency and
community partners, including the Emergency Medical Care Committee (EMCC) and the County Fire Chiefs, to determine which
recommended changes will work best for our County. In the meantime, we must move forward with an ambulance selection process in
accordance with our EMS system plan and state requirements. Currently, our EMS system is facing a number of uncertainties associated
with fire service funding, changes in ambulance transport destinations in west county, and changes in health care reimbursement patterns
affecting both governmental and private insurance programs. In this uncertain environment, it makes sense to include in the ambulance
service RFP options that would largely retain existing response standards as well as options that would incorporate changes as
recommended in the Fitch report as needed to support sustainable emergency ambulance services without subsidy. The RFP and the
resulting emergency ambulance contract will be developed with language to facilitate potential changes to the EMS system as may be
approved by the Board of Supervisors. The RFP will also identify ambulance contract administration costs which the Board may choose to
recover from the ambulance provider. The existing ambulance contract includes provision to allow for changes in patient charges to cover
changes in governmental reimbursements (e.g., MediCal, Medicare) and increased operational costs that could not have been reasonably
anticipated. These provisions would be expanded to include Board-approved increased charges to cover significant changes in private payer
reimbursements.
RFP Workshop Report:
On August 5, 2014, the Contra Costa County Board of Supervisors directed the EMS Agency to conduct a full day facilitated RFP
development workshop with EMS system stakeholders to assure that the local knowledge and expertise was incorporated into the
emergency ambulance RFP. The day long RFP development workshop was conducted on September 17, 2014 at the Contra Costa County
Schools Insurance Group in Pleasant Hill, and was facilitated by Rick Keller of Fitch and Associates. The PowerPoint presentation used for
the workshop is available at http://cchealth.org/ems/pdf/RFP-Workshop-2014-0917.pdf
Nearly fifty persons attended the workshop, including representatives from fire and law enforcement, labor groups, hospitals and emergency
physicians, consumer advocacy groups, several ambulance services, and staff from some local agencies and elected officials. Attendees were
invited to provide comments and suggestions during and after the workshop. Organizations unable to attend the workshop were invited to
submit written comments.
During the workshop, participants were oriented to the components of emergency ambulance procurement process covering safety net
provisions, performance requirements, general legal provision, competitive criteria, procurement evaluation process and request for
proposal timeline. After that orientation there was facilitator led discussion and question-answer period on the current call demand, issues
related to service sustainability and findings from the EMS Modernization Study that were pertinent to the RFP preparation.
The key design changes being presented during the workshop were:
1) Consolidation of five emergency response zones to three zones in the following manner.
Combining Zones A & B in West County
Continuing with Zone C in Central County
Combining Zones D & E in East County
2) Increase the consistency of response time requirements (Richmond and East County)
3) Lengthen response times by 60 seconds (Urban-only)
4) Eliminate Quick Response Vehicles
Key comments and suggestions made during the workshop and in post-workshop follow-up included the following:
1) The question was raised as to why not initially seek proposals for services maintaining existing response times. The fire chiefs,
especially, were concerned that any reduction in service (longer response times, reduced staffing requirements, elimination of QRVs) prior
to seeking proposals would be premature. Fire was particularly concerned that longer ambulance response times or reduced ambulance
staffing requirements would commit fire units to longer scene times or keep fire units out of service for extended periods if firefighters
were needed to augment ambulance staffing while transporting patients to the hospital.
2) It was thought that the ambulance RFP was not the appropriate place to address the issues of emergency medical dispatch consolidation.
3) Consumer representatives expressed the importance of assuring that the ambulance provider maintained a robust mechanism for
reviewing and resolving consumer complaints.
4) The desirability of an improved method of handling mental health transports was a priority.
5) Support was expressed for a neutral, primarily out-of-county RFP review panel, but with one in-county member.
6) Hospital, health plan and physician stakeholders recommended that advanced life support intra-facility medical transportation be
incorporated into the RFP.
Public and Stakeholder Feedback: A summary of the September 17th post workshop feedback is posted at
http://cchealth.org/ems/system-review.php#simpleContained8
Status of RFP Timeline (subject to change)
CONSEQUENCE OF NEGATIVE ACTION:
Development of the ambulance RFP may be delayed.
CHILDREN'S IMPACT STATEMENT:
Approximately 8-10% of EMS system services are provided to children.
CLERK'S ADDENDUM
Speakers: Alan Hartford, CCC Fire Protection District; Erik Rohd, General Manager, American Medical Response; Jeff Carman, CCC
Fire Protection District.
ATTACHMENTS
Supervisor Update 2014
EMS Procurement ProjectStakeholder Input at RFP Development WorkshopSupervisor Update1
Competitive Process ERA I, II, V2
Summary of Prior Board Direction3yApproved projected timeline, process and compliance with legal requirementsy5 year performance based contract at no cost to county with renewal optionyInclude ability to cooperate with future uniform single dispatch in the futureyApproved credentials and qualification for RFP candidates y“Demonstrate ability”yApproved RFP dedicated resources for support of AED, CPR and HeartSafe Community effortsyApproved neutral review panel to include one member who is a resident of Contra Costa.
Summary of Prior Board Direction4yAuthorize EMS Agency to incorporate key features of EMS Study in RFP with input from RFP Development Workshop Sept 17, 2014yResponse times, zone consolidation, urban area expansion, 1:1 ambulance staffing, QRV changesyIncorporate input from Executive Chiefs of Fire Protection DistrictsyEvaluating impact on proposed EMS Study changesyApproved requirements for cost recovery for data and contract management, medical quality oversight, yInclude requirements for Bariatric ambulances, data management, technology integration, EMS System of Care monitoringyConduct in RFP Development Workshop with EMS System StakeholdersyStakeholder feedback to determine what components of EMS System Study recommendation are appropriate to include in the RFPyBilling dispute reporting requirements
What We Have Done 5yFire Chiefs WorkshopySeptember 23, 2014yDay Long RFP Development Stakeholder WorkshopySeptember 17, 2014 yReview of RFP stakeholder post-conference comment yInput with Executive Chiefs post-conferenceyTransparent public comment and post-conference feedback yhttp://cchealth.org/ems/pdf/RFP-Workshop-2014-0917-public-comment.pdf
EMS RFP Development Workshop Input Report Rick Keller, ConsultantFitch and Associates6
RFP Development Workshopy47 Attendeesy6 PhysiciansyRepresentatives from John Muir, Kaiser, Sutter, County Health Systems & Hospital CouncilyAt least three consumer representativesyMultiple fire agencies / 3 Fire ChiefsyConFire, San Ramon and Richmond DispatchyFire and EMS labor groupsyLaw enforcementyLAFCO, City ManageryPotential bidders –AMR, Rural/Metro, Paramedics Plus, Falck, CCCFPD7
Goals of Procurement ProcessyRedesign of System to mitigate negative financial trends of increasing costs and decreased funding for Contractor and other system stakeholdersyComply with state lawsyImplement changes in system designyUse competition to stimulate innovationyControl Costs8
Key Recommended Design ChangesyConsolidate to 3 zonesyIncrease consistency of response time requirements (Richmond, East County)yLengthen response times by 60 seconds (Urban-only)yEliminate QRV9
Zone RecommendationsyCombine Zones A & B –West CountyyContinue with Zone C – CentralyCombine Zones D & E – East CountyyConsolidate from 5 Zones to 3 Zones10
Impact of Design ChangesySavings in excess of $3 millionyDistribute savingsyOffset increased costs (Doctor’s Medical Center, decreased reimbursement, labor cost increases)yFund EMS Agency oversight activities ($500 - $750 k)yImprove medical communication center performance (±$1.5 M)11
Proposed RFP StructureyIncorporate two options in the RFPyPlan A: Substantially retain status quo and include option for bidders to request subsidiesyPlan B: Incorporate the recommendations for System Design changes with contract oversight payments to County, and zero subsidyyRequire bidders to submit options for immediate or mid-term consolidation of medical communications (to be addressed separately at a later date)12
RFP OptionsPlan A – Status Quo with Following ChangesPlan B – Incorporates EMS Report Recommendations 13yCombine Zones D & E in East CountyyInclude Discovery Bay under urban requirementsyAllow 1 EMT and 1 paramedic responding to RichmondyCombine Zones A & B in West County and D & E in East CountyyInclude Discovery Bay and Bethel Island under urban requirementsyAllow 1 EMT and 1 paramedic responding to Richmond
RFP OptionsPlan A – Status Quo with Following ChangesPlan B – Incorporates EMS Report Recommendations 14yMaintain urban response times @ 11:45 /90% with Richmond 10:00 / 90%yEliminate provision of QRV as a Contractor responsibilityyRelax urban response times for transporting ambulance by 60 seconds to 12:45 / 90% countywideyEliminate provision of QRV as a Contractor responsibility
RFP OptionsPlan A – Status Quo with Following ChangesPlan B – Incorporates EMS Report Recommendations 15yCommitment of $100,000 annually for community education, health status improvement, bystander trainingyProvision for identifying subsidy requirements for contract yearsyCommitment of $300,000 annually for community education, health status improvement, bystander trainingyNo subsidy - $750 K to cover costs of contract administration, medical direction, quality management, etc.
RFP OptionsPlan A – Status Quo with Following ChangesPlan B – Incorporates EMS Report Recommendations 16yCommitment of up to $1.5 million annually for medical communications center
Common Provisions of RFP17yInclude ALS interfacility transports in EOAyBiannual opportunity to modify contract requirementsyResponse time and penalty provisionsyZones, Urban, and Rural area boundariesyPricingyScope of services providedyOther changes needed to respond to healthcare delivery changes
Common Provisions of RFP18yFlexibility to incorporate contractor responsibility changes to address improvements for Medical DispatchyHave Contractor quote cost of QRV for consideration and purchase by County or Cities who wish to augment First Medical Response.yIncluded provisions to encourage retention of incumbent workforce
ReviewersyIndependent, knowledgeable, committed , without conflict of interestyEMS Medical DirectoryEMS Contract Administrator (Dir of Health, EMS Agency Director, etc.)yEMS Operational Expert (Ops Manager, CEO, COO, etc.)yFire Representative (Chief w/ EMS ambulance experience)yIndependent respected County representative (retired judge, former city manager, business person, etc.)19
Input Included in RFP20yTo address concerns about increasing response times and changing Richmond’s unique requirements, the two-option RFP design is established allowing the proposer’s the opportunity to quantify fiscal parameters and to allow the County to select the option providing greatest good to communityyALS interfacility transports was identified as an issue for health systems and will be included in the EOA with defined performance requirements
Input Included in RFP21yAdditional provisions will be included in the RFP to ensure robust action on consumer complaints and require the proposers to define their policies for addressing financial hardship situationsyInclude one independent in-county representative on review panelyInclude a independent review of proposers’ financial strength, proposed budgets, and performance securityyDefer creation of a centralized medical communications center