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HomeMy WebLinkAboutMINUTES - 03051991 - 2.6 TO : BOARD OF SUPERVISORS FROM: Contra Mark Finucane, Director ��,,.. �L , Health Services Department �JLIJta DATE: February 20, 19 91 ""u' "y SUBJECT: Measure H Implementation SPECIFIC REQUEST(S) OR RECOMMENDATION(S) & BACKGROUND AND JUSTIFICATION RECOMMENDED ACTION: 1. Accept report on Measure H implementation. 2 . Authorize the Health Services Director to execute an agreement, approved as to form by County Counsel, with Regional Ambulance, Inc. , for emergency ambulance service for the period January 3 , 1991 through January 2, 1993 (two years) providing payments of up to $1,312,207 and $2, 502,389 for enhanced paramedic ambulance services to be provided within Emergency Response Areas 1, 2, and 5 during the first and second contract years, respectively, and with a provision for extension for up to two additional years with any subsidy to be negotiated prior to extension. FISCAL IMPACT• No County General Fund impact. Subsidy payments will be funded under CSA. EM-1 (Measure H) without exceeding the voter-approved limits of $5.50 per household for the first year and $10. 00 per household for subsequent years. BACKGROUND: On June 5, 1990, Your Board approved and authorized distribution of a Request for Proposal (RFP) for emergency ambulance service. The RFP set standards for ambulance service based upon the Measure H Service Plan for enhanced emergency medical services and established a process for proposal review. On September 11, 1990, Your Board approved the selection of Regional Ambulance, Inc. , and San Ramon Valley Fire to provide emergency ambulance services and authorized the Health Services Director to negotiate contracts based upon their submitted proposals. Both agencies were the sole bidders for their respective service areas. (Your Board also authorized negotiation of an agreement with Moraga Fire, which was exempt from the competitive selection process, to continue providing emergency ambulance service within their area. CONTINUED ON ATTACHMENT' YES SIGNATURE; / RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD CONIMITTEE APPROVE OTHER SIGNATURE(S)' ACTION OF BOARD ON March 5, 1991 _ _ APPROVED AS RECOMMENDED X-_and .OTHER X-.--- REQUESTED the Health Services Director to report back to the Board on the status of Measure H implementation in East County. VOTE OF SUPERVISORS 1 HEREBY CERTIFY THAT THIS IS A TRUE X UNANIMOUS (ABSENT III AND CORRECT COPY Or AN ACTION TAKEN AYES: _ NOES:_ AND ENTERED ON THE MINUTES OF THE BOARD ABSENT: ABSTAIN: OF SUPERVISORS ON THE DATE SHOWN. ATTESTED 15� 19,91C County Administrator PHIL BATCHELOR, CLERK OF THE BOARD OF County Counsel SUPERVISORS AND COUNTY ADMINISTRATOR Auditor/Controller Health Services Administration Emergency Medical Services BY DEPUTY "The attached report on Measure H implementation discusses: - Measure H program implementation, - Involvement of the Oversight Committee, - Review of system issues. - The ambulance RFP and selection process, and - Key provisions of the proposed contracts. Regional Ambulance Contract. The proposed contract with Regional Ambulance provides for major enhancements in emergency ambulance system, including establishing a standard of all paramedic response to life-threatening calls. This will be accomplished by adding six 24-hour paramedic ambulance units over a ten month period beginning in January 1991. Costs of the additional coverage will be offset through a subsidy paid by the County from Measure H funds. During the first year of the proposed two year contract, subsidy payments of up to $1, 312,207 based upon the actual addition of new paramedic units. During the second year, subsidy payments would total $2,502, 389. There is provision for renewal of the contract for up to two additional years with any additional subsidy payments to be negotiated. The proposed contract permits Regional to make certain changes in patient billing procedures allowed under the federal Medicare program which will result in increased revenues necessary to offset higher operating costs. The projected increases in revenue from patient billing, however, are insufficient to fully cover operating costs at the existing level of service during the second contract year. Therefore, the second year subsidy will exceed the incremental costs of the added services by about $500, 000. Without the subsidy, however, existing levels of service could not be maintained. Key provisions of the proposed contract include: - Improved ALS (paramedic) ambulance coverage with two-paramedic staffing - 10 minute response requirement for 95 percent of Code 3 calls (20 minutes for rural areas) . - Improved physician or nurse directed quality assurance program. - Rigorous data reporting and contract monitoring program, including a formal annual performance review to be reported to the Board. - Financial review or audit by County of all contractor's finances related to performance of services under contract. In order to evaluate to feasibility of establishing an 8-minute response time standard, bidders were required to submit separate bids for both 10-minute and 8-minute response time standards. Based upon Regional's bid to meet an 8-minute response standard, we are not recommending that the County adopt such a standard at this time. CONTRA COSTA COUNTY HEALTH SERVICES DEPARTMENT Emergency Medical Services Agency February 13, 1991 Report on Implementation of Measure H to Provide Enhanced Emergency Medical Services (CSA EM-1) In November 1988, the voters of Contra Costa County passed Measure H calling for establishment of a countywide benefit assessment to fund enhanced emergency medical services. Following passage of Measure H, the Board of Supervisors directed the Health Services Department to undertake the necessary steps to implement the measure and invited all cities to join in formation of a countywide County Service Area (CSA) for emergency medical services. An implementation task force was formed and, with considerable input and assistance from a number of organizations, agencies, and other County departments, a Measure H Service Plan was developed and approved by the Board, all 18 cities agreed to join in the CSA, and CSA EM-1 formally constituted in December 1989 with funding to begin with the FY 1990-91 property assessments. County Service Area EM-1 includes all Contra Costa County and is divided into two zones for assessment purposes. Zone A is the San Ramon Valley area and was formed to coincide with Ambulance Emergency Response Area (ERA) 4 in which emergency ambulance services have been provided by San Ramon Valley Fire. Zone B is the remainder of the county and includes ERA's 1, 2, and 5 served by Regional Ambulance and ERA 3 served by Moraga Fire. Zone A was established as a separate assessment rate zone at the request of Danville, San Ramon, and San Ramon Valley Fire. This enabled the San Ramon Valley area to be included within CSA EM-1, but assessed a lower rate since an ambulance subsidy would not be necessary. The purpose of this report is to provide an update on the Measure H program implementation and to provide background on the ambulance selection process and the proposed ambulance contracts. The report is divided into the following sections: - Implementation of EMS System Enhancements - Oversight Committee - Review of System Issues - Ambulance Selection Process - Proposed Ambulance Contracts 1 1 Implementation of EMS System Enhancements The Measure H Service Plan provided for enhancements of paramedic ambulance coverage, medical dispatch and communications, and first responder medical training and equipment. Implementation activities to date have included: (1) Paramedic Ambulance Service. Developed Request for Proposal and conducted proposal review and selection process resulting in recommendations for selection of Regional Ambulance and San Ramon Valley Fire to continue providing ambulance service within their respective service areas under the Measure H standards. (Moraga Fire will also continue providing ambulance service under the new Measure H standards, but is exempt from the competitive selection process. ) Contracts have been negotiated with Regional Ambulance and with San Ramon Valley Fire, subject to Board of Supervisors approval. A similar agreement will be negotiated with Moraga Fire. (2) MEDARS Radio System. The County's 2-channel MEDARS system used for ambulance-to-hospital communication and for communication between ambulances and Sheriff's dispatch is being upgraded to a 4-channel system. This will accommodate increased ambulance-to-hospital communication and will provide additional capacity for communications with hospitals in the event of a disaster. (3) Dispatch. A link has been established between Sheriff's dispatch and Regional Ambulance dispatch by providing a dispatch terminal off the Sheriff's CAD system at Regional Ambulance. Additionally, proposals have been solicited from each fire/medical dispatch center to identify ways in which Measure H funds can be used to improve medical dispatching. (4) Disaster Medical Caches. A plan has been developed with the County Fire Chiefs to establish 15 to 20 caches of first aid supplies to be maintained by the fire service in various locations throughout the County for use in multicasualty or disaster situations. The stocking of the caches has been agreed upon and supplies are being purchased. County Fire has agreed to assemble and distribute the caches to participating agencies. Each participating agency will agree to maintain supplies in its caches and to transport caches to any location in the county if requested. All supplies are standard items familiar to fire and ambulance personnel from day-to-day operations. (5) First Responder Defibrillation. The County has contracted for the services of a part-time defibrillation program medical director. All fire agencies have been contacted to determine their interest in undertaking a defibrillation program. Results of these contacts were quite positive. Currently, an RFP is being developed to obtain bids on defibrillation equipment and a staff position is being developed to provide training and monitoring. 2 (6) Quality Assurance. Ambulance service providers are being required to submit detailed quality assurance programs that are subject to approval and monitoring by the County. (7) Ambulance Data System. A comprehensive data system for monitoring ambulance response has been established by Regional Ambulance and reporting requirements have been incorporated into the ambulance service agreements. Oversight Committee The Measure H Service Plan provided for the establishment of an Oversight Committee advisory to the Health Services Director to provide budgetary review and to review ambulance deployment. Membership on the Oversight Committee was established by the Service Plan. Membership on the oversight committee includes: - Bob Adams, Public Managers' Association - Dr. Allan Longshore, Emergency Medical Care Committee - Janiece Nolan, East Bay Hospital Conference - Chief Jerry Fender, Fire Chiefs' Association - Chief Ted Barnes, Police Chiefs ' Association This committee has been appointed and has met three times for an orientation, to review the current year's budget, and to review the terms of the proposed Regional Ambulance contract and Regional's proposed implementation plan. Members of the Oversight Committee also were invited to participate on the ambulance proposal review process discussed below. Review of System Issues At the time LAFCO was making its final review of the CSA EM-1 application, an issue was raised at the Mayors' Conference regarding the cost efficiency of the existing private ambulance model vis-a-vis a proposed model in which existing firefighter personnel would be trained as paramedics and emergency ambulance service provided by the various fire agencies. A committee of the Mayors' Conference was formed to review this issue and the Health Services Department agreed to work with the Mayors' Conference committee regarding this issue. A preliminary meeting has been held with the Mayors' Conference committee, the chair of the EMCC, and staff of the Health Services Department and County Fire. It was agreed that the Health Services Department would undertake an independent review of the proposed model to evaluate the potential for cost savings. To accomplish this task, an independent consultant has been retained and is currently conducting an analysis. 3 Ambulance Selection Process The ambulance provider selection process included development of a request for proposal (RFP) and review of proposals by Health Services Department staff and by an independent Ambulance Proposal Review Panel. An RFP incorporating enhanced standards for ambulance service was developed and approved by the Board of Supervisors on April 17, 1990. The RFP also specified a process for proposal evaluation including a review panel comprised of individuals from within and outside the county to be appointed by the Health Services Director. Although the RFP was widely distributed and active interest was shown by one major ambulance company outside the county, actual proposals were received only from the incumbent providers and for their existing service areas. (Hartson's Ambulance of San Diego had submitted an intent to bid and did attend the bidders' conference. Before the proposal due date, however, Hartson's was selected as the new emergency ambulance provider in San Mateo County and notified Contra Costa that they would not be submitting a proposal for this county. ) A Proposal Review Panel was selected included medical, consumer, fire, city and county government, and hospital representatives both from within and outside Contra Costa County. That Panel rated both the Regional and the San Ramon Valley Fire proposals quite highly. The report of the Panel and a recommendation from the Health Services Department was submitted to the Board of Supervisors. On September 11, 1990, the Board approved selection of the recommended providers and authorized the Health Services Department to negotiate contracts. As a result of its April 17 and September 11, 1990, actions, the Board of Supervisors has approved selection of the following emergency ambulance providers: - Moraga Fire Protection District to serve Emergency Response Area (ERA) 3 covering the area of the Moraga Fire Protection District; - San Ramon Valley Fire Protection District to serve ERA 4 covering the area of the San Ramon Valley Fire Protection District and that area of the City of San Ramon lying outside the District; and - Regional Ambulance, Inc. , to serve ERA's 1, 2, and 5 covering all remaining areas of the county. The following section discusses the key provision of the proposed Regional Ambulance .contract. Contracts with similar standards will be proposed for San Ramon Valley Fire and Moraga Fire. 4 Proposed Regional Ambulance Contract The proposed contract with Regional Ambulance, Inc. , is for a two year period (renewable for an additional two year period) and provides for emergency ambulance service covering Emergency Response Areas 1, 2, and 5. These areas comprise all Contra Costa County except San Ramon Valley and Moraga and comprise Regional Ambulance's existing service area. Key provisions of the proposed contract are as follows: (1) Provision of a County subsidy of up to $1,312,207 during calendar year 1991 and $2,502,389 during 1992 for paramedic ambulance and related services. (2) Requirement for Advanced Life Support (paramedic) response within 10 minutes of notification (20 minutes for rural areas) for all potentially life-threatening (Code 3) medical responses. (3) Recognition of goal to achieve 10 minute response standard within each community and commitment to deploy ambulances accordingly. (4) Provision for renegotiation of subsidy following significant MediCal or Medicare rate changes. (5) Changes in the permitted patient charges permitting paramedic charges for all patient transports by paramedic unit. (6) All Advanced Life Support ambulances staffed with a minimum of two paramedics. (7) Basic Life Support (EMT-I) ambulances normally limited to non-life-threatening (Code 2) emergencies. (8) Second patient attendant for transports of critical patients over 15 minutes, to relieve fire of the need to send personnel to accompany the patient. (9) A formal physician or nurse directed quality assurance program subject to approval by the County and to be maintained on file with the County. (10) A rigorous data reporting system for contract monitoring including monetary penalties for failure to comply with reporting requirements. (11) Audit or review by the County of financial and other records related to performance of services. (12) Participation in a formal annual performance review including a report to the Board of Supervisors. 5 To meet the performance criteria of the proposed contract, Regional has proposed the addition of six 24-hour paramedic units and related supervisory staff, one quality assurance nurse, administrative staff necessary to implement the data reporting system. A gradual phase-in of the six paramedic units will be accomplished over first year with all units scheduled to be in place by November 1991. This phase-in is necessary to assure that high caliber paramedic personnel can be obtained and provided appropriate orientation to the Contra Costa County EMS system. Basic Life Support (EMT-I) ambulance coverage will be retained at a slightly reduced level to respond to non-life-threatening emergencies. These include 9-1-1 calls that have been screened by a trained Emergency Medical Dispatch and determined not to require a fire first response or paramedic level ambulance response. Use of call prioritization by Emergency Medical Dispatchers and BLS ambulance response will help to assure the availability of fire and paramedic units to respond to more critical emergencies. The Health Services Department will conduct a full scale financial review of Regional Ambulance's emergency operations in Contra Costa County following the first year of services. The results of this review will be used as a basis for negotiating future ambulance contracts. Additionally, the Health Services Department and the contractor will participate in a formal annual performance review that will result in a report to the Board of Supervisors. 6