HomeMy WebLinkAboutMINUTES - 05182004 - D.4 TO: BOARD OF SUPERVISORS ........,o Contra
FROM: William B. Walker, MD, Director, -
Health Services Department Costa
a A
MATE: May 18, 2004 --- '
sr�'co��"�'{ County
SUBJECT: Ambulance Contract and RFP I Paramedic Engine Services A
SPECIFIC REQUEST(S)OR RECOMMENDATION(S)&BACKGROUND AND JUSTIFICATION
RECOMMENDATIONS:
1. Authorize the Health Services Director to execute a one-year extension through June 30, 2005 to the
American Medical Services ambulance service agreement as follows:
a. Two months(July I through August 31,2004)at the existing service payment levels.
b. Ten months(September 1, 2004 through June 30, 2005)with the following changes in service
and payment provisions:
(1) County subsidy payments to AMR eliminated.
(2) Services to County Health Services responsible patients(currently included in County
subsidy)to be billed per service at Medical rate for indigents or Medicare rate for non-
indigents.
(3) Code 3 response time requirement to be changed to 11:59 for 90 percent of responses as
measured in each of four response zones with first responder paramedic coverage. (Note:
This will include all areas currently served by AMR except for the City of Richmond.
Existing ambulance response standards and staffing requirements will remain in place for
Richmond until such time as the City determines to establish paramedic first responder
services.)
(4) Minimum paramedic ambulance staffing will be changed to one paramedic and one EMT-I
for ambulance units normally responding within the four response zones with first responder
paramedic coverage. (Two-paramedic staffing to remain in effect for ambulance units
normally responding within the City of Richmond.)
(5) AMR to provide, at no cost to County, a total of four Quick Response Vehicles(non-
transporting paramedic first responder vehicles)to provide paramedic first response
coverage in East County and to augment paramedic engine coverage in northwest county.
Housing for QRVs is to be provided by host fire service.
(6) Allowable AMR patient charges be increased as follows: effective September 1,2004, ALS
base rate to $$77.69 (from$801.49),BLS base rate to $570.00 (from$535.71), and mileage
to$19.75 (from$1499)and, effective January 1, 2005, a three percent cost of living
increase in all allowable charges.
CONTINUED ON ATTACHMENT: X YES SIGNATURE: WLR✓ �. /"
- --- --
�RECOMMENDATION OF COUNTY ADMINISTRATOR RECOMMENDATION OF BOARD COMMITTEE
: AIPPROVE OTHER
SIGNATURE(S):
- ----------------------------------------------------------------------------------------
ACTION OF BOAR N May 18, 2004 APPROVE AS RECOMMENDED X OTHER X
See attached addendum for Board action
VOTE OF SUPERVISORS I HEREBY CERTIFY THAT THIS IS A TRUE
AND CORRECT COPY OF AN ACTION TAKEN
X UNANIMOUS(ABSENT ) AND ENTERED ON THE MINUTES OF THE
BOARD OF SUPERVISORS ON THE DATE
AYES. NOES: SHOWN.
ABSENT: ABSTAIN:
ATTESTED MAY 18, 2004
JOHN SWEETEN,CLERK OF THE BOARD OF
SUPERVISORS AND COUNTY ADMINISTRATOR
Originating Department: Emergency Medical Services 646-4690
cc: County Administrator
County Counsel �...
Health Services Administration
Emergency Medical Services
Contra Costa County Fire Chiefs Association
Each Fire Chief
BY "Ii : 'moi UTY
cam'•
2. Direct the Health Service Department to prepare a request for proposal (RFP) for emergency
ambulance services based upon the above service levels with no County subsidy and to submit the
RFP for Board approval by July 27,2004.
3. Authorize the Health Services Department to establish a First Responder Paramedic Fund and to
deposit into that fund from CSA EM-1 revenues each year in an amount equal to the savings achieved
by elimination of the AMR subsidy, less $350,000 annually beginning September 1,2004 to be
retained by the Health Services Department for ambulance transport provided by the County for
indigent patients.
4. Authorize the Health Services Department to enter into agreements with fire services in CSA EM-1
Zone B (all of county, except San Ramon Valley Fire Protection District)for the payment of
$30,000/year($2,500/month)per paramedic engine from the First Responder Paramedic Fund to
partially offset the cost of providing first responder paramedic services. Payment will be subject to
(a)each participating fire service meeting standards for data reporting as set by the Health Services
Department consistent with the Contra Costa EMS System consultant report(Fitch report)
recommendations and(b)each participating fire service agreeing to place any existing CSA EM-1
paramedic first responder or ambulance funding into the Health Services Paramedic First Responder
Fund.
5. Approve expenditures of up to $375,760/year($31,313/month)by the Health Services Department for
paramedic first responder system oversight activities approved by the Health Services Department
consistent with the Contra Costa EMS System consultant report(Fitch report)recommendations, such
activities to be within the EMS Agency or fire services.
6. Authorize the Health.Service Department to designate remaining funds as may be available from the
First Responder Paramedic Fund to be used for(a) augmentation of paramedic first responder
services through purchase of QRV or ambulance unit hours in any areas determined to be deficient in
paramedic coverage, (b)reimbursement to fire services for paramedic engine startup costs including
training, wages, equipment and supplies, and(c)reimbursement to fire services for other paramedic-
program-related costs.
FISCAL IMPACT:
No direct General Fund impact. Implementation of these recommendations will result in a shift of CSA
EM-1 funds from ambulance subsidy to Ere paramedic first responder program subsidy. The proposed
subsidies for fire paramedic programs will not cover the full cost of these programs,but will provide an
additional source of ongoing funding for existing Ere paramedic services and for implementation of new
or expanded services.
An estimated$1,845,760 annually($1,538,133 for FY 2004-05— 10 months)will be made available for
the First Responder Paramedic Fund through elimination of existing expenditures as follows:
$1,436,664 AMR ambulance subsidy
474,624 AMR ARVs(2)
174,600 CCC Fire paramedic program subsidy
79,872 Moraga-Orinda Fire ambulance subsidy(subject to MOFPD agreement)
30,000 El Cerrito Fire(subject to El Cerrito agreement)
$2,195,760 Total
Less amount retained by Health Services for indigent ambulance
350,000 services
$1,845,760 Total available for First Responder Paramedic Fund
Projected annual expenditures(I"year) from.First Responder Paramedic Fund would be as follows:
$870,000 Paramedic engine subsidy -est. 29 engines @ $30,000/engine
CCC Fire—21 engines($630,000)
Moraga-Orinda Fire—5 engines($150,000)
El Cerrito Fire—2 engines($60,000)
Rodeo-Hercules Fire— 1 engine ($30,000)
570,000 Available for paramedic engine startup—est. 19 engines @$30,000/engine
CCC Fire—9 engines(up to $270,000)
Richmond Fire—6 engines(up to $180,000)
Pinole Fire—2 engines(up to $60,000)
Rodeo-Hercules Fire— 1 engine(up to $30,000)
El Cerrito Fire— 1 engine (up to$30,000)
East CCC Fire—not applicable (QRV coverage)
Page 2
Crockett-Carquinez Fire--not applicable(QRV coverage)
405,760 System oversight and other paramedic first responder expenses
$1,845,760 Total proposed expenditures from Paramedic First Responder Fund
The above figures are annualized. Since the proposed changes are scheduled to begin September 1,2004,
only 10 months of these changes (83.3%)would apply to FY 2004-05. Availability of funds after June
30, 2005 will depend upon the results of the competitive ambulance selection process and might be more
or less than shown above.
BACKGROUND:
These recommendations stem from a process initiated in 1996 when the Board of Supervisors approved
an extension of the AMR contract with a provision requiring AMR to "participate in a pilot first
responder paramedic project with Contra Costa County Fire Protection District"and authorizing Health
Services to make certain changes in ambulance staffing and response time standards related to that pilot
project. Two years later on November 3, 1998,the Board authorized a shift of$174,600/year from the
CSA EM-1 (Measure H)AMR ambulance subsidy to support the expansion of Contra Costa County
Fire's paramedic first responder program. In return for the subsidy reduction,AMR agreed to a change
in ambulance response time requirements in the central county area of the pilot program from 10-
minute/95%to 10-minute/90%. The Board directed Health Services and Contra Costa Fire to, "continue
working with AMR and with other fire agencies within the county to determine the feasibility of further
integration of public and private paramedic services,conditioned upon the identification of new or
existing funding sources." A follow-up report prepared for the Board May 25, 1999 showed that there
had been no change in ambulance response times in central county and that paramedic arrival times had
been reduced by two minutes.
During 1999,the County Fire Chiefs' Association together with the EMS Agency established a
Paramedic Engine Task Force to develop standards for an integrated ambulance and engine-based
paramedic program and to identify fire service costs for implementation and operation of paramedic
services. AMR participated in this process by providing estimates of cost savings resulting from various
changes in ambulance staffing and response time requirements. During this period,with support from the
Emergency Medical Care Committee,the EMS Agency began working with El Cerrito Fire on the
development of a paramedic first responder program to improve paramedic response in the Kensington
and El Cerrito hills area.
On March 14, 2000, following a report from Health Services on fire paramedic services and on the AMR
contract, the Board(1)directed Health Services to continue assisting the fire chiefs in development of a
county-wide first responder paramedic plan, (2)authorized continuation of AMR contract changes in
central county, (3)authorized an AMR subsidy reduction of$30,000 annually(with corresponding
response time changes)to support a paramedic first responder program in El Cerrito Fire, and(4)
authorized Health Services to negotiate with AMR to achieve additional subsidy reductions to support or
partially support paramedic first responder services. The El Cerrito Fire paramedic program began
operation in January 2001.
The Fire Chiefs' Paramedic Engine Task Force continued its work and on May 18, 2001 issued a report
recommending that the County undertake a competitive ambulance selection process and that the EMS
Agency retain the services of a professional consultant to assist in the development of an EMS service
plan, to assist with the development of the ambulance RFP, and to assist in the proposal review process.
The recommendations of the Fire Chiefs'report were supported by the EMS Agency and endorsed by the
Emergency Medical Care Committee. A competitive process was established to select a consultant, and,
on June 13, 2002,the Board approved a contract with Fitch and Associates "to assist in designing an EMS
response system what would achieve optimal integration of fire and private paramedic services."
The Fitch and Associates report on the Contra Costa EMS System(Fitch Report)was issued in September
2003. The report contained 13 specific recommendations on the EMS system and provided a financial
analysis of fire paramedic first responder costs and of potential savings to be realized through changes in
ambulance staffing and response requirements. The report proposed that the areas currently served by
AMR be divided into five response zones and that an ambulance RFP be developed that would allow
implementation of integrated paramedic first responder and paramedic ambulance services on a zone by
zone basis conditioned on fire services in a specific zone being ready to provide paramedic first responder
coverage for the zone. The zones proposed in the Fitch report included:
Zone A—City of Richmond(Richmond Fire)
Zone B—West County, except Richmond(El Cerrito Fire,CCC Fire,Rodeo-Hercules Fire,
Pinole Fire,Crockett-Carquinez Fire)
Zone C—Central County(CCC Fire)
Zone D—Pittsburg,Bay Point,Antioch area(CCC Fire)
Page 3
Zone E—East County(East CCC Fire)
Under the Fitch recommendations,as endorsed by the Emergency Medical Care Committee,when fire
services within any zone were prepared to provide zone-wide paramedic first responder coverage,
ambulance the response standard for that zone would change from the existing 10-minute standard to a
13-minute/90010 standard and ambulance staffing requirements would change from the existing two-
paramedic requirement to one paramedic and one EMT-I. The resulting savings in ambulance cost would
be used to support fire paramedic first responder service. The Fitch report further recommended that the
change to one paramedic/one EMT-I staffing be made without waiting for paramedic first response in
order to provide some funding for paramedic engine startup costs. This latter recommendation was not,
however, supported by the Emergency Medical Care Committee.
The financial analysis provided in the Fitch report showed a projected savings in ambulance costs of
$2,365,394 if both the staffing and response time changes were implemented countywide. This would
only partially offset Witch's estimated recurring costs for countywide fire paramedic first responder
services of$3,008,201. Two important factors to note,however,are: (1)the actual funding that would be
available beginning July 1, 2005 will not be known until the competitive ambulance selection process has
been completed; and(2)most of the fire service cost or providing paramedic first responder services is
currently being covered without CSA EM-1 subsidy.
While the Fitch report recommendations were supported by the Fire Chiefs' Association and endorsed
with some changes by the Emergency Medical Care Committee,there were significant concerns raised by
some groups, including SEILJ Local 250 representing AMR paramedics,regarding the proposed
ambulance staffing and response time changes. In an effort to arrive at a compromise that could be
supported by all stakeholders, an alternative plan was proposed by AMR and EMS. The main features of
the alternative plan included:
(1) Provision of 4 QRVs(3 east county, 1 northwest county)by AMR at no cost to the County
which,when combined with existing paramedic engines, would assure paramedic first
responder coverage in all ambulance response zones except for the City of Richmond.
(2) Maintenance of existing ambulance staffing and response time standards in the City of
Richmond.
(3) Establishment of 11:59/90%response standard in all ambulance response zones except for the
City of Richmond.
(4) Establishment of a pilot 1-paramedic/1-EMT-I staffing program outside the City of Richmond
with the provision that there be no paramedic layoffs.
(5) Elimination of all AMR subsidy, except payment of up to$350,000/year for County-
responsible indigent patient transports.
(6) Extension of AMR contract for three years through June 30, 2007.
(7) Acceptance of proposed increases in allowable AMR patient charges.
Although this alternative plan was initially supported by SEIU Local 250,the plan failed to gain a
consensus support of the stakeholders. Ultimately,both SEIU Local 250 and IAFF Local 1230 opposed
the plan and favored a competitive ambulance selection process.
Benefits of Proposed Plan
The plan currently being proposed to the Board is based on the recommendations of the Fitch report,but
incorporates some of the advantages of the alternative plan. Key benefits are:
(1) Uses QRVs to augment paramedic engine coverage where feasible. When combined with
existing and planned paramedic engines, all response zones except the City of Richmond will
have first responder paramedic coverage by September 1, 2004.
(2) Maintains existing response time and staffing standards in the City of Richmond.
(3) Provides for a shift of$905,553 over 10 months (September 2004 through June 2005)from
ambulance subsidy to support fire paramedic first responder services and adds two additional
QRVs.
(4) Changes ambulance response times in zones with paramedic first responder service to
11:59/90% in place of 13-minute/90%as proposed in Fitch report.
(5) Maintains two-paramedic ambulance staffing in zones without paramedic first response as
recommended by Emergency Medical Care Committee.
(6) Provides quicker paramedic response to 9-1-1 emergencies and better assurance of paramedic
availability.
(7) Extends AMR contract through June 30,2005 allowing appropriate time to conduct competitive
ambulance selection process.
Existing AMR Contract
The existing AMR contract expires June 30, 2004. This contract was initially approved by the Board on
October 28, 1997 following a competitive selection process initiated in November 1996. The contract
was awarded for a 5-year term November 3, 1997 through November 2, 2002, and was extended to June
30,2004.
Page 4
Compztitive Selection Timeline
May 18, 2004 Board direction to develop RFP
July 27 Board approval of RFP
Aug 18 Bidders conference
Sept 30 Proposals due
Nov 17 Proposal review and recommendation to Board completed
Nov 30 Presentation to Board; negotiation of contract authorized
Dec 17 Contract negotiations completed
Feb 22 Board approval of contract
July 1 Startup of new contract
Page 5
ADDENDUM TO ITEM DA
May 18, 2004
The Board of Supervisors considered the Ambulance Contract and RFP/Paramedic Engine
Services.
Art Lathrop, Director, Emergency Medical Services presented the staff report and
recommendations along with a Powerpoint presentation..
The chair then invited those who wished to address the Board on this item. The following
presented testimony:
Anne Martin, SEIU Local 250
Leslie Mueller, American Medical Response, 1124 Flowerwood Place, Walnut Creek;
Lou Paulson,Firefighters Local 1230, 112 Blueridge Drive, Martinez.
The chair then returned the matter back to the Board for further discussion.
Supervisor DeSaulnier moved to accept the staff recommendations and requested that the
concerns addressed in the letter dated May 14, 2004 from the Contra Costa County Firefighters
Local 1230 and SEIU 250 Health Care Workers Union is included in the Request For Proposal
and return to the Board of Supervisors on July 27, 2004. Supervisor Gioia second the motion
and the Board took the following action:
i AUTHORIZED the health Services Director to execute a one-year
extension through June 30, 2005 to the American Medical Services
Ambulance service agreement;
• DIRECTED the Health Services Department to prepare a request for
proposal (RFP) for emergency ambulance services based upon the
above service levels with no County subsidy and to also include the
concerns addressed in the letter dated May 14, 2004 from the Contra
Costa County Firefighters Local 1230 and Health Care Workers Union
SEIU and submit the RFP for Board approval by July 27, 2004
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Marne: Phone ' _ c
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Address: 1 ! /`` �'yI ' V�_' C: t� City i, l�. Zip Code: 3 C
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Name: �.`ay.J Pone_ I. 13
Address: - City. 6-3 Zip Code.
I am speaking for myself or organization:
CHECK ONE; \,,,_ ane of organization)
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May-21 -04 09 : 58A Contra Costa EMS 925 646 4379 P- 02
SEM
ANML
LOCAL IZ30
May 14€, 2004
Art Lathrop
Director,Contra Costa Emergency Medical Services
1346 Arnold Drive, Suite 125
Martinez, CA 94553-1631
Fax (926)6461.4379
Lear Mr. Lsthrop,
Healthcare Workers Union, SEW Local 250 and IAFF Local 1230 know that emergency
services here in Centra Costa are of vital importance to all county residents. Our
members, who are responsible for providing emergency services in Contra Costa
County, have many concerns about how these services are irmplemented incur
Community. We view our participation; in the RFP process as vital flo iosuring that the
knowledge and experionce of those who actually provide these services to the
community on a daily basis are utilized to guerantse the bust possible medical care in
emergency situations. Through continuing discussions between au:two organizations,
we have developed a list of components we believe are essential to insuring a
successful RPP process:
1. Both lAFF local 1230 and SEIU Loral 260 should each have a voting €Wermer on
the Committee:that recommends an ambulance provider to the County Board of
Supervisors.
2. The REP should have worker retention language for ail EMS personnel currently
employod by American Medical' Response that also recognizes the unman and
maintains the Durrant collective bargaining agreement in case another provider other
than American Medical Response is chosen.
3. All 911 responding ambulances shall maintain the Dual Medic configuration, which
could be phased out, by attrition, to a 1 EMT to 1 Medic configuration during the life
of the contract. The Dual Medic configuration shall remaln In place for West County
May-21 -04 09: 58A Contra Costa EMS 925 646 4373 P. 03
and other areas in the County where Fire Departments are not capable of providing
Engi
May-21 -04 09 : 58A Contra. Costas EMS
925 646 4379 P. 04
We make these recommendations in the hope that by working together wqh the leaders
of our County,we Can ensure that our Community is a safe place to live and work for
our families,friends, and ne ghbors.
Sincerely,
Sal Rosselli Lou Paulson
President Presidbnt
SEW Local 250 lAFF Local 1230
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