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Home My WebLink AboutCOUNCIL - AGENDA ITEM - 05/26/2015 - EMERGENCY MANAGEMENT SERVICES (EMS) AMBULANCE CONTDATE: STAFF: May 26, 2015 Mike Gress, Support Division Chief Tom DeMint, PFA Fire Chief WORK SESSION ITEM City Council SUBJECT FOR DISCUSSION Emergency Management Services (EMS) Ambulance Contract. EXECUTIVE SUMMARY The purpose of this item is to share information regarding the recently approved contract for provision of 911 ambulance services in Poudre Fire Authority’s jurisdiction. Poudre Fire Authority, through the RFP process selected and entered into a formal agreement to define a level of service, establish guidelines and methods for public input. GENERAL DIRECTION SOUGHT AND SPECIFIC QUESTIONS TO BE ANSWERED Poudre Fire Authority wishes to share information regarding the EMS contract for ambulance services. BACKGROUND / DISCUSSION Supported initially by the Poudre Valley Hospital District, Poudre Valley Hospital (PVH) has been the sole source provider of ambulance services since the mid-1970s. In 1994, the PVH Ambulance Service became an independent, not-for-profit entity, separate from the Health District of Northern Colorado and later combined with University Colorado Health System where it currently resides. The need for an agreement to provide 911 ambulance service was unnecessary initially since the Poudre Valley Hospital District had the authority to provide ambulance service within its jurisdiction. The growth of the greater Fort Collins area has resulted in additional hospital providers expressing an interest in 911 ambulance delivery. The realization that a changing health care system in PFA’s jurisdiction emphasized the need for an open and transparent system to define an exclusive service provider for emergency medical calls received through the Public Safety Answering Point (PSAP). The potential of additional entities desiring to deliver 911 ambulance services lead to the need to establish a competitive bid process to identify a sole provider for EMS services. An examination of the legal environment for EMS services concluded that PFA has the authority to be the lead agency in the development and administration of the process. At the direction of the PFA Board of Directors, Poudre Fire Authority was appointed the lead agency to complete a Request for Proposal (RFP). A detailed RFP was developed by Poudre Fire Authority and the City of Fort Collins Purchasing Department to identify and contract a sole source provider for all 911 ambulance service requests within the current boundaries of the Health District of Northern Colorado. To ensure that all areas within the Health District were represented, PFA became the representative (through an Intergovernmental Agreement) for seven fire departments/districts to ensure the current delivery of Advanced Life Support services did not degrade. These independent fire departments provide services to many of the rural areas of northern Larimer County beyond the boundaries of the PFA. At the January 28, 2014, PFA Board Meeting the process began for selecting and contracting with an ambulance service provider with the Poudre Fire Authority and the Northern Larimer County Emergency Response Area (NLCERA). Subsequently a comprehensive RFP was published on November 11, 2014. Three (3) proposals were received and Poudre Valley Hospital EMS (PVH EMS) was determined by the assessment team to best meet the RFP requirements. At the March 24, 2015, PFA Board Meeting the Board approved the assessment May 26, 2015 Page 2 team’s recommendation to enter contract negotiations with PVH EMS to provide ambulance service to PFA and the NLCERA. The parties initiated contract negotiations on April 2, 2015. Because PVH EMS only requested one (1) exception of PFA’s requirements, the contract negotiations focused primarily on ensuring alignment with the operational elements of the contract. In their proposal, PVH EMS recommended PFA consider placing the responsibility for oversight of PVH EMS’s performance with the PVH Clinical Quality and Risk Management Department rather than to fund a position at PFA. During the contract negotiations, PVH EMS supported PFA’s requirement to fund a new PFA position for compliance monitoring as originally put forth in the RFP. A key item of interest to the Council and the community will be the impact of this contract on the cost of service by PVH for 911 EMS calls. The PVH EMS annual review of rates for patient transport within the contract coincides with its fiscal year. Therefore, the rates provided in the proposal are effective through June 30, 2015. As part of the negotiations, PVH EMS also provided their rate schedule effective July 1, 2015. In aggregate, the new rates will increase by 4% percent attributable to operating expense increases that occur during the fiscal year and covering a 2.8% pay increase plus inflation. KEY CONTRACT ELEMENTS This contract supports PFA’s strategic goal to reduce the frequency and severity of emergency incidents by establishing a high standard of quality care and comprehensive performance requirements, metrics, and accountability. Some of the more noteworthy contract provisions include: Personnel and Clinical Standards a) CAAS Accreditation - Accreditation by the Commission on Accreditation of Ambulance Services (CAAS) represents the highest-level third-party verification for EMS service quality. b) Medical Director - PVH EMS will supply a PFA approved Physician Advisor with defined hours/week dedicated to PFA and participating providers for administrative and educational requirements. c) Certifications - All ambulances will be staffed by at least two individuals including one Certified Colorado State Paramedic and one Advanced EMT, EMT-IV or EMT. System Improvements a) Ambulance 1. Additional ambulance coverage at peak hours of use. 2. Ambulance coverage for Wellington (available to PFA District). 3. Ambulance dedicated to routine transfers - seven days a week/daytime hours. 4. Ambulance (Critical Care Transport) to handle high acuity inter-facility transfers, bariatric transfers and 911 system needs at Ambulance Level 1. 5. System Controller - controls real time deployment needs, monitor response time exceptions as they occur. 6. Increase of Staffed Ambulance Hours (approximately 50%). Performance Standards a) Deployment Plan - PVH EMS is provided a current Deployment Plan detailing how it will meet the established response time including peak periods and during unexpected periods of unusually high call volume. b) Response Times - Detailed maximum response times have been established with the goal to continuously improve the EMS system. c) 90% Compliance Standard and Maximum Response Times with Penalty - PVH EMS’s response time performance will be assessed monthly and a penalty may be assessed in the event PVH EMS’s does not achieve 90% compliance. Any funds generated by penalties will be utilized to improve EMS delivery May 26, 2015 Page 3 within the NLCERA. EMS Advisory Board will provide recommendations for funds to be approved and allocated by PFA. Reporting a) Performance Reports - PVH EMS will prepare monthly and quarterly reports detailing performance and contract compliance in a format approved by PFA utilizing CAD standardized times. PVH EMS will also complete an Annual Report. b) Customer Satisfaction - PVH EMS will conduct ongoing surveys to rate the patient’s experience with their pre-hospital care and to help identify areas for improvement. Survey results will be published monthly and shared with PFA. Special Operations and Event Coverage a) Special Operations & Emergency Incident - PVH EMS will support high-risk training events, stand-by emergency incident coverage, and search and rescue missions at no cost. b) Disaster Preparedness and Response - PVH EMS will be actively involved in planning for and responding to any declared disaster in the NLCERA. c) Event Coverage - PVH EMS will provide stand-by ambulance coverage and EMS personnel for City sponsored events at no cost to the City. d) Public Relations and Education - PVH EMS will partner with PFA and other participating providers to implement community programs, safety awareness and training. Financial Considerations a) Transparent Patient Fees - PVH EMS will make the patient fees available to the public by posting on the PVH EMS website. b) Notice of Changes - PVH EMS will provide PFA written notice of changes to patient fees at least 30 days in advance of the effective date. c) Billing - PVH EMS is solely responsible for all customer billing and collection. d) Penalty and Credits - Penalties may be applied monthly in the event PVH EMS’s performance is less than 90% compliance or exceeds maximum response times. PVH EMS also has the opportunity to earn credit toward reduction of the penalties for any given month for surpassing 90% compliance. e) EMS Systems Performance Position - PVH EMS will fund $70,000 annually for a position at PFA to oversee the EMS system performance. f) Dispatch Services - PVH EMS will pay the City its prorated share of expenses for dispatch services provided by Poudre Emergency Communications Center (PECC). For 2015, the anticipated reimbursement will be approximately $340,000. In 2016, PVH EMS will also fund an Emergency Services Dispatch position at an estimated cost of $64,000. g) Opticom System - PVH EMS agrees to reimburse PFA 50% of annual maintenance costs for the Opticom System in traffic signals controlling operational intersections and 50% of the cost for additional intersections if needed. h) Insurance - PVH EMS shall maintain Medical Professional Liability, General Liability, and Network Security and Privacy Liability with limits of $5 million per claim and $5 million aggregate. i) Performance Security - PVH EMS will provide an irrevocable Letter of Credit for $1,500,000 in the event of a contract breach by PVH EMS. Continuous Improvement PVH EMS will prepare an annual Performance Improvement (PI) program plan delineating specific initiatives and outcomes. PVH EMS will report status monthly on the PI program and performance to the plan. Outcome The PVH EMS contract was approved by a 4-0 affirmative vote at the May 5, 2015 Poudre Fire Authority Board Meeting. Implementation of contract has started with the development of statistical measurement instruments. May 26, 2015 Page 4 ATTACHMENTS 1. Powerpoint presentation (PDF) EMS CONTRACT OVERVIEW POUDRE FIRE AUTHORITY Council Work Session 5/26/2015 ATTACHMENT 1 Work Session Purpose • Overview of contract • Review of process • Contract highlights • Address any questions Purpose of Emergency 911 Ambulance Service Contract • To ensure high quality, timely emergency ambulance service in Northern Larimer County • To ensure a sole source for emergency ambulance service • To create a monitoring system for quality PROCESS • IGA with seven local fire departments • Formal RFP process through City Purchasing Department • Interviews with finalists PROCESS • Selection and Notification of Award • Contract Review, Negotiations and Implementation Timelines • Contract Signed: May 5, 2015 • Contract Enforce: June 1, 2015 SCOPE OF SERVICE Highlights • Background – Northern Larimer County Emergency Response Area • Performance Requirements – Deployment Plan – Response Time (90% Standard & Maximum) – Response Zones – Exemptions – Mutual Aid Highlights • Fort Collins 911 Dispatch – Contract Highlights • Service to Public Agencies, Community, Committees – Disaster Preparedness and Response – Standby, Special Event/Operations Coverage – Courtesy Standby for Public Service Personnel – Public Relations – Safety Education – Committee Participation Highlights • Equipment and Supplies – Vehicles and Equipment – Medical Equipment, Medications and Supplies – Opticom Highlights • Personnel and Clinical Standards – Command and Control (IMS) – Staffing Requirements – Training – Medical Direction – Conflict Resolution Highlights • Program Management – Data Programs and Collection Systems – Information Reporting – Quality Control and Performance Improvement – Contract Manager (.5-1 FTE) Highlights • Finance and Administration – Liquidated Damages – Incentives – Contract Coordinator – Insurance Requirements – Legal Requirements