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HomeMy WebLinkAboutMinutes Ambulance Advisory Committee - 06/14/1990AMBULANCE ADVISORY COMMITTEE MINUTES June 14, 1990 7:30 a.m., MMC Basement I. Members Present: Pauline Clarke, Chairperson Ezequiel P. Elizondo Dr. David Grav Wheeler Lipes� 0o; -L / Others Present: Dr. Richard Davis Juan J. Adame Ronald Coleman Ricardo R. Ramos R. J. Herschbach (Citizen) A2provai of the April 19, 1990 Minutes - Pauline Clarke Mrs. Pauline Clarke, Chairperson, called the meeting to order. She informed the committee that Carl Young had submitted his resigna- tion. She asked that the approval of the minutes be put off for later, allowing members who had not yet arrived an opportunity to make any corrections they may have. II. F inancia l Report - Kevin Sigler Mr. Coleman presented the Financial Report for Mr. Sigler who was absent due to illness. He reported that collections for the past six (6) months have been averaging about sixty thousand ($60,000} dollars a month. The projection for the 1990 calendar year is roughly seven hundred thousand ($700,000) dollars. The projection for the City's Fiscal Year from August 1, 1989 through July 31, 1990 is si.X hundred fifty thousand ($650,000) dollars. As reported two months ago, the increase in collections is due to the recogni- tion of our new fee rates by Medicare and the insurance companies. Other efforts that have helped collections is the insurance card which is being given to the patients or their family members while being transported in the ambulance. Memorial Hospital has also been very helpful in providing EMS a copy of their insurance report on those patients we transport. The collection office has also been following up by calling everyone to obtain the necessary data. Mr. Coleman continued, stating that the collection rate for the year .nay be up by eight (8 %) to ten (10 %) percent above last year from an average collection rate of thirty -two (32 %) to forty (40 %) percent. Mr. ITApes commented that it would be helpful if the report had a "year -to- date" column to compare monthly collection rates. Discussion followed. M r Ambulance Advisory Committee Minutes June 14, 1990 Page 2 Mr. Lipes asked if the service was accepting credit cards to which Mr. Coleman replied, "No." Mr. Lipes stated this was the coming thing:-- - - -Fa -m- -1 -y -- members-- -w -ho -- rid -e- a- long--w] L- th._.. -the ._p.a t and - are .... - emotionally involved, will pay with the credit card. Some hazards are the use of an invalid card or one which has reached the credit limit. Mr. Lipes continued, stating that at MINC they warn people with whom they dealing with that medical care is not a secondary debt and as such, it is treated as a primary debt. Mr. Coleman asked the committee for direction on how vigorous they want the billing office to pursue collects. Discussion followed. Mrs. Clarke stated the committee was on record on collections being pursued very vigorously. There is no reason to change this view point since it goes along with our public relations campaign that EMS is not a free service. Dr. Davis suggested one approach to collections may be to inform patients that partial payments can be arranged. Discussion followed. Dr. Davis stated there should also be a nay to collect from neop_e who have assets. Maybe we should have a lien on their property. At somte point the service that pro -;idea the services is more entitled to -_nose assets than the heirs. Discussion followed. Mr. Lipes asked Mr. Elizondo what is the write off procedure for the City? Mr. Elizondo stated that he didn't know of an existing procedure through which bills get written off. If there were a general system of pressure points that *mould get the bills written off, then the system would have a real problem with consistent collec- tions. Writing off bad debts is not done by elected officials or anyone like that. The highest level -hat a complaint normally reaches is his office. There are inquiries from time to time, in written form., r.rom patients through council members. A response is written explain- ing the services which were delivered and the charges due. The patient is advised that if he has any further questions to please call us. i Ambulance Advisory Committee Minutes June 14, 1990 Page 3 III. An nual Report - Ronald Coleman: _._ Mr.,...... -Coleman -- ref.. er - red ----- th -e - -c- ommi- tt- ee--- to--- th-e-- Annua -1 -- Report i-n-- - -the r_ packet which was submitted as Attachment "B" and provided the following summary: Con Education - Two EMT and one Paramedic refresher courses were conducted in 1989 with nineteen EMTs and eight Paramedics being recertified. - one forty -hour EMS Instructor Course was also taught with seven personnel completing the course. New Equipment - Seventeen (l7) additional Automatic External Defibrillators were purchased and deployed. Public Education - Sixty -one (61) presentations were conducted with two thousand three- hundred seventy (2,370) people in attendance. Community Servi - Twelve (i2) EMS stand -bys at community events; with fifty -seven thousand ei.aht- hundred (57,800) attendees. Qu ality Assuran Pro gram - A Medical Information Committee, made up of EMTs and paran'edics was established to review interesting calls and to interact with the system Medical Director. Multinle Patient Drills - Two (2) drills were conducted at Corpus Christi International Airport simulating a hazardous materials incident and a 737 airliner crash and fire with eight -four (84) victims. Maintenan - The maintenance of the EMS Division continues to be performed within the fire department. In order to decrease maintenance cost, a new ambulance design was approved with the first unit placed in service in August, 1989. 6 Ambulance Advisory Committee Minutes June 14, 1990 Page 4 1989 Highlights Th.e.. new - EMS-- r--at- e-s.-- w'ere- -a -pp- raved - -. and - -- implemented -. A -1. 1989. 2. 3. Ey 5. RN 7. An EMS mechanic was sent to Nashville, Tennessee to attend the 4th Annual Ambulance Maintenance Seminar. Three personnel were sent to Kilgore, Texas, to attend a Bois Rescue /Extrication course. Assistant Director of EMS attended the National Fire Academy EMS Management course. Director of EMS attended the National Fire Academy Fi nancial Management course. The seventh ambulance went into service on November 1, 1989 at Fire Station #14. All firefighters completed training in the use of the Automatic Defibrillators. 8. The EMS Standard Operating Procedures (SOP) were completed. Major Issues for FY 90 -91 1. The City of Corpus Christi must actively take the leadership role in establishing Mutual Aid Agreements with surrounding cities and counties. When a major incident /disaster occurs, the city does not have an adequate number of ambulances to properly handle a mass casualty incident. 2. All EMS personnel must receive 24 hours of Hazardous Material Training within the next year. 3. Fleet replacement is handled through the purchase each year of one (1) new ambulance fully equipped and one (1) remount. 4. The new 800 Public Safety Radio System will allow full coordination between police, fire and EMS units on any emergency scene. 5. Once the computer aided dispatch is fully implemented, EMS will be able to track response times accurately. 6. All dispatchers need to be trained as emergency medical dispatchers so accurate pre - arrival instructions can be given to the public while the medic unit is in route. s Ambulance Advisory Committee Minutes June 14, 1990 Page 5 7. Addressing the issues regarding efficient and effective ways of funding our EMS service which will meet the needs of our community- f- or-- f- ut- u- r- e- generati- ons--- t -o ---- come;-------- .. _. __ . _... .._...._ ..... __ .__ _...__ Mr. Lipes commented that Mutual Aid Agreements with both the Navy and Coast Guard should be obtained. During a mass casualty, the Navy and Coast Guard, working together, will be able to transport a large amount of victims. Mrs. Clarke stated that training dispatchers on providing the public with pre - arrival instructions is vital. The committee has expressed this concern over the last few years. Mr. Coleman proceeded to the next phase of his report, "EMS Com- munications Center Staffing," Attachment "C ". Mr. Coleman stated that the current cost of 911 operations to EMS and the Fire Department is one hundred ninety -six thousand six hundred ($196,600) dollars and sixty- -five thousand five hundred ($65,500) dollars, respectively, for a combined total of two hundred six--two thousand one hundred ($262,100) dollars per year. The Police Department contributes one million three hundred thousand ($1,300,000) dollars per year. Dr. Davis stated the cost distribution is supposed to be set up according to some relationship between the number of dispatches to the number of calls. It would seem we need to renegotiate our percentage. Discussion followed: Mr. Coleman continued his report outlining possible options in solving the problem of having dispatchers who are not trained in giving prearrival medical instructions. According to Mr. Coleman, there is an emergency medical dispatcher course developed by Dr. Jeff Clauson out of Salt Fake City, Utah. This course trains dispatchers to recognize medical emergencies through telephone interrogation, assign priorities to different types of emergencies, dispatch appropriate equipment, and give prearrival instructions. To bring someone down here to teach the course would cost ap- proximately six thousand five hundred ($6,500) dollars. if we wanted to lower the cost, we could invite other people from the area to enroll in the course. The fee charged them would defray most of the expense of bringing someone down here. Mr. Coleman stated that civilian paramedics could be hired for an annual salary of approximately twenty -three thousand ($23,000) dol- lars, while placing one of our own firefighter paramedics as dis- patchers mould cost $34,000 annually. Present dispatchers earn $18,000 annually. f Ambulance-: Advisory Committee Minutes June 14, 1990 Page 6 IV. General Discussion of EMS Funding - Ezequiel Elizondo ...... Eliz_ond.o__ b_e_g.an---- t.he... di. s. c. us_ s. i.. o. n_. b. y-- _st- at.ing.._h.e_._.w-o..u.ld. a few minutes to explain some of the issues that are before the committee. First of all, we no longer have the relationship with the hospital district that we have had for seventeen years. We estimate the EMS system will cost us approximately three million four hundred thousand ($2,400,000) dollars in 1990 -91. As pointed out in the financial report, we anticipate about seven hundred thousand ($700,000) dollars in revenues. This means that the citizens of Corpus Christi are subsidizing the EMS service to about the point of two million seven hundred thousand ($2,700,000) dollars. The system is basically safe, but we do have some traditional ailments such as twenty -four (24)hour staffing. Some of this rigidness is causing some inefficiency. We have a subsidy that ranges from on a high end of average to being very high, depending on which figures you use. A subsidy of about five ($5) dollars per citizens is reasonable concerning our demographics. A five ($5) dollar subsidy using Nueces County population base will give us one million five hundred thousand ($1,500,000) dollars. This will result in a one million two hundred thousand ($1,200,000) dollar gap which is identified as subsidy which we should be making a major effort to reduce. As Mr. Stout pointed out, the :ost succes=sful EMS services are the single provider or sole provider in a particular jurisdiction. our City Council has a policy decision -o make in this area. Be it the Corpus Christi Fire Department, the EMS division, or somebody else, there has to be a single provider or sole provider. There are some revenue opportunities in nonemergency transports. There are between ten thousand (10,000) and twelve thousand (12,000) nonemergency transports occurring in this community per year. If you charge between one hundred fifty ($150) and two hundred ($200) dollars for a nonemergency transport team and multiply that by the coordinates,.you would run into a revenue of about one million five hundred thousand (51,500,000) dollars. You could probably get a seventy -fine (75 %) percent collection rate. In order for the City to do nonemergency transports, new resources have to be employed.. We have a contract that we must honor with our association that says we have twenty -four (24) hour shifts. We have already started contract negotiations saying we would like to talk to the association about eight. (8) hour shifts, ten (10) hour shifts, twelve (12) hour shifts fourteen (14) hour shifts or whatever. This will allow us to improve our units utilization per hour that Mr. Stout talked about. As far as the practicality of a Ambulance Advisory Committee Minutes June 14, 1990 Page 7 a paramedic being on duty for twenty -four (24) hours and having to do emergency and transport, that's not going to work. He is _. _...__ phy. s. ically .__no_t.._.ca.p.able... ----- - The -_ con.tr-a.c- t-- limits . us as.. to who in t.h. _ ... .. _._. City of Corpus Christi can provide EMS service if it is going to be a City of Corpus Christi function. Dr. Gray asked what was in the contract. Mr. Elizondo replied that the contract is used as a tool to provide staffing for the EMS service for the City of Corpus Christi. Discussion followed. Mrs. Clarke asked if the City could separate the EMS and have it as a separate service. Chief Adame replied that it could separate into a third city service using noncertified personnel not covered by the contract. Discussion followed. Mr. Elizondo stated the association would like the City to accept EMS as a basic service. They don't want to.be held accountable if and when the service does not break even. Other issues of significance according to Mr. Elizondo are: - The City Council first has to decide whether it is willing to put the ten (10) units that are presently doing nonemer- gency transports out of business. - Do we staff crews which are doing nonemergency transfers with uniform personnel at an average yearly salary of thirty -four thousand ($34,000) dollars, or do we use civilian personnel at a cost of twenty -two thousand ($22,000) dollars? - Other services are able to operate with lower subsidies or no subsidies at all. To the degree that we can, we need to move toward this goal. - We need to strive for the nationally- - recognized response time standard for paramedic service of eight (8) minutes ninety (90 %) percent reliability. This is the equivalent to an average response time of four and one half (4 -1/2) minutes. e Ambulance Advisory Committee Minutes June 14,1990 Page 8 Mr. Elizondo stated staff's recommendation to City Council will be for the City to be the sole provider. He also believes the subsidy can be reduced _to. --- a... level -.-. s _.o.me- where ..._..be.twe..en, a.._.fz.ve_.......($5.). and-seven ..... ..._ _._.... ($7) dollar range. Dr. Gray asked if an ambulance authority was going to be con- sidered. Mr. Elizondo replied that if EMS would continue to be managed by the City there probably would not be an ambulance authority. Dr. Gray asked if Dr. Davis and any of the physicians that man the base stations that provide on going medical control had formal input into the City budget committee. Dr. Davis replied he had met with the City Manager. As to other physicians providing input, Mr. Elizondo stated he would rely on the Medical Director. Dr. Davis continued, stating that one of the difficulties that one faces in saying that the service is going to move into private or third city service, is that one tends to assume that the expense is going to be removed. We are not going to reduce our overhead out of the Fire Department by the total amount that we budget EMS. Some personnel expenses will still remain; therefore, the Fire Department budget will have to increase since they will continue to provide first response service. Discussion followed. Referring on the need for a Medical Authority, Dr. Gray descr an incident that occurred where a patient was worked on by one of the EMS ambulance crews, put on a helicopter and flown across toTpjn to the trauma center. Landing at the helipad, the helicopter waited there with the patient in full arrest because: they hadn't bothered to call medical control until they were on the ground. According to Dr. Gray, the ambulance that they were waiting for was the same ambulance that had worked on the patient at the scene originally. The ambulance had to race across town, put the same patient back in the ambulance and then, instead of taking him three hundred (300) yards to the Trauma Center, they took him across town_ to another emergency room. Dr. Gray asked who is the authority to say you have to get the helipad, which is three (300) yards away from the trauma center, moved to where you don't have to rely on an ambulance to carry the patient into the emergency room. i Ambulance Advisory Committee Minutes June 14, 1990 Page 9 Dr. Davis stated that particular incident was under investigation between him and Mr. Coleman before it was over. The personnel involved. at the scene._ did._ not.. make_- .the ..right de.cision....Most o.f- the ... other things that Dr. Gray has identified are problems between Dr. Gray and Memorial Medical Center administration. Dr. Gray stated this was not a problem with the hospital district. It is a problem with the EMS system that we have which can't hold anybody accountable. Discussion followed. Dr. Gray stated one of the problems is physicians like himself and his colleagues who man the radio is that they have no input. Discussion followed. Dr. Gray described another incident where Halo Flight landed its helicopter on the street to deliver a patient to Spohn Hospital. He asked who is in authority to tell them they are out of bounds landing a helicopter in the street. Discussion followed. Dr. Davis commented that the Police Department had already spoken to Halo Flight about landing on the street. Discussion followed. Ir. Elizondo informed the coTT_mittee that Mr. Page, an EMS consul- tant, has been invited to view our system very ,similar to what Mr. Stout did in his visit. He also added that the City Council T, be discussing the EIS budget on June 25, 1990. Dr. Gray, returning to the Halo Flight discussion, stated he was very concerned over giving orders to the helicopter with no control over what they are doing, where they are going and no real recourse to find out what is happening. He asked if the committee is not the right forum to discuss this issue. Mrs. Clarke responded that the committee was not the right forum since it does not control or have any say so over Halo Flight. Mr. Elizondo stated that more control was probably needed over Halo Flight. When we request Halo, we are going to have to be much more explicit. They will come at our request and will have to follow our instructions. Discussion followed. I' Ya f_v i ! Ambulance Advisory Committee Minutes June 14, 1990 Page 10 Dr. Davis stated that if Dr. Gray is having significant problems as an on line physician with the helicopter paramedics in terms of following orders and their judgements, - then ..he.- . {Dr_. Davis) -. be made aware of it. But more directly, Dr. Gray should contact Halo Flight Medical Director and inform him that his staff are not following instructions and are not making good judgement calls. V. Unfinished Business None. VI. New Business Mr. R. J. Herschbach, 4650 Hackberry of Corpus Christi, requested to address the committee. He spoke against privatization of the EMS service, describing problems with private companies prior to 1973. He also complained about the present EMS system and related several personal experiences where the ambulance in route became lost and /or refused to transport a nonemergency patient. Mr. Elizondo informed the committee that he would be meeting with Judge Barnes to discuss the contract with the county, If the county accepts becoming a funding partner, then they will assume the responsibility of making the committee appointments previously made by the hospital district. If the county chooses not to participate, then it will be up to the City to make the appoint- ments. Mrs. Clarke stated that if the committee is going to be reor- ganized, she hopes the City will look at the suggestions submitted a couple of years ago when the City Council sent out is question- naire. Mr. Elizondo stated that over the years considerable frustration has been expressed by members at meetings in regards to the city not listening to them or not having an impact on the Council. But in reflecting back, the EMS service has come a long way. Some things that have taken place during that time are the placement of a civilian director, enhanced training, equipment replacement schedules, mechanic put in place, defibrillator project, placement of the seventh ambulance, the awareness that is being created, and the collection service that is presently being looked over. Discussion followed. The next meeting will be scheduled at a later date. Ambulance Advisory Committee Minutes June 14, 1990 Page 11 The meeting adjourned at 9:30 a.m. Respectfully submitted, Ricardo R. Ramos Administrative Assistant V Mrs. Pauline Clarke Chairperson Approved: (Date)