12/05/2011 - Special Work SessionSPECIAL WORK SESSION AGENDA Council Chambers -City Hall 12/5/2011 -9:30 AM 1. Call to Order 2. Council Discussion Items 2.1 Fire EMS Presentation -Robert Weiss, Fire Chief Attachments
2.2 Financial Perspective on EMS -Jay Ravins, Finance Director Attachments 2.3 Pinellas County EMS -Maureen Freaney, Pinellas County Health and Human Services Director Attachments 2.4
Provide Staff Direction Attachments 3. Adjourn
Special Work Session Council Chambers -City Hall Meeting Date:12/5/2011 SUBJECT /RECOMMENDATION: Fire EMS Presentation -Robert Weiss, Fire Chief SUMMARY: Review Approval: 1) Clerk Cover
Memo Item # 1
Special Work Session Council Chambers -City Hall Meeting Date:12/5/2011 SUBJECT /RECOMMENDATION: Financial Perspective on EMS -Jay Ravins, Finance Director SUMMARY: Review Approval:
1) Clerk Cover Memo
Financial Perspective City of Clearwater Finance December 5, 2011
Fire and EMS Reconfiguration Committee – September to December 2008 with all interested parties actively involved. Committee reviewed various options for Fire Transport Early option
rejected was flat fee reimbursement model similar to Sanford Millican model
“Hybrid” cooperative model reviewed and rejected despite estimated $7 million in annual savings “Full” Fire emergency transport model preferred Resulted in $10.4 million swing to ($3.4)
million loss versus Hybrid $7 million gain
“Full” Fire transport model subsequently modified to improve from ($3.4) million loss to $1.25 million gain Consensus -Fire transport not justified financially – minimal potential savings
relative to risks of Fire Transport system Committee disbanded
Fire staffing should be based on fire suppression requirements Medical first response and emergency transport with existing fire suppression personnel and vehicles saves $$$ Adding Fire
personnel and vehicles, versus ambulance provider medical first response and transport, costs $$$
Ambulance provider less expensive for incremental medical first response and emergency transport Efficient to use existing fire suppression personnel for medical first response and emergency
transport
Support IPS study “3.6 multiplier” option with two recommended modifications: • High volume “two unit” stations should be reimbursed for an additional position • Reimburse for accelerated
vehicle replacement due to medical first response usage
IPS Model – supports reimbursement of marginal costs for use of existing Fire suppression resources Sanford Millican – increased costs of additional Firefighter personnel and vehicles
vs. ambulance provider Optimal Model – minimum Fire suppression used for medical first response & transport – hybrid model
Financial Perspective City of Clearwater Finance December 5, 2011
Special Work Session Council Chambers -City Hall Meeting Date:12/5/2011 SUBJECT /RECOMMENDATION: Pinellas County EMS -Maureen Freaney, Pinellas County Health and Human Services Director
SUMMARY: Review Approval: 1) Clerk Cover Memo Item # 3
Clearwater City Commission EMS Outreach Update December 5, 2011 1 Item # 3
Analysis Flow • Preliminary Report to BCC on May 3, 2011 • Integral Performance Solution (IPS) Reviewed all Aspects of the Pinellas County EMS System 2 • IPS Thoroughly Analyzed Fire
Transport • Primary Recommendation: Marginal Engine Funding at Standardized Rate Rationale: Fairness Across Jurisdictions and Cost Containment while protecting the level of service.
Item # 3
Outreach Tour • Listen 3 • Fact Finding • Open to Other Ideas Item # 3
County Primary Principles • Protect the Level of Service 4 • Seek Fairness and Equity in Funding • Implement Cost Control Measures Item # 3
EMS Community Outreach • Community Outreach Meetings 1) Cities 2) Fire Districts 5 3) Community Groups 4) Firefighter Union 5) Other Stakeholders Item # 3
Key Feedback Received • Misc technical and system clarification ?s • Discontinue running so many units to minor incidents • Desire to maintain level of service, particularly to critical
incidents 6 • Support for the principle of Priority Dispatch •Not overly concerned with who responds – just somebody (Primarily Community Groups) • Confusion regarding “7½ min 90% of
the time” standard vs. the 4½ min avg response •Desire for more clarity on system support costs Item # 3
Key Feedback Received (cont.) •Other cost reductions to the system – Aprox. $16M of cost reductions and revenue enhancements during FY 09/10 and FY 10/11 • Clarification on Fire Service
impact analysis methodology 7 • Why not just increase the EMS Millage? • Problem is the huge loss of property tax revenue. • EMS system is not broken Item # 3
Key Feedback Received (cont.) • Have we looked at implementing the plan over a longer period? • The countywide EMS system is not a gold/platinum system but average cost compared to national
standards. The system is seamless and functionally 8 consolidated. • Profit level of Private Ambulance Company (9% cap) • Sentiment that having a standardized salary & benefit rate made
sense. • Clarification on System Design • Isn’t it cheaper to run a Rescue (Box) vs. a Fire Engine? Item # 3
Advanced Life Support Engines – Win/Win • Paramedics on Fire Apparatus for First Response is a good investment • Fire Station, Fire Engine and Firefighters in place and necessary • Decreased
number of Fires allows for First Response assignments • County providing Firefighter/Paramedic funding augments Fire Staffing • Cities providing integrated service is cost effective
9 Item # 3
2010 Fire & EMS Responses 21048, 13% 753, 1% EMS Fire 10 138703, 86% Working Fire Item # 3
Background -ALS Engine 11 -Most effective and integrated means of providing ALS First Responder and Fire Protection Services – A Win/Win Approach -EMS Funded Paramedic Position (Blue)
helps reduce costs of meeting the staffing requirements of the Fire Engine. City or Fire District would otherwise incur the full cost of minimum staffing. -Fire Funded Positions (Red)
assist the Paramedic on scene. Item # 3
Background -ALS Ambulance 12 -This is the most effective means of providing Ambulance Services -EMS Funded Paramedic/EMT Positions (Green) are funded solely through Ambulance User Fees.
Private employees are utilized to contain costs. Item # 3
Fire Transport Proposals • 10/3 (District Chief Koda) Proposal 13 • Sanford/Millican Proposal Item # 3
History • 1987 – County asked the Cities if they wanted to provide Transport Outcome: Cities did not elect to participate • 1987 – Competitive RFP Process Outcome: County consolidated
7 private providers to one Countywide Service • 1999 -County Fire Transport Feasibility Study Outcome: 1) Clearwater, Largo, St. Petersburg and County joint study prior to bid 2) Clearwater
and St. Petersburg did not participate 14 Item # 3
History • 1999 -Competitive RFP Process Outcome: Largo and Paramedics Plus joint bid-highest cost • 2004 -Competitive RFP Process Outcome: 1) Bid specifications encouraged Cities participation
including integrated First Responder and Ambulance Services 2) No bid received from Cities • 2009 – Hybrid Proposal Outcome: 1) Analysis by City Managers, EMS Resource Group and County
staff 2) Proposal deemed not feasible 15 Item # 3
Integral Performance Solutions (IPS) EMS Study • Consultant looked at ALL aspects of the EMS System • Consultant assessed feasibility of Fire Transport 1) Determined it would cost $12
Million more for Emergency Transport 2) Plus $7.7 Million for Non-Emergency Transport 3) Plus $6.7 Million Ambulance Program Support Costs 4) Determined costs would exceed Ambulance
Revenue 16 Item # 3
IPS Analysis of the 10/3 Model and Sanford/Millican Proposal • IPS analyzed both proposals as an independent consultant • Determined they are not financially or operationally feasible
17 Item # 3
County Review of the Proposals • County Staff consisted of: 1) Assistant County Administrator 2) Director of Public Safety Services 3) EMS Division Manager 4) EMS Finance Manager (CPA)
5) Fire Division Manager 6) 9-1-1 Computer Support Manager 7) Management & Budget Senior Analyst 18 Item # 3
Commonalities of County’s Plan and the Proposal • All Proposals are Dual Response 1) 1st Responder to Arrive First and Stabilize Patient 2) Transport Unit to Arrive Second if Transport
is Necessary • All Proposals support ALS Engines for Medical First Response • All Proposals reduce and equalize the cost of ALS First Responder Services across the 18 Cities and Fire
Districts • All Proposals Support Priority Dispatch • All Proposals support existing consolidated and centralized services 911/Dispatch, Radio System, Medical Control, Ambulance Billing,
Continuing Medical Education, Protocols, Standardized Equipment and Medication, Critical Care Transport; All Children’s Transport Team partnership. 19 Item # 3
Two Prime Concerns • Cost • Logistics 20 Item # 3
Cost Analysis – EMS MFR & Ambulance Transport Current EMS FY 10-11 Adopted Budget IPS Marginal Engine Funding (Paid Position Option) Union (Sanford/Millican) Proposal 10/3 Proposal 1
2 3 4 Medical First Responder (MFR) Program Medical First Responder Costs Per Proposal $43,984,410 $32,984,917 $30,243,550 $19,911,000 Uncosted MFR $0 $0 $4,320,000 $10,233,000 Total
First Responder Costs $43,984,410 $32,984,917 $34,563,550 $30,144,000 21 Ambulance Program Ambulance Costs Per Proposal $41,556,949 $41,556,949 $49,620,392 $58,130,000 Uncosted Ambulance
$0 $0 $15,201,761 $21,874,656 Total Ambulance Costs $41,556,949 $41,556,949 $64,822,153 $80,004,656 Total EMS System Cost $85,541,359 $74,541,866 $99,385,703 $110,148,656 Item # 3
Cost • Salary/Benefits/Pension Costs of Government Employees 1) Sunstar Paramedic = $58,000 2) Countywide Average Firefighter/Paramedic = $98,209 3) St. Petersburg Firefighter/Paramedic
= $134,000 4) $40,000 to $76,000 per Paramedic in New Costs is not financially possible Average Salary & Benefit Comparison 22 Salary, $46,400 Salary, $63,280 Salary, $71,494 Benefits,
$11,600 Benefits, $34,929Benefits, $62,506 $0 $20,000 $40,000 $60,000 $80,000 $100,000 $120,000 $140,000 $160,000 Sunstar $58,000 Countywide $98,209 St. Petersburg $134,000 Item # 3
Logistics Concerns • No Deployment Analysis Completed • 18 Provider agencies would fragment the Countywide Consolidated Ambulance Service • No Accountability for Countywide Performance
• Performance Standards not identified or guaranteed • Proposers do not represent nor speak for the Cities • Unclear how multiple agencies would provide centralized management, oversight
and administration • Fails to address licensure issues which could impact Medicare and Medicaid compliance 23 Item # 3
Other Considerations • If a City or multiple Cities do not participate the Plan would be unworkable. • Are Cities willing to give up control of City Fire/EMS equipment being redirected
on a regular basis to cover other communities? • Would Cities take on new responsibility and liability including new employees? 24 Item # 3
Key Features Necessary for successful Fire Based Transport In Pinellas County • A Single Responsible Entity and Management Structure • Significant Reduction in Labor Costs 25 • A Fully
developed dynamic Deployment Plan • A Fully costed Proposal The Cities have always been able to submit a bid – They have chosen not to. Item # 3
Total Transports by Organization Type Total Transports by Organization Type Organization Type Total Transports Percent of Total Community, Non-Profit 45,286 2.15% Fire Department 875,975
41.58% Governmental, Non-Fire 398,392 18.91% Hospital 86,665 4.11% Private, Non-Hospital 699,148 33.18% 26 Source: Florida Department of Health 2010 Florida Emergency Medical Providers
Report Tribal 1,355 0.06% Total 2,106,821 100.00% Not aware of any Fire Transport System in Florida that produces a positive cash flow and is not property tax subsidized. Item # 3
Sanford/Millican Forecast – Ambulance Service 80.0 90.0 100.0 (millions) Sanford /Millican Proposal Forecast Ambulance Revenue & Expense 27 30.0 40.0 50.0 60.0 70.0 2013 2014 2015 2016
2017 2018 2019 2020 2021 Dollars milli REVENUES EXPENDITURES * Forecast assumes no adverse impact to Ambulance User Fee revenue associated with transitioning to Fire-Based Item # 3
Current County Ambulance Service • Only Aspect of System that’s Already Consolidated into one Provider • Pinellas County’s Ambulance Service is working well 1) Financially 2) Operationally
3) Quality of Care 4) Accredited Services (Ambulance, Critical Care, Comm) • Patient satisfaction scores are very high (96%) • Dynamically Deployed • Paramedics & EMTs – Reasonable Salary
& Benefits • Performance Based Contract 1) Response Time Compliance (Per Minute Fines) 2) Billable Run Reports (No Payment to Provider if not Completed Properly) Note: If Performance
Standards are not met they don’t get pai2d8 . Item # 3
Current County Ambulance Service • Cap on Profit Level: Loss of $5.7M in first 3 years (2004-2006); $1.3M average profit over last 4 years (2007-2010) •Overall system coordination, quality
of patient care, service levels, response times are excellent. 29 • Over the last 3 years $9.5 Million in Ambulance Revenue has been used to directly support the ALS First Responder
Program. • In addition, $9 Million has been used from EMS Reserves over the last 3 years (75% from user fees) Item # 3
Conclusions • Continue to Function as a Dual Response System (All Proposals Agree) • Operationalize the full utilization of Advanced Life Support Engines for Medical First Response (All
Proposals Agree) • Fully Implement Priority Medical Dispatch. This reduces multi-unit response. (All Proposals Agree) • Continue to Competitively Bid & Contract for Ambulance Service.
(Cities have always had the ability to Bid as a single unified Service Provider) 30 Item # 3
Additional Updates • November 28th County Commission Work Session • November 30th Legislative Delegation Meeting • December 6th County Commission Meeting • Notice to Advertise -Change
in Definition of Prudent Net Worth (25%) • Resolution -Establishing EMS Districts as taxing units • Notice to Advertise – Ordinance to establish processes for handling calls received
by 911 Center •December 20th County Commission Meeting • Ambulance Service Agreement • Ordinance Hearing – processes for handling calls received by the 911 Center • Ordinance Hearing
-Change in Definition of Prudent Net Worth (25%) 31 Item # 3
32 Questions? Item # 3
Special Work Session Council Chambers -City Hall Meeting Date:12/5/2011 SUBJECT /RECOMMENDATION: Provide Staff Direction SUMMARY: Review Approval: 1) Clerk Cover Memo Item # 4
Meeting Date:
12/5/2011
Special Work Session
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Fire EMS Presentation - Robert Weiss, Fire Chief
SUMMARY:
Review Approval:1) Clerk
Cover Memo
Item # 1
Meeting Date:
12/5/2011
Special Work Session
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Financial Perspective on EMS - Jay Ravins, Finance Director
SUMMARY:
Review Approval:1) Clerk
Cover Memo
Meeting Date:
12/5/2011
Special Work Session
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Pinellas County EMS - Maureen Freaney, Pinellas County Health and Human Services Director
SUMMARY:
Review Approval:1) Clerk
Cover Memo
Item # 3
Meeting Date:
12/5/2011
Special Work Session
Council Chambers - City Hall
SUBJECT / RECOMMENDATION:
Provide Staff Direction
SUMMARY:
Review Approval:1) Clerk
Cover Memo
Item # 4