Loading...
HomeMy WebLinkAbout16 - NB-5 - Ambulance Transportation for the City - 1/19/2016CITY COUNCIL AGENDA REPORT MEETING DATE: JANUARY 19, 2016 ITEM NUMBER: NB -5 SUBJECT: AMBULANCE TRANSPORTATION FOR THE CITY OF COSTA MESA DATE: JANUARY 7, 2016 FROM: THOMAS R. HATCH, CHIEF EXECUTIVE OFFICER DANIEL A. STEFANO, FIRE CHIEF PRESENTATION BY: DANIEL A. STEFANO, FIRE CHIEF FOR FURTHER INFORMATION CONTACT: JASON PYLE, DIVISION CHIEF (714) 754-5106 RECOMMENDED ACTION: The Fire Chief and Chief Executive Officer recommend that the City Council approve the following recommendation, in accordance with the second phase of the Fire Department Reorganization Plan, and as it pertains to a policy decision involving patient transportation via ambulance vehicles. 1. Review and approve the recommended option of the public/private partnership ambulance transportation model (e.g., consultant report option #3; City of Costa Mesa providing Advanced Life Support (ALS) emergency transportation and a private ambulance provider providing Basic Life Support (BLS) emergency transportation and backup support for patient transportation). BACKGROUND: The delivery of fire, emergency medical, and community risk reduction services is a core component of maintaining the life, property, and environmental safety needs of the community and consistently rates high in terms of importance to the residents, businesses, and community of Costa Mesa. The Costa Mesa City Council has recognized this and has consistently invested in maintaining a well-equipped and highly -trained Fire and Rescue Department. As a result, the cost of these services is 17.69% of the City's adopted FY 2015-16 general fund budget. Further, with emergency medical services/rescue related calls now accounting for approximately 70% of the Fire and Rescue Department's calls for service and in light of ongoing fiscal challenges facing public agencies throughout the nation, the direction for a more effective and efficient public safety model was brought forward. In May 2013, the City Council unanimously approved the CEO's recommendations for the reorganization of the Fire Department, inclusive of the "Alternative Model" Restructuring Plan. A key part of the CEO's alternative plan was that it be implemented in a two-phase approach as it related to ambulance transportation, along with a comprehensive list of 17 recommendations related to various operational and administrative components of the fire department. For example, the new deployment model has also required building modifications to Fire Station 4; alterations to apparatus; selecting, procuring, and placing six rescue ambulances into service; and significant (initial and on-going) training for personnel including dispatchers. The two-phase approach has allowed the first phase of implementation to be very strategic and methodical, thus providing valued time to thoughtfully execute and evaluate the various dynamics of the plan, each step of the way. While there is no question that our highly trained and professional staff have the ability to quickly adapt to change, because the change in this new deployment is arguably the most significant change in the history of the organization, additional time to transition has absolutely benefitted this process. As a simple overview, the first phase has been focused on preparing the new deployment infrastructure, personnel training, and operational changes. In perspective, it has focused on transitioning our fire apparatus resources to include rescue ambulances, thus creating a more efficient model with ultimately providing more resources to be available for emergency response. Due to the magnitude of the change, the two-phase approach has been a cornerstone to the successes and evolution of the plan so far. In July of this past year, the second phase of the Reorganization Plan was initiated and the services of a consultant were retained to complete an analysis related to identifying options for ground ambulance transportation and the utilization of the City's rescue ambulances (e.g., patient transport options, pros/cons, financial implications, etc.). Ultimately, the analysis was intended to bring forth the most viable options with the related financial analysis for City Council consideration, through a final recommendation from the Fire Chief and CEO. Included in this analysis, the benefits of Ground Emergency Medical Transport (GEMT) reimbursements to fire -based transportation providers was also addressed. At this point, with approximately 90% of the Fire Department Reorganization Plan now addressed, and before moving forward, a policy decision on patient transportation via ambulance vehicles is necessary. Immediately following the City Council policy decision, a Request For Proposals (RFP) process seeking bids for private providers to conduct ambulance billing services for the City will be developed and released to coincide with a separate RFP process seeking bids for private ambulance providers to transport patients, consistent with the final policy direction. Pursuant to California Health & Safety Code Section 1797.201, because the City of Costa Mesa has provided and/or contracted for emergency ambulance services continuously at least since June 1, 1980, the City has retained all rights, remedies, and privileges regarding the provision, administration, and operational control of all prehospital Emergency Medical Services (EMS) within its jurisdiction (e.g., local control), including, but not limited to, emergency ambulance response and patient transport services. In accordance with its Section 1797.201 powers, on November 20, 2007, the City initiated a competitive process by issuing a "Request for Proposals," coordinated by the Fire Department, in which qualified ambulance companies were reviewed, analyzed, and compared. The Fire Department chose to use the competitive process consistent with the format outlined in California Emergency Medical Services Authority Publication #141 due to its efficiency, rather than developing a new format. On July 1, 2008, the City Council accepted the proposal submitted by Care Ambulance Service, Inc., and authorized the Fire Department to negotiate an agreement for the provision of emergency ambulance and patient billing services. The City and Care Ambulance Services entered into an agreement effective on September 1, 2008, at 7:30 a.m., for a period of two years. The Ambulance Services Agreement allows for extensions of the term providing that the total length of time, including the initial two-year term beginning in 2008, is no more than ten years. Following the initial agreement period, the City and Care Ambulance Services entered into subsequent agreements that have most recently been extended until June 30, 2016 (e.g., Amendment Number Four; Attachment 8). In FA accordance with the terms and requirements of the original Ambulance Services Agreement, the City of Costa Mesa will need to pursue a new competitive process for ambulance and billing services to be implemented prior to September 1, 2018. ANALYSIS: The CMFD Ambulance Service Feasibility Study is (Attachment 1) was conducted by AP Triton, LLC consultants. It provides an objective review of the four deployment options for patient transport via ambulance vehicles. The consultant's report was first introduced at the December 1, 2015 City Council meeting and made available for City Council and public review immediately thereafter. Prior to and following the receipt and review of this report, City staff conducted research and met with a range of stakeholders, including, but not limited to: members of the Costa Mesa Pension Oversight and Financial Advisory Committees; Dr. Samuel J. Stratton — Orange County EMS Agency Medical Director, members of the CARE Ambulance management team; members of the Orange County Fire Chiefs; members of the Costa Mesa Firefighters Association Board of Directors; and community members. The four models identified represent the most viable options available within the current Orange County EMS system. Inclusive of any of these models is the approval of the established OCHCA EMS Ground Ambulance Rates. Included in the consultant's report is an assessment of the pros and cons and a financial analysis of each. While there are a number of variations of each of the four transportation models identified, it is clear that the core elements of these models represent the fundamental application, deployment, and operational consistency options for immediate implementation. As such, the four ambulance transportation models are identified below as follows, inclusive of the pros and cons and the financial overview (e.g., cost recovery) of each: • Model #1— Current Model *Continuation of the existing deployment strategy of sending afire department apparatus (e.g., an engine or truck) and a rescue ambulance along with a private ambulance to be the transportation component of all Emergency Medical Services calls for service (e.g., ALS & BLS). Pros • Requires no changes in current deployment • Reduced financial risk to the city • Potential surge capacity from provider • Fixed rate of reimbursement for ALS services provided Cons • Less control of the system • Potential increased costs to taxpayer Total (Annual) Realized Cost Recovery $645,372 3 • Model #2 — Costa Mesa Assumes All Ambulance Transportation; Private Ambulance Company Utilized as Back -Up Only * Fire department assumes 100% of ambulance transportation for all emergency ambulance services in the City. Pros • Requires limited changes in current deployment • Provides maximum local control • Consistent with the redeployment plan • Provides flexibility/cost recovery Cons • May require a contract for surge • An increase in workload • Will require additional time to completely implement Total (Annual) Proiected CostRecovery $4,095,456 *$3,895,456 — additional overhead related costs estimated at $200, 000 **$3,250,084 — total new cost recovery/net revenue • Model #3 — Public / Private Partnership * Fire department engages in a partnership with a private contractor and provides ALS ambulance transportation while the private contractor provides BLS transportation and back up support service for ALS transportation. Pros • Requires limited changes in current deployment • Provides increased level of service • Consistent with the redeployment plan • Provides for increased cost recovery • Provides the highest level of flexibility and opportunities to concurrently explore in an evolving local, regional and statewide EMS landscape Cons Could impact the current contractor Could create a two tier billing system Total (Annual) Realized Cost Recovery $2,504,725* *$2,304,725 — additional overhead related costs estimated at $200, 000 **$1,659,353 — total new net cost recovery/revenue 4 • Model #4 — Hybrid Model / AO Program *Fire department assumes 100% of all emergency ambulance transportation services using a new class of employees to staff Rescue Ambulances. Pros • Requires limited changes in current deployment • Provides increased level of service • Consistent with the redeployment plan • Provides for increased cost recovery • Provides the highest level of flexibility and opportunities to concurrently explore in an evolving local, regional and statewide EMS landscape Cons Could impact the current contractor Could create a two tier billing system Total (Annual) Realized Cost Recovery $2,461,836* *$2,261,836 — additional overhead related costs estimated at $200, 000) **$1,616,464 — total new net cost recovery/revenue ALTERNATIVES CONSIDERED: The City Council could decide to direct staff to reevaluate the previously approved deployment model. FISCAL REVIEW: It is understood that the consultant's cost recovery projections could vary within a reasonable margin above/below the projections identified. Additionally, the consultant's cost recovery projections are in line with similar municipal agencies that currently provide some or all of the ambulance transportation services within their jurisdiction (Attachment 7). To that end, the city's Finance Department has reviewed this report and confirms that the cost recovery projections appear reasonable and attainable. LEGAL REVIEW: The City Attorney's office has reviewed the 201 rights issue with respect to the provision of ambulance services and has been assisting the Fire Department in asserting and maintaining these rights. The City Attorney's office has also reviewed the current Ambulance Service Agreement and prepared the existing extensions thereof. 5 CONCLUSION: Based on the information and data provided in the CMFD Ambulance Service Feasibility Study and subsequent analysis, the Fire Chief and Chief Executive Officer recommend approving the public/private partnership ambulance transportation model (consultant report option #3; City of Costa Mesa providing ALS emergency transportation and a private ambulance provider providing BLS transportation and back-up support for ALS transportation). This recommendation is grounded in the effort to provide the most effective and efficient service to the community, while maintaining the highest quality of patient care, enhancing the City's cost recovery revenue, and providing the most flexible ambulance transportation model to adapt to an evolving EMS landscape. In addition, to ensure that the City is meeting or exceeding cost recovery expectations, an initial six month evaluation to review the cost recovery projections would be initiated, followed by another six month evaluation and then subsequent regular quarterly evaluations. DANIEL A. STEFANO THOMAS R. HATCH Fire Chief Chief Executive Officer STEPHEN DUNIVENT Interim Finance Director THOMAS DUARTE City Attorney Attachments: 1) Consultant Ambulance Study Report 2) Fire Department Reorganization Report 3) City of Costa Mesa Paramedic/Ambulance Billing (2012-2015) 4) OCHCA EMS Maximum Ground Ambulance Rates 5) Los Angeles County Survey on California Ambulance Transportation Rates 6) Orange County Ambulance Transportation Cost Recovery/Rate Comparatives 7) Orange County Fire Department Ambulance Transport Service Comparatives 8) Copy of the Ambulance Transportation Agreement with Care Ambulance 9) Copy of the ALS Cost Recovery Agenda Report and Resolution 10) Memorandum Regarding Private Paramedic Cost and Review 2015 CMFD Ambulance Service Feasibility Study - -y iFinMEF -ARE a xesr J 14 qw X83 Feasibility Study AP Triton LLC© 11/30/2015 CMFD Ambulance Service Feasibility Study November 30, 2015 Daniel Stefano Fire Chief City of Costa Mesa Fire Department Dear Chief Stefano, On behalf of A.P. Triton LLC° please accept this review of options for delivery of Emergency Medical Transport Services for the City of Costa Mesa. The future of healthcare in California, as well as the entire country, is on the verge of change. While many have chosen to look the other way the City of Costa Mesa has taken on the task of exploring options for the future. For this we commend you and your city's leadership. While there is no single pathway to the best method for the delivery of ambulance services within the City, there are options that provide better benefits than others. We believe the document presented provides a fair and unbiased assessment of the available solutions to the reorganization plan adopted by the City. We encourage both you and the City Council to not only look at the bottom line, but strongly consider the options that best serve patient care, system stability, flexibility for change and most importantly, local control. We will remain available to address questions comments or concerns brought on by this study and are prepared to assist in future presentations to your elected officials as needed. Sincerely, Kurt P. Henke Managing Partner A.P. Triton LLC° 1IPage A.P. Triton LLC° CMFD Ambulance Service Feasibility Study Section 1: Executive Summary The Costa Mesa Fire Department has undergone an extensive reorganization of their operational deployment model in order to maximize the efficiency of their organization. On May 7, 2013 the Costa Mesa Fire Department presented to the City Council a recommendation for reorganization. The City Council approved the "Alternative Model" of the restructuring. (See attachment 1- City Council Agenda Report). The current practice is the response of an engine company, a fire based ambulance and a private ambulance provider to all EMS incidents. This type of response to medical emergencies is atypical when compared to best practices throughout the United States. Simply stated, this deployment model is not the most efficient for an urban city, operationally or financially. The reorganization plan included the purchase of ambulances and the redeployment of personnel from engine companies to ambulances. As a result, there is no new personnel cost to the implementation of this new ambulance delivery model. The City of Costa Mesa is an H&S Code 1797.201 provider and therefore retains the obligation to provide ambulance services unless it is transferred to Orange County. Along with the obligation to provide the services, the City also retains administrative control of these services. The purpose of this study is to evaluate the various options available for the efficient delivery of ambulance services for Costa Mesa. The objective is to determine the key factors fire department staff feels are important in selecting a delivery model and recommend the model which most closely meets these goals. Those goals encompass: enhancing the delivery of patient care, improving cost recovery, promoting efficiency in the system, and the ability to be flexible and proactive in making changes in the EMS delivery model as both health care and EMS evolve into the future. The Fire Department has already begun the transition to providing a more efficient system, with implementation of fire based ambulances. What has been lagging is a City policy on how those units should be utilized, and to what level cost recovery for those services will be implemented. It is the 21 Page I A, P. Triton LLCM CMFD Ambulance Service Feasibility Study opinion of this consultant that the response of multiple ambulances to the same incident is not in the best interest of the community, nor is it the most efficient use of resources. A well -coordinated plan for the community's resources starts at the commencement of the call for service and is complete not when the patient is delivered to the emergency department, but when patient outcome is relayed back to the providers, so that training and system modifications can be implemented to achieve better patient outcomes. The more streamlined this process is, the more likely positive patient outcomes will improve. In order to facilitate changes that may create increased positive patient outcomes, there must be the ability to push money into the delivery model to cover equipment and personnel improvements. EMS systems, particularly the transport component of the system, allow for cost recovery through billing and collection. A sound, well thought out cost recovery program must not only be considered but also implemented. The City of Costa Mesa has the ability and obligation to create a billing and collection policy for the utilization of their ambulances that will generate a cost recovery program which includes no out of pocket costs to the residents they serve. As the City moves forward in considering the possible deployment models that best suit their needs, they must also consider what they feel is the primary objective for providing not only ambulance but EMS services in general. Is the objective simply to transport the sick and injured to the hospital, or is it to provide an EMS system that increases the quality of life for those who live, work and visit the City of Costa Mesa? The city needs to determine not what the EMS system will look like in the short term, but how the City will address and embrace changes in the health care system in the next decade and beyond. 31 Page A. P. Triton LLCM CMFD Ambulance Service Feasibility Study This report will present four deployment models for consideration by the City of Costa Mesa 1. Continuation of the existing deployment strategy of sending a fire department engine and rescue ambulance along with a private ambulance to all EMS calls 2. Fire department assumes 100% of all emergency ambulance services in the City 3. Fire department engages in a partnership with a private contractor to provide Advance Life Support (ALS) transport while the private contractor provides Basic Life Support (BLS) transport 4. Fire department assumes 100% of all emergency ambulance services using a new class of employees to staff Rescue Ambulances. Model # Model #1 Model #2 Model #3 Model #4 Deployment Current Model CMFD CMFD 24 New Type Service Assumes All Handles Employees to Description Ambulance ALS/Private Provide Service Handles BLS Ambulance Service Net Cost $645,372 $4,297,848 $2,623,395 $4,297,848 Recover 711ing Cost None $202,392 $118,670 $202,392 New None None None $1,633,620 Employee Cost Total $645,372 $4,095,456 2,504,725 $2,461,836 Realized Cost Recovery 41 Page A. P. Triton LLCM CMFD Ambulance Service Feasibility Study Section 2: City of Costa Mesa Fire Department Formal Feasibility Study The City of Costa Mesa Fire Department (CMFD, also referred to as the Department or Costa Mesa Fire) contracted with A.P. Triton LLC* to deliver a feasibility study to provide an objective assessment of emergency ambulance transportation options as identified in the Fire Department's reorganization plan. The scope of work was to: determine the most viable emergency ambulance deployment options specific to the City of Costa Mesa, recommend the best options for the City in providing emergency ambulance service, evaluate the City's plan to provide ambulance services and provide the cost benefits, and pros and cons of each option. This also included submitting additional reimbursement options for the Fire Department to present to the City Council for a policy decision on emergency ambulance transportation. To provide ambulance service, the City has numerous options, and within each option there are many sub -options that can be developed. This study we will focus on four (4) basic options. The first model is the currently operating deployment model. The second relies on CMFD providing all Advanced and Basic Life Support care and transport. The third model explores CMFD providing all ALS care and transport while a private ambulance contractor provides BLS transport. And, lastly the creation of a CMFD Rescue Ambulance Transport Program utilizing EMT employees With each scenario, this study will provide a financial breakdown which will include: cost of development, cost of infrastructure, startup costs, overhead costs, revenue potential and cost recovery to be realized. With the information provided in this report, CMFD, with the Chief Executive Officer, can then make a sound and objective recommendation to the City Council for 51 Page A. P. Triton LLCJ CMFD Ambulance Service Feasibility Study consideration and final policy decision based on the best interests of the citizens of the City of Costa Mesa as well as the operational effectiveness of the CMFD. l When determining whether or not to provide ambulance services, perhaps the most difficult aspect is determining what criteria to use. For the private sector, the decision is relatively simple; the goal is to provide the best patient care possible at the lowest cost in order to extract the maximum amount of profit. Or, at the very least, maintain a profit margin that sustains the operation. This formula is not necessarily concurrent with the goals of the public sector provider. In order to determine the best model for the provision of emergency ambulance services, the Department, as well as the City, must first determine their objectives or reasons why they are looking to provide the service. Reasons for moving into the ambulance transport service can include: expanding the types of services already being provided, generating revenue for the purpose of cost recovery that is not currently being tapped, enhancing the level of patient care that is currently being provided, or creating stability in a system that is near a breaking point. While each of these goals is not mutually exclusive, and several of them may even be combined, each example requires a very different deployment strategy and thus very different infrastructure, startup and operational costs. Determination of success may not be decided by the revenue received but by whether or not the objective is met. If the objective is to deliver a better level of patient care, shorter response times, and optimal unit hour utilization than what is currently being delivered, and it is discovered that the selected deployment model meets or exceeds all of these objectives, the program would be considered a success regardless of cost. Although the fiscal impact is not the sole reflection of success in today's fire service, the rising cost of providing service is a reality, and revenue must be considered. Service related industries rely on providing 61 Page A.P. Triton LI -Cu CMFD Ambulance Service Feasibility Study a needed service at a cost the public is willing or able to pay and must include maintaining a profit margin in order to be successful. The level of success is evaluated by how close the end result is to meeting the needs and goals which are determined prior to the outcome, with fiscal impact a major consideration. 71 Page A. P, Triton LLC° CMFD Ambulance Service Feasibility Study Table of Contents Section1: Executive Summary...................................................................................................................................................2 Section 2: City of Costa Mesa Fire Department Formal Feasibility Study...........................................................5 Criteria................................................................................................................................................ 6 Section3: Minimum Requirements......................................................................................................................................10 Section 4: Determination of Objectives..............................................................................................................................11 Items identified as "Key Elements" by CMFD for Consideration of Assumption of Ambulance Services ..........................................................................................................................................................12 OptimizingPatient Care....................................................................................................................12 Efficient/ Effective Deployment Model.............................................................................................13 Cost Recovery for the Services Provided...........................................................................................14 Applying Revenue to the Current Infrastructure................................................................................16 Flexibility to Adapt to a Changing EMS Landscape through Control of Emergency Operations ........... 17 Stability within the Service Area and Operational Control.................................................................18 Section 5: Determining the Value of the System...........................................................................................................20 BillingPolicy......................................................................................................................................20 CollectionPolicy................................................................................................................................21 TransportRates.................................................................................................................................21 Documentation.................................................................................................................................22 Billing Contractor's execution of the City policy................................................................................. 22 UnderstandingPayer Mix..................................................................................................................23 Population/Demographics for Orange County....................................................................................23 Population/Demographics for Costa Mesa.........................................................................................24 CostaMesa Payer Mix....................................................................................................................... 25 Alternate Rate Adjustment................................................................................................................ 28 GE M T/ i GT........................................................................................................................................................................................... 30 Section6: Deployment Models...............................................................................................................................................31 Deployment Model I — Current Model............................................................................................... 31 Deployment Model I — Fiscal Summary..............................................................................................33 Deployment Model II — Fire Department provides both ALS and BLS Transport .................................. 34 Deployment Model 11— Fiscal Summary ............................................................................................. 36 81 Page A.P. Triton LLCg CMFD Ambulance Service Feasibility Study Deployment Model III - Fire Department provides ALS, Private Contractor provides BLS Transport.... 37 Ability to Provide Services under Deployment Model III....................................................................39 Deployment Model III — Fiscal Summary............................................................................................40 Deployment Model IV -Staffing four 24 hour units with non -suppression. Single Role EMT [SRE]...... 42 Deployment Model IV - Fiscal Summary.............................................................................................44 Section 7: Federal Supplemental Reimbursement Programs.................................................................................46 Section 8: First Responder and ALS fees Deployment Models / Cost/ Cost Recovery Table.........................................................................................................49 Conclusions........................................................................................................................................................................................50 91 Page A. P. Triton LLC-' CMFD Ambulance Service Feasibility Study Section 3: Minimum Requirements CMFD currently provides ambulance services to this jurisdiction. In doing so the Department meets the minimum requirements to provide ambulance service which includes both equipment standards as well as adherence to Medical Control as described in H&S Code 1797. 101 Page A.P. Triton LLC0 CMFD Ambulance Service Feasibility Study Section 4: Determination of Objectives Note: As with all feasibility studies conducted by A.P. Triton LLC* a primary goal is to reach a consensus by the agency team members as to the reasons they wish to explore engaging in this venture. It is based upon these objectives that we develop "Key Elements" by which each of the deployment models is measured In initial meetings with the Fire Chief and members of the Fire Departments staff, it was made clear that the intent of the study was to provide an objective analysis of the various transport options for CMFD and the City of Costa Mesa in accordance with the approved "Alternative Model". The primary objective was then used to develop the program key elements. It was established that unless there was consensus among all the parties on at least the majority of these key elements, there was little sense in moving forward with a new program. The key elements which were identified as having consensus with all parties were as follows: 4 Optimize patient care 4 Efficient/effective deployment model +4 Cost Recovery +4 Flexibility to adapt to a changing EMS landscape Determining how each one of these key elements will be or can be achieved, will aid in the selection of the best model for the Department to use in moving forward. Because there were four key elements identified, each has its own operational, financial and administrative requisites that must be shared with all of the system needs. 111 Page A. P. Triton LLCc CMFD Ambulance Service Feasibility Study Items identified as "Key Elements" by CMFD for Consideration of Assumption of Ambulance Services At the initial meeting with Department staff, there were four "Key Elements" that they identified as priorities in providing ambulance services. These Key Elements will be the foundation for determining whether the ambulance system, as well as the delivery model(s) will meet the needs of the Department, citizens and the City's plan for reorganization. Optimizing Patient Care The team assembled by the Department identified four key elements that they felt were important to the undertaking of ambulance transport. Each by themselves provides advantages to the system. Combined, they actually deliver, at the very least, the opportunity to maintain the standard of care but would likely result in an overall enhancement of the current system. As the participants in the system become more streamlined in numbers and philosophy, the synergy lends itself to higher levels of care and customer service. The licensing of paramedics and certification of EMT's is uniform across the state. All EMTs and Paramedics (EMTP) must meet the same requirements and have the same basic scope of practice within their fields. while the training and scope of practice remain the same for all EMS providers, what may not be the same is the institutional knowledge and longevity that is possessed by providers that may have a greater vested organizational commitment and stake in the community they serve. Paramedics and EMT's in the private sector tend to be more transient often moving from company to company. A career life span in the private sector is often measured in years, while in comparison, the careers of fire department employees are measured in decades. The cohesiveness of team members with long standing working 121 Page A. P. Triton LLC' CMFD Ambulance Service Feasibility Study relationships and the impact on the delivery of both patient care and outcome cannot be underestimated. In order to distinguish a higher or improved level of care and service, there must be a quality measure that can be evaluated for comparison. This measure can be anything from: documentation, surveys, time on scene, Return of Spontaneous Circulation (ROSC), interval from dispatch to intubation, patient outcome for certain conditions, to any combination of factors. Integrating streamlined ALS transport into the existing system would likely provide for better patient outcomes and optimize patient care. When patient care and transport in the most critical of conditions is facilitated in the most expeditious manner, better patient outcomes are a measurable result. Efficient/ Effective Deployment Model As discussed, there are numerous deployment models that can be utilized and integrated into the CMFD operation. Each has its own positives and negatives which must be balanced against the "key elements." The terms "efficient' and "effective" in the context of this report mean that they must meet all of the operational needs to support the EMS functions and take into consideration that CMFD must also be able manage the non -EMS needs that fall under their mission. In addition to meeting those requirements, the model chosen must be operated in a fiscally sound manner, not just in the short term but the long term as well. The deployment model selected must also take into account the reorganization plan that the City Council has already approved. The City is currently responding an engine and ambulance to each call for medical services within the City along with the current private ambulance provider. Developing a system that better utilizes the available resources currently in the system will allow for a more 131 Page W A.P. Triton LLC" CMFD Ambulance Service Feasibility Study cost effective and safer system. Streamlining of services is the most cost effective and efficient means to increased delivery. When the 9-1-1 system is activated, pre -arrival instructions are provided to the caller while units are being dispatched. Once on scene, a coordinated effort can be initiated to address the patient's needs. Having the ability to transport critically ill or injured patients at the most optimum time in the call can yield the most benefit to that patient. This key element may be the single most important consideration. Cost Recovery for the Services Provided In order to achieve a well -orchestrated EMS delivery system, it may be necessary to develop a cost recovery plan for those services provided. If the City chooses to implement an emergency ambulance service, they may also choose to adopt a cost recovery plan for the provision of those services. In doing so, the City may also adopt a liberal and compassionate billing and collection policy that would result in achieving an enhanced level of service as well as a more efficient deployment model without increasing cost to the local taxpayer. The function of local Government is to provide for essential services. Government code §54980 (a) "Legislative body' means the board of supervisors in the case of a county ora city and county, the city council or board of trustees in the case of a city, and the board of directors or other governing body in the case of a district. (b) "Local agency" means any county, city, city and county, or public district which provides or has authority to provide or perform municipal services or functions. (c) "Municipal services or functions" includes, but is not limited to, firefighting, police, ambulance, utility services, and the improvement, maintenance, repair, and operation of streets and highways. 141 Page `� A. P. Triton LLC'D CMFD Ambulance Service Feasibility Study Being the ambulance provider of record, the City assumes full responsibility both financially and operationally for emergency ambulance services. Insuring that the system is supported by a fee structure that creates stability for the long term, along with reducing cost to that city taxpayer, is in the best interest of all parties. 151Page A.P. Triton LLC° CMFD Ambulance Service Feasibility Study Applying Revenue to the Current Infrastructure As identified previously, additional revenue is available from other sources, as well as the ability to create additional new revenue strategies that can be utilized to enhance the current EMS infrastructure. If there is a private ambulance provider doing business within an urban area, there is profit to be made. If there was not profit to be derived in the system, there would be no competition among private providers. Thus, there would be no reason to create an RFP for ambulance services. Ambulance companies are in the business of providing a service that makes money like any business. The EMS industry in California has created a competitive system that encourages the submission of low, unsustainable bids to secure ambulance Exclusive Operating Areas (EOA's). Historical examples suggest that both the State Emergency medical Services Authority `BMSA" and the Local Emergency Medical Services Authority "LEMSA' play a significant role in creating and approving unrealistic UP's in which local government has had to step in with subsidies in order to continue to provide citizens with ambulance services. With this being stated, it should be understood that an EOA, or in this case the City, has a fixed financial capacity or cap regardless of who is providing the ambulance service. If every provider operated in the same way and had the same revenue generating options available to them, then every agency would generate the same amount of profit and pay the same amount of operational costs. However, since each agency operates uniquely, the amount of profit that can be realized is determined by a host of items that impact collections for service. The largest item is the cost of personnel and the number of unit hours provided. Also note that depending upon the billing and collection policies of the provider, the amount of revenue pulled from a system can 161 Page A. P. Triton LLC'Q a:3 CMFD Ambulance Service Feasibility Study vary greatly. Through multiple delivery models, the Department can collect revenue over and above the cost of the transport component of the system and return the additional revenue back into the EMS system as a whole. There are multiple fire agencies in California successfully doing just that. In addition to collecting revenue from the transport of patients, there is substantial revenue that is available through Ground Emergency Medical Transport (GEMT) and Inter -Governmental Transfers (IGT's) for transport of Medi -Cal fee for service and managed care patients. These supplementary revenue generating programs will be discussed later in this document. Flexibility to Adapt to a Changing EMS Landscape through Control of Emergency Operations As a participant in the system, a provider can have input into making the system better, but unless the participant is also the ambulance transport provider they have little ability to make changes in the system. Health care and EMS in particular are on the edge of seeing potentially significant changes in the delivery of EMS. The future of what EMS delivery looks like is changing every day, and the ability to meet the new demands must be proactive, not reactive. Engagement through direct control of the system allows the City the best possibility to be proactive as the system changes. Only as the primary provider or as an active participant of the transport component can CMFD have the ability to ensure vital changes take place in a proactive manner. As the transport provider, the Department will retain local control both administratively and operationally of all aspects of patient care. This includes the initial call for service, patient contact with the EMS system, transport, transfer of the patient to hospital staff and follow-up as part of the CQI process. As needs change, CMFD will be able to establish trigger points in system delivery that will alert staff that modification in the system need to be considered or evaluated. An example may be changes in reimbursement for transport of low 171 Page A.P. Triton LLC" CMFD Ambulance Service Feasibility Study acuity patients within an HMO to clinics. CMFD may be in alignment with those HMO's and be able to provide a lower cost transport unit to get those patients to the right facility at the right time in the right vehicle. This is a benefit to the City and the patient and is in alignment with the triple aim of healthcare. This component should be a focus for consideration. Stability within the Service Area and Operational Control The establishment of an Exclusive Operating Area (EOA) is conducted by the Local Emergency Medical Service Authority or LEMSA. The primary reason for establishing an EOA is to create a stable financial market in a specific geographical, socioeconomic area so that emergency ambulance services can be provided to all citizens on an equitable basis, and the area can be financially self-sustaining. In the case of cities, in lieu of an EOA, their area is confined to the city limits, as is the case with Costa Mesa. Theoretically, the EOA also provides the LEMSA a certain level of administrative oversight of the ambulance provider, but in reality once an agreement has been reached between the winning party of an ambulance EOA and the LEMSA, the agreement becomes more of a shared partnership between the county and the provider. CA Health and Safety Codes 1797.201 and 1797.224 provide the LEMSA administrative and operational oversight, and the contract then provides the ambulance provider control to work within the provided regulations. Because the EOA becomes a contractual obligation that was entered into between the LEMSA and the provider, only the exclusive provider has any control over the daily operations of the ambulance services. Therefore, in order to meet this key objective of operational control, the Department must exercise their 1797.201 rights and obligations. Then CMFD will be able to operate the system in a manner that is not only fiscally stable for the City but operationally stable for the other providers within the County and citizens they serve. Stability can be gained through control of the entire EMS 181 Page as� A.P. Triton LLCO CMFD Ambulance Service Feasibility Study delivery process. The crucial point to remember is that the City of Costa Mesa is a 1797.201 provider and thus is solely responsible for the provision of ambulance services to its jurisdiction without interruption. 191 Page A. P. Triton LLC` CMFD Ambulance Service Feasibility Study Section 5: Determining the Value of the System There are numerous factors that impact the value of an EMS system and the provider's ability to exercise cost recovery. Billing Policy Establishing a billing policy is one of the primary steps a provider needs to accomplish in order to get the best and reasonable cost recovery from the system. There are several factors that will determine what is included in the patient billing policy. However, there are areas that do have a fixed rate attached to the service, and this alone will create a fixed cap on the maximum potential collections that are available within the system. Other factors that can impact billing are: Types of calls for which the City will charge 4 Rates the City will charge for services Cost to provide the services Level of cost recovery to be obtained All systems experience fluctuations in the call volume, however, significant or seasonal changes in call volume are fairly predictable. Based upon previous transport data and census data, an expectation of approximately a 3% increase in calls for service annually is reasonable. Therefore, the reimbursement for some services based upon the number of calls is relatively established. The areas of the billing policy which will determine revenue are: collection policy, transport policy, documentation accuracy, billing contractor level of effort and understanding the Orange County payer mix. 201 Page A. P. Triton LLC'g) CMFD Ambulance Service Feasibility Study Collection Policy The collection policy is the most significant and political aspect of the collection process affecting the revenue stream. Federal regulations which control billing require that every patient receive a bill for services rendered in order to prevent what is known as "cherry picking" where only specific groups of patients are billed. How aggressive a company is with the collection of bills is a matter of business philosophy. Most private ambulance companies, and hospitals for that matter, have very aggressive collection policies, while many public ambulance providers have much less aggressive collection policies. The reason for this disparity is simple; private ambulance companies are in the business of generating profit. For these companies, sending a patient to collections or placing them on a rigorous payment plan is standard operating procedure and best business practice. Conversely, in the public sector there are political considerations and public relations concerns which must be balanced, as the vast majority of patients will also be taxpayers. Local governments that provide ambulance transport are in a superior position to take several different approaches to their collection policies: �6 Softer collection policies reduce costs to the local taxpayer as profit is not a primary consideration 4 Cost recovery lends itself to focus on better delivery ail. When revenue generation is achieved, it is returned back into the system 4 Revenue returned to the system provides "added value" to the taxpayer Transport Rates It has already been discussed that there is a fixed number of transports that will occur in a given period of time, but there is a subsection of patients whose medical condition will not require immediate transport. There will always be a percentage of calls that will not result in a transport due to circumstances. This is to be expected and can be projected as a percentage of the 211 Page �9 A.P. Triton LLC CMFD Ambulance Service Feasibility Study overall call volume. It should be noted that within this category of patients the ability to bill for what is called "treatment and non -transport" is allowed by the State for Medi -Cal patients and is accepted by most commercial insurance providers. With this in mind, additional revenue is available for certain patients that are not transported. Documentation Documentation provided by a paramedic on the Patient Care Report "PCR" also plays a significant role in the collection rate achieved by the provider. CMFD currently uses state of the art electronic Patient Care Reporting approved by the Local EMS agency and is already in compliance. Billing Contractor's execution of the City policy The billing contractor or billing office plays a major role in the collection for services. With the City's ability to control the billing and collection policy, they will be in a position to have the most significant impact on how emergency ambulance services affect the citizens of the City of Costa Mesa. As previously stated, the private sector bills for services rendered and establish a collection policy that provides for a profit margin. Aggressive billing and collections is the norm in this scenario. Collection of co -pays and payment plans for non-insured individuals is a common practice. While a municipal provider has the ability to use cost recovery for the services provided, the ability of the billing contractor to identify non-insured and those with co -pays and either eliminate them from the process or accept the coverage available reduces cost for the patient, contractor, and the city. 221Page A, P. Triton LLC© CMFD Ambulance Service Feasibility Study Understanding Payer Mix When billing for services in the healthcare arena, there are four categories of payers; this is often referred to as the payer mix or payable cost centers. These cost centers consist of Medicare, Medi -Cal (both Fee for Service and managed care), private pay (uninsured), and commercial insurance. Sub categories of these groups consist of patients covered under workers compensation and medical coverage under an auto policy. An agency's percentage of each of these categories varies widely depending on the demographics of that agency. An agency with a very high percentage of working age adults and higher percentage of larger businesses will have a higher percentage of commercial insurance, while an area consisting of a large population of seniors will have a higher rate of Medicare coverage. Population/Demographics for Orange County Costa Mesa/ Orange County Work Force Employment Category 3CostaMesa D Orange County 3,145,515 1453951 12 7 6691 Population Civilian Labor Force 1180616 4906 1 4814 1 654 8 Private Government Self Employed Wage/Salary Workers http://f`ac yiinder.census.gov/facesltablese"iceslisf/pageslproducNiew.xhtml 231 Page A. P. Triton LLC CMFD Ambulance Service Feasibility Study Population/Demographics for Costa Mesa Costa Mesa / Orange County Health Care 3500000 3000000 2500000 2000000 1500000 1000000 500000 0 Health Coverage Civilian With Health With Private With Public With No Population Insurance Health Insurance Coverage Coverage ■ Costa Mesa o Orange County http:11fagflnder. census.gov/faces/tableservices/jsf/pages/producNiewxht ml It should be noted that the percentage of transports for each payer mix is not directly related to the percentage of that population. For example, even though senior citizens may only represent 20% of the agency's population, their use of medical services increases with age and results in a higher usage of the EMS system than those with commercial insurance who represent a larger percentage of the agency population. "Fifteen percent of the U.S. population, or 44.8 million individuals, are enrolled in Medicare. While California has the largest number of Medicare beneficiaries in the nation at 4.5 million, they make up a comparatively small percentage of the state's total population. Medicare payments for beneficiaries age 85 or older are nearly 80 percent higher than payments for those 65 to 84."" 1 htto://www.chcfore/—/media/MEDIA%20LIBRARY%20Files/PDF/PDF9/o20M/PDF4o20MedicareFactsF'eures2010 odf. October2015 241 Page A.P. Triton LLCC CMFD Ambulance Service Feasibility Study Costa Mesa Payer Mix Using data provided in the last Orange County ambulance RFP, AP Triton LLC has developed the following breakdown. Breakdown is based upon an 8,750 incident call volume, assuming an annual call increase. Call volume is derived from 8,450 calls in 2014 with a projected call volume of 9,473 in 2015. Costa Mesa has a historical transport rate in the range of 80% all emergency medical related services. Costa Mesa Payer Mix ➢ Medicare/Medicare HMO - 36% - 2,520 ➢ Medi-Cal/Medi-Cal HMO - 26%- 1,820 p ➢ Commercially Insured - 26% - 1,820 ➢ Private Pay/non-insured/other - 12% - 840 251Pa; Payer Mix S ■ Medicare &Medicare HMO ■ Medi Cal & Medi Cal HMO s Insurance ■ Private Pay & Other A. P. Triton LLCt CMFD Ambulance Service Feasibility Study Payer Mix Reported Collection Rates ➢ Medicare/Medicare HMO - 93% - 2,344 ➢ Medi-Cal/Medi-Cal HMO - 92%- 1,820 ➢ Commercially Insured - 90% - 1,820 ➢ Private Pay/Non-insured/Other - 3% - 25 The following estimation of the system value is based on the data provided above with charges at current Orange County rates. The total number of EMS transports for the EOA was estimated to be 7,000. Current Orange County Rates ➢ Medicare/Medicare HMO Cap ➢ Medi-Cal/Medi-Cal HMO ALS/BLS rate ➢ Commercially Insured Average of ALS/BLS ➢ Private Pay/non-insured/other Av. ALS/BLS @ 0% $488 $145 $1,025 $1,025 Based upon these rates for service, an estimate of the value of the system can be determined for the city of Costa Mesa Valve of the System ➢ Medicare/Medicare HMO $488.00 x 2,344 = $1,143,872 ➢ Medi-Cal/Medi-Cal HMO $145.00 x 1,675 = $242,875 ➢ Commercially Insured $1,025.00x1,638 = $1,678,950 ➢ Private Pav/non-insured/other $1.025.00 x 25 = $25.625 IL Transports subtotal $3,091,322 261Page33 A. P. Triton LLC° CMFD Ambulance Service Feasibility Study In addition to the transport rates and collections estimates above, there are additional funds from treat and no transport (Treat and refused transport was calculated at a flat 10% across each payer mix with the exception of PP @ 5 %.) ➢ Medicare/Medicare HMO non -covered benefit = $0 ➢ Medi-Cal/Medi-Cal HMO $118.00 x 227 = $26,786 ➢ Commercially Insured $400.00 x 227 = $90,800 ➢ Private Pay/non-insured/other $400 x 53 = $21.200 Treat and refused transport subtotal $138,786 Payer Mix Revenue $3.2 Million ■ Medicare & Medicare HMO ■ Medi Cal & Medi Cal HMO ■ Insurance ■ Private Pay & Other The total value of the Costa Mesa 9-1-1 services is approximately $3,230,108 271Page �� A. P, Triton LLC° CMFD Ambulance Service Feasibility Study With a clear estimate of the value of the EOA, it is possible to determine if participation in the system is feasible or practical and explore the various options for participation models. It should be noted that the above estimate, although very realistic, is based upon a reasonable billing and collection model that includes collections from those with no insurance as well as collection from those with co -pays, as is likely the current practice from the private contractor. It is feasible that additional revenue for cost recovery could be realized by increasing the rate structure to a level more in line with `like' agencies across the state. However, for this study the current Orange County rate of $1,025 will be used. Alternate Rate Adjustment For illustration purposes only, a calculation is presented using a higher base rate of $1,750.0 to demonstrate the amount of cost recovery that could be seen with a slightly higher rate being used. This report is not recommending that a rate increase take place and is only presenting this calculation for discussion purposes. When developing the rate structure, a "bundled" billing schedule with the inclusion of a mileage charge, oxygen charge, night charge and a treat and no transport charge should be considered. Rate with Increase Base rate increase= $1,750.00 ➢ Mileage charge = $45.00 (use 6 miles per transport) ➢ Oxygen charge = $150.00 ➢ Night charge = $75.00 ➢ Treat no transport = $400.00 281Page �� A. P. Triton LLCM CMFD Ambulance Service Feasibility Study If the above rates were to be adopted, the financial impact would introduce an estimated: Financial Impact ➢ Base rate increase = $725.00 = $1,187,550 ➢ Mileage charge = $29.00 (@ 6 mi.) _ $285,012 ➢ Oxygen charge = $68.00 = $111,384 ➢ Night charge = $75.00 = $57,330 ➢ Total increase with new rate structure = $1,641,276 If the previous rate structure were to be adopted, the estimated revenue for CMFD could be reassessed with an estimated value of nearly $5 million dollars annually. 291 Page :3� A.P. Triton LLCM CMFD Ambulance Service Feasibility Study GEMT/IGT Two factors which have not yet been addressed are the availability of Federal Supplemental Reimbursement programs and the additional money that is available to public providers for offsetting the unreimbursed cost of providing transport and services to the State's Medi -Cal recipients. The GEMT program and the currently operating IGT program have the ability to bring in significant amounts of money for what would normally be one of the lowest paying groups in the payer mix. The GEMT program is entering its fourth year of reimbursements, and contracts with participants have just been completed for the next three years. The IGT program is in its first year of funding and does not contain a sunset clause. The amount of funds that are available depends on the model that has been chosen for the delivery system. In order to address this component cost recovery, each model will be presented with the cost breakdown, and the Federal Supplemental Reimbursement will be shown as an added value to the bottom line. 301 Page 377 A. P. Triton LLCD CMFD Ambulance Service Feasibility Study Section 6: Deployment Models Deployment Model I - Current Model Deployment Model 1 is the current delivery method for services that the City of Costa Mesa is providing. In this model CMFD provides first responder services at the Advance Life Support "ALS" level while at the same time the City utilizes a private ambulance contractor who responds to all EMS calls within the City providing transport at the Basic Life Support "BLS" level. In addition to the private ambulance, the City responds a Rescue Ambulance to all EMS incidents. Once CMFD paramedics have assessed the patient and have determined that patient care requires only BLS services the patient is transferred to the ambulance contractor for transport. However, when ALS intervention is required, CMFD paramedics maintain and continue patient care and treatment while being transported to the hospital in the private ambulance. When CMFD paramedics provide ALS care, the county approved ALS fee is charged by the ambulance provider and passed to the Department for those services. The advantages to this plan are as follows: ➢ Reduced financial risk to the city ➢ Possible surge capacity from a larger provider A Fixed rate of reimbursement for ALS services provided Disadvantages to this relationship are as follows: ➢ More limited cost recovery ➢ Potential increased cost to the taxpayer ➢ Less control of the system 311 Page A. P. Triton LLCO CMFD Ambulance Service Feasibility Study The City of Costa Mesa has maintained their status and eligibility to provide all aspects of pre -hospital EMS including: dispatch, first response, BLS, ALS and ambulance transport. In order to maintain this status of recognition under Health and Safety Code Div. 2.5 Sec. 1797.201, the City is obligated to provide ambulance services at all times to everyone within the city limits of Costa Mesa. The City has chosen to fulfill this obligation through a contractual agreement with a private provider for ambulance services. However, both the financial and operational obligation to provide those services lies completely on the shoulders of the City, independent of the contract with the provider. In the event that the provider becomes insolvent or is unable to meet the requirements of the contract, the City immediately assumes full responsibility to provide for ambulance services. The term "immediate" implies without interruption of services as written in H&S Code Sec. 1797.201. In executing the contract with a private provider, the City has reduced its risk for incurring cost to the General Fund but has not extinguished it entirely. As has already been seen in at least two other counties, Alameda and Santa Clara, the county shares the same risk as 1797.201 providers for the provision of ambulance services. In both of those situations the county had to financially bailout the private provider who failed to remain solvent and capable of continued ambulance services. In order to maintain the city's 1797.201 standing, continued and uninterrupted services must be maintained at all times. 321 Page A. P, Triton LLC° CMFD Ambulance Service Feasibility Study Deployment Model I - Fiscal Summary Service Delivery Deployment Model 1 is the current delivery of services that the City of Costa Mesa is providing. The City utilizes a private contractor that responds to all EMS calls within the City along with an engine and Rescue Ambulance. Cost of Service No new costs as services are currently being provided Cost Recovery Cost Recovery is limited to the ALS fee's charged to the patient by Contractor as well as First Responder Fee's "FRF" that are charged to non-residents. ➢ For 2014 the ALS passed through to CMFD was $289,288 ➢ For 2014 the FRF collected for non-resident response was $233,808 ➢ For 2014 the Cost Recovery of Medical Supplies $122,276 ➢ Total fees collected for 2014 $645,372 Pro's Requires no changes in deployment Reduced financial risk to the city Possible surge capacity from provider Con's Less Control of the System Potential increased cost to taxpayer Fixed rate of reimbursement for ALS services provided 331 Page A.P. Triton LLCO 0, CMFD Ambulance Service Feasibility Study Deployment Model 11— Fire Department provides both ALS and BLS Transport Within deployment Model II, CMFD would be expected to deliver 100% of the ambulance services for all 9-1-1 emergency services using current firefighter staffing. This model provides for four (4) 24hour ambulances and eight (8) personnel per shift. This deployment model is consistent with the current redeployment model adopted by the City. This model provides for a 25% increase over and above what is provided by the current ambulance contractor which is three (3) units, with a fourth unit moved into to the City as needed. The Fire Department would provide all transport of both ALS and BLS patients. The positive aspects of this plan are as follows: ➢ Requires no change from the approved counsel plan ➢ Is consistent with the City objectives. ➢ Provides for the appropriate number of firefighters on duty every day as adopted in the City redeployment plan. ➢ Provides for the expected number of units needed in the system to handle typical peak load demands and an overall increase in the daily Unit Hour Utilization "UI IU" over the 24 hour operational period. This model would meet all of the "key elements" determined by the team members and would place CMFD in a position to control all aspects of the transport delivery system. ➢ Uses existing employees that are already encumbered in the budget and does not require appropriation of new funds to implement. ➢ Allows for an enhanced level of service (four units vs. three) with the potential of no out of pocket cost to residents. 341Page A.P. Triton LLC q/ CMFD Ambulance Service Feasibility Study ➢ Allows for the most flexibility in the billing and collection process that can benefit both the City and its residents. This model also has the highest capacity to maximize cost recovery to the City. As the City currently has the staffing to implement this model as well as the equipment and rolling stock, there are no significant negative aspects identified to prohibit this deployment model form being implemented. 351 Page A. P, Triton LLC") CMFD Ambulance Service Feasibility Study Deployment Model 11 - Fiscal Summary Service Delivery Costa Mesa Fire assumes provision of 100% of the ambulance transport services and no longer utilizes a private ambulance contractor for ambulance services. Cost of Service No new costs as services are currently being provided Cost Recovery Current Orange County billing rates EXCLUDING co-pays/out of pocket costs • Cost Recovery for services = $3,230,108 • First Responder Fee o $275.00 x 7,000 tx x .26 • ALS Fee o $387.35 x 3,150 x .26 • GEMT/IGT • Net total cost recovery • Billing services @ 5% Total net cost recovery for model I1 Pro's Provides maximum local control Requires no changes in deployment Consistent with redeployment plan Provides flexibility/cost recovery _ $500,500 _ $317,240 +$250.00 _ $4,297,848 -$202,392 _ $4,095,456 Con's May require contract for surge Increase in workload 361 Page A.P. Triton LLC" q3 CMFD Ambulance Service Feasibility Study Deployment Model III - Fire Department provides ALS, Private Contractor provides BLS Transport Deployment model III involves developing a public-private partnership between the Department and a private ambulance provider. The relationship of a public-private partnership already exists to some extent. However, this deployment model will provide for a slight modification to the existing system. This deployment model will utilize the current staffing of Department ambulances with Firefighter paramedics as described in plan I and as approved in the City redeployment plan. Units would be dispatched as they are currently. However, upon discovery that the patient requires Advanced Life Support (ALS) measures, Costa Mesa ambulance units would not only maintain patient care but would provide the transport as well as the continuum of care needed during transport. Once transport has been completed, the patient care record will be submitted electronically to the billing company for collection. However, if upon discovery that the patient requires no Advanced Life Support measures, the Costa Mesa Paramedic units would clear and hand off the transport of the Basic Life Support (BLS) patient to the private contractor. This ambulance deployment model staffing is the same as described in deployment plan A. The positive aspects of this plan: ➢ Is an overall increase in the number of ambulances available daily compared to the number of ambulances provided if the current contractor was the sole provider of ambulance service. ➢ Is in line and consistent with the approved deployment plan. ➢ Is consistent with the City objectives. 371 Page A.P. Triton LLC" CMFD Ambulance Service Feasibility Study ➢ Provides for the appropriate number of firefighters on duty every day as adopted in the City redeployment plan. ➢ Provides for the expected number of units needed in the system to handle typical peak load demands and an overall increase in the daily Unit Hour Utilization "UHU" over the 24 hour operational period. ➢ Would meet all of the "key elements" determined by the team members and would place CMFD in a position to control all aspects including the continuum of care for the most critical patients of the transport delivery system. ➢ Uses existing employees that are already encumbered in the budget and does not require appropriation of new funds to implement. ➢ Provides for significant cost recovery to offset city expenditures ➢ The most important aspect of this deployment model is that it will increase the level of service to those who are critically injured or sick while at the same time creating a cost recovery model that will allow the City to rapidly change their deployment and EMS delivery product as the healthcare industry changes. The negative aspects of this plan are as follows: ➢ Provides for lesser cost recovery to offset city expenditures as the number of transports and collections will be based upon a lower percentage of calls, i.e. ALS vs. BLS transports ➢ Potentially creates a two tier system of billing and collection 381 Page A. P, Triton LLC° LI CMFD Ambulance Service Feasibility Study ➢ A two tier system of billing and collection means those transports by the ambulance contractor will incur out of pocket expenses while those transported by CMFD ambulance may not incur any out of pocket expenses. ➢ May create instability in the ambulance delivery system. Ability to Provide Services under Deployment Model III This deployment model is nearly the same as what is currently being provided today with the exception that patient transportation (provider) will be determined based upon patient needs. The typical breakdown between Advanced Life Support (ALS) and Basic Life Support (BLS) patients runs roughly 40/60 with a low of 25/75, with the greater being Basic Life Support. Although there are more BLS patient transports than ALS, the reimbursement for BLS is less. The current private contractor's ability to provide three units per day or 504 weekly unit hours is based upon the mix of transporting both the ALS and BLS patients. By reducing the number of patient transports, along with reducing the reimbursement rate, the contractor may not be financially able to continue to provide three units per day, which is the current level of coverage. As there is no time of day or schedule when ALS calls occur as opposed to BLS calls, there lies the potential that CMFD ambulance units will absorb the lost unit hours by the private contractor and transport BLS patients when the contractor's units are unavailable. Even with the introduction of call triaging, the loss of ALS transports by the private contractor may reduce the weekly unit hours that the private contractor could provide. Under this scenario, the long term financial stability of the private provider within Costa Mesa could become a challenge. 391Page A.P, Triton LLC CMFD Ambulance Service Feasibility Study Deployment Model III — Fiscal Summary Service Delivery Costa Mesa Fire assumes provision of transport for ALS services while the private contractor has primary responsibility for BLS services. Cost to provide services No new costs; services are currently being provided. Cost Recovery Current Orange County billing rates EXCLUDING co-pays/out of pocket costs • Cost Recovery for services o $3,230, 108 Full Value x.45 = $1,453,549 o Treat and Refused tx = $102,106 = $1,555,655 • First Responder Fee o $275.00 x 7,000 tx x .26 = $500,500 • ALS Fee o $387.35 x 3,150 x .26 Comm.= $317,240 • GEMT/IGT • Net total cost recovery • Billing services @ 5% Total net cost recovery for model II +S250,00 = $2,630,930 -$118,670 = $2,504,725 401 Page A.P. Triton LLCD q9 CMFD Ambulance Service Feasibility Study Pro's Requires no changes in deployment Consistent with redeployment plan Provides for reasonable cost recovery Con's Could impact the current contractor Could create a two tier billing system 411 Page A.P. Triton LLC CMFD Ambulance Service Feasibility Study Deployment Model IV -Staffing four 24 hour units with non -suppression Single Role EMT (SREJ This deployment model would utilize a new employee class and salary to be determined by the City. Salary rates for this model are based upon $12/hr. for EMTs, both working a 40hr work week withl6hrs FLSA OT/month factored in to fully encumbered cost. The hourly rate is based upon both current private ambulance industry standards for the general service area as well as the general provision for the same type of employee as used by other like public providers. This class of employee is non -suppression and thus does not require safety status. They do, however, fall under standard FLSA rules which require overtime pay after 40 hours worked per week. Staffing 24 hour ambulances with this class of employees could utilize a number of staffing scenarios including 8, 10, 12 and 24 hour shifts. For this scenario we will use a three (3) platoon system consistent with the current fire department shift schedule. If this deployment model were to be selected, this would employ four (4) 24 hour ambulances, requiring two (2) personnel to staff each 24 hour ambulance. This would result in total program personnel of twenty-four limited term contract employees. This model does allow for a more creative deployment model based upon peak needs for services through overtime coverage. The positive aspects of this plan are as follows: ➢ Fulfills all of the key elements proposed by CMFD. ➢ Creates potential new pathways for future employment and community outreach as well as creating new opportunities for diversity. ➢ Based upon the revenue estimate previously provided, this program has the potential to generate significant cost recovery. 421 Page �9 A.P. Triton LLCM CMFD Ambulance Service Feasibility Study This program also has the potential to reduce costs to the residents of Costa Mesa by not charging out of pocket costs to residents. The negative aspects of this plan are as follows; This model requires the creation of a new class of employee for a new position within the CMFD. As a result, there will be initial and ongoing costs to maintain the workforce. This group of employees is likely to be actively seeking employment within the fire service as Firefighters. Although this does create a class of candidates from which CMFD will also pull from for positions within their ranks, these non -suppression employees will become highly sought after by other organizations. ➢ Quality control can be an issue with a workforce that is constantly changing. Although it is good that this model creates gateways to future employment both within the City and outside the City, there exists a challenge in maintaining familiarity with the City itself as well as the culture of the agency. However, it should be noted that the private sector can also be a "revolving door" as there exists a high turnover within the private ambulance industry. 431 Page A.P. Triton LLCj' CMFD Ambulance Service Feasibility Study Deployment Model IV - Fiscal Summary Service Delivery Costa Mesa Fire assumes provision of 100% of the ambulance transport services utilizing a new class of Single Role EMT's (ambulance operators), no longer requiring a private ambulance contractor for everyday ambulance services A private ambulance contractor may be utilized for surge protection and large scale incidents. Cost to provide services Twenty-four new employees = $1,533,620 ➢ Annual salary per employee $39,938 x 24 = $958,512 ➢ Roll -ups (PERS, Health, Dental, Vacation, SL) estimated @.50 $479,256 ➢ Additional 10% coverage cost for SL, Vacation, WC $95,852 ➢ Funds for recruitment, uniforms, program management $100,000 Cost Recovery Current Orange County billing rates EXCLUDING co-pays/out of pocket costs • Cost Recovery for services = $3,230,108 • First Responder Fee o $275.00 x 7,000 tx x .26 = $500,500 • ALS Fee o $387.35 x 3,150 x .26 Comm.= $317,240 • GEMT/IGT • Net total cost recovery • Billing services @ 5% • Employee costs Total net cost recovery for model IV 441 Page �1 +$250,00 _ $4,297,848 -$202,392 -$1,633,620 _ $2,461,836 A.P. Triton LLC* CMFD Ambulance Service Feasibility Study Pro's Con's Provide some degree of flexibility Inconsistent with redeployment Creates moderate cost recovery Potential high turnover Creates new employment pathways Requires a new class of Employee Ability to expand diversity in CMFD 451 Page A. P. Triton LLCJ m CMFD Ambulance Service Feasibility Study Section 7: Federal Supplemental Reimbursement Programs Supplemental reimbursement programs through the Federal Government have been in operation for more than 30 years. Each state that has created a State Medicaid program is entitled to participate in these programs. The State of California created the Medi -Cal program which is part of the Federal Medicaid program. Under the Social Security Act, a unit of government as defined under CFR 433.5 is entitled to share in the cost of providing Medicaid services for the amount that is not covered from the cost of providing the services compared to the amount that is received by the agency. For example, if it cost an agency $1000 to provide a service and that agency only received $100 from Medicaid, the difference, or gap, is $900. That gap is known as the uncompensated cost and can be shared on a 50150 split with the Federal Medicaid program. California created the Ground Emergency Medical Transport program (GEMT) and developed a Certified Public Expenditure (CPE) program to offset the cost of providing service for the Medi -Cal Fee for Service (FFS) beneficiaries. Orange County has a lower number of FFS Medi -Cal participants (14%) compared to Medi -Cal Managed Care beneficiaries (86%). Managed Care, also known as HMO participants, are not allowed to participate in the current GEMT Certified Public Expenditure process. The estimated financial impact of the current GEMT program for CMFD is based upon the Department providing the ambulances including the billing for those services. The estimate below was derived using Costa Mesa Medi -Cal percentage and the average lows and highs from like providers across the state. The actual reimbursement rate cannot be determined until a 461 Page A. P. Triton LLCO CMFD Ambulance Service Feasibility Study deployment model has been selected along with a billing and collection policy has been established. GEMT Estimates for Costa Mesa based upon statewide averages s:J Estimated Medi -Cal FFS GEMT dollars = $250,000- $400,000/yr. "? 471Page _ A. P. Triton LLCM CMFD Ambulance Service Feasibility Study Section 8: First Responder and ALS fees Costa Mesa Fire Department currently receives both First Responder and ALS Fee's. First Responder Fee's "FRF" are charges for the response and services provided to non-residents of Costa Mesa that utilize EMS services while in the city. Advanced Life Support "ALS" fees are charged for the added cost of ALS services. On July 21, 2015 the Board of Supervisors for Orange County approved an emergency ambulance rate adjustment. Within that rate adjustment the ALS rates was increased to $396.55. These fees are charged to the patient when CMFD paramedics treat and transport the patient to the hospital. Once collect by the ambulance contractor they are passed on to CMFD. For calendar year 2014 CMFD received the following; First Responder Fee collected........ $233,808 ALS FEES ............................... $289,288 Cost Recovery of Medical Supplies ... $122,276 Total Fee's collected for 2014........ $645,372 481 Page 5s� A.P. Triton LLC` CMFD Ambulance Service Feasibility Study Deployment Models / Cost/ Cost Recovery Table Model Modell Modell Model Model Modelo Deployment Current CMFD Providing Partnership CMFD Type / Deployment 100% Delivery Description model Initial Cost $0 $3,230,108 $1,555,655 $3,230,108 Recovery First $233,808 $500,500 $500,500 $500,500 Responder Fee (FRF) Advanced $289,288 $317,240 $317,240 $317,240 Life Support (ALS Fee Cost $122,276 $0 $0 $0 Recovery Medical Supplies GEMT/IGT $0 $250,000 $250,000 $250,000 Billing $0 $202,392 $118,670 $202,392 Services C 5% Net Cost $645,372 $4,095,456 $2,504,725 $4,095,456 Recover New None None None $1,633,620 Employee Costs Total Cost $645,372 $4,095,456 $2,504,725 $2,461,836 Recovery 49 1 P 1 = 5b A. P. Triton LLCO CMFD Ambulance Service Feasibility Study Conclusions The delivery of healthcare throughout the country is changing. Although the extent of those changes is not fully known, what is known is that the status quo is not acceptable for the future. The City of Costa Mesa is positioned to choose between the status quo and changing their EMS delivery models to be as flexible as the environment in which they are operating. Cost effective and efficient delivery of services that fall under direct local control are available now if the City is willing to take advantage of the opportunity presented to them. Presented are four models that offer at the least the status quo; to full local control of a flexible efficient EMS delivery model adaptable to the needs of the future. 501 Page A.P. Triton LLCn f) CITY OF COSTA MESA FIRE DEPARTMENT INTEROFFICE MEMORANDUM TO: DANIEL A. STEFANO, FIRE CHIEF FROM: JASON PYLE, DIVISION CHIEF DATE: JANUARY 12, 2016 SUBJECT: OPERATIONAL REVIEW OF ADDING A PRIVATE PARAMEDIC TO THE AMBULANCE PROVIDER FOR TRANSPORT As directed, the following is the operational review of adding a private paramedic to the ambulance provider for transport. Although, this concept is not consistent and coordinated with the currently approved EMS medical plan, it is always important and valuable to be mindful of the ever evolving EMS landscape. On December 18, 2015, Staff met with the Orange County Medical Director, Dr. Stratton. From that meeting the following information was obtained. Per Dr. Stratton, adding a private paramedic to a private ambulance for 911 emergency response and transport is a change to the approved OCEMSA medical plan. Any medical plan change needs to be approved by the County Medical Director, Dr. Stratton. To do a medical plan change the jurisdiction would need to submit to Dr. Stratton a request that details the change. The Medical Director would then evaluate the request and develop the parameters for the new medical plan. This would include any conditions, stipulations and restrictions on the plan. The Medical Director would also establish, if needed, new guidelines and standing orders that the new medical plan would need to follow. When discussing a medical plan change, Dr. Stratton identified that he supports the current Fire Department based First Responder EMS system that includes two firefighter paramedics to respond. Additionally, Dr. Stratton identified that by state law, all medical plans need to be consistent and coordinated. While placing a single private paramedic on a transport ambulance does enhance its capability, it lacks elasticity and compatibility with the currently approved EMS system in Orange County. This position is shared by Dr. Stratton as well. However, should there be a county wide system change to the currently approved medical plan, then the elasticity, effectiveness and compatibility of the afore mentioned concept would be reevaluated. After reviewing the concept of adding a private paramedic to the ambulance provider for transport, the following was identified: 1. The conceptual medical plan change does not change the current deployment of emergency resources. a. The private ambulance is a transport unit, the Fire Department remains the Advanced Life Support First Responder. 2. The conceptual medical plan change would be unique to the Costa Mesa area and would not be consistent and coordinated with the current EMS medical plan that operates throughout the county. 3. The City of Costa Mesa will have a potential decrease in revenue. a. The City receives ALS cost recovery from the insurance company for ALS transport in the amount of $289,288, if the Fire Department Paramedics were replaced by a private paramedic the City could see a loss of cost recovery of up to $289,288. 4. The conceptual medical plan change will increase the operational costs to the private company. a. The private transport company will have the increased operational cost of employing a higher paid paramedic vs an EMT. Per payscale.com, paramedic pay is an increase of 48% - 64% over an EMT. CITY COUNCIL AGENDA REPORT MEETING DATE: May 7, 2013 ITEM NUMBER: NB -3 SUBJECT: REORGANIZATION OF COSTA MESA FIRE DEPARTMENT DATE: APRIL 13, 2013 FROM: OFFICE OF THE CEO PRESENTATION BY: THOMAS R. HATCH, CHIEF EXECUTIVE OFFICER FOR FURTHER INFORMATION CONTACT: THOMAS R. HATCH, (714) 754-5328 RECOMMENDATION: The CEO recommends that the City Council approve the following recommendations: 1. Adopt the "Alternative Model" Restructuring Plan In Attachment 1 as recommended by the Interim Fire Chief; 2. Adopt the two-phase approach to the implementation plan as recommended by the CFO and outlined in number 1 to 8 on page 3-4; 3. Direct staff to obtain the necessary information and conduct appropriate studies concerning ambulance transportation then agendize for City Council consideration in the future; 4. Adopt the recommendations numbers 1 through 17 of Table A as outlined in this staff report; and 5. Direct staff to modify the CEO's Proposed FY 2013-2014 Budget to include the financial impact as described in the outlined recommendations. BACKGROUND: The delivery of fire, paramedic, and fire prevention services is a core component of maintaining the public and life safety of the community and consistently rates high in terms of importance to the residents and businesses of Costa Mesa. The Costa Mesa City Council has recognized these facts and has continuously invested in maintaining a well- equipped and highly -trained Fire Department. As a result, the cost of fire, paramedic, and fire prevention services represents approximately 20% of the City's general fund budget. Over the decades, the medical response operations of local fire departments have significantly grown in service levels and effectiveness. Now, approximately 70% of the Fire Department's calls for service are related to medical aid/rescue with approximately 2% related to fires. In light of the major fiscal challenges facing Costa Mesa and all cities throughout the nation, it is appropriate to examine alternative delivery options that are available to ensure quality and efficient services. Accordingly, the Costa Mesa City Council directed staff, based upon a request from the Costa Mesa Firefighter's Association, to seek a proposal from the Orange County Fire Authority (OCFA) for contract Fire Services. After extensive debate and study, on April 17, 2012, the City Council decided to reject the OCFA proposal and explore other alternative delivery options related to Fire Department services. This was based on the fact that Costa Mesa can provide services at as high a quality of service as the OCFA and that our local community could continue to retain local control over services and most importantly costs. The Fire Department began an internal review of the department structure and deployment using new data that projected the historical service needs throughout the community. This data driven approach was lead by Interim Chief Tom Arnold and his assessment Is included as an attachment to this report. ANALYSIS: Attachment 1 of this report is Interim Fire Chief Torn Arnold's assessment of the restructuring of the Fire Department, This assessment is a thorough review of the current deployment model as well as three other models each with detailed pros and cons related to their use. The OCFA proposal of Option 2 and Option 3 are included as Attachment 2 for reference. While all of the alternatives would be acceptable, the "Alternative Model" is the preferred model and is being recommended for implementation by both the Interim Fire Chief and the CEO. This recommended model includes many advantages for the community Including a gradual increase in the number of paramedics per day of at least 3, an increase in the number of response units for the community from 8 to 10, improved response times and a lower cost of service. The details and analysis is included on Attachment 1. The CEO supports the assessment on Attachment 1, but would add the following observations about all of the models: Care Ambulance provides six dedicated first responder personnel to Costa Mesa per day (18 total dedicated personnel). The six personnel serve in three ambulances that are strategically located in the community (see Attachment 3 for map of Costa Mesa). The personnel are trained emergency medical technicians (EMT's) and are currently part of our response team. A fourth ambulance is always close to provide service as a key backup and Care has many more units that could support the community in a significant emergency. Discontinuing this service is a significant decision, The current deployment model uses fire engines that are designed to serve as fire fighting apparatus Instead of medical response units. The new model of rescue ambulances provides increased efficiency by allowing front line engine companies to resume readiness for firefighting and other emergency responsibilities more quickly since they would no longer be required to travel to and from hospitals. This change also was the catalyst to thinking about creating additional paramedic assessment units, that when implemented, will increase the number of paramedics in the community from 10 to 13 per day. The process of studying new models also helps serve to expedite further discussions with neighboring jurisdictions leading to automatic aid agreements to provide better assistance if needed, Implementation Plan Although the CEO fully supports the assessment on Attachment 1, he is recommending a different implementation approach than the plan recommended by the Interim Fire Chief. The CEO is recommending a two-phase approach that would first implement the significant changes in a new deployment model before commencing ambulance transportation with City personnel. In short, the modifications to the deployment model represent significant change to the method currently used to perform life -safety operations and a phased approach which is better given the complexity and importance of this change. While it is clear that our highly - s^ � 2 trained and dedicated staff can quickly adapt to these changes, it is also clear that taking a little more time to transition will benefit the situation. The new model will require building modifications to Station 4, alterations to apparatus, selecting and procuring six rescue ambulances, and significant training for personnel including dispatchers. The implementation of this first phase can move forward now without delay. However, it seems prudent to allow for additional transition time, perhaps six to nine months, before moving forward with any plan to include transportation by Fire Department personnel. The second phase would involve patient transport via ambulance vehicles. Ultimately, the Council will have to determine whether this function will remain with a private provider, or whether the Fire Department will assume that responsibility. Based on the analysis in Attachment 1, it is recommended that the City of Costa Mesa utilize Fire Department personnel to provide the full range of ambulance transportation services. However, this would be another significant change with increased dynamics and workload. It is so important that this transition be conducted strategically and smoothly and therefore, a period of time to study this issue further is certainly necessary, as we do not want to rush this decision. We recommend that the City Council authorize staff to complete the following: 1. Develop and release a Request For Proposal (RFP) seeking bids for private providers to conduct ambulance billing services for the City; 2. Further study the pros/cons and strengths/weaknesses of City personnel providing ambulance transportation services including a comprehensive financial study with research into the benefits of Ground Emergency Medical Transport reimbursements to fire -based transportation providers; 3. Develop and release a Request For Proposals (RFP) seeking bids for private ambulance providers to transport Advanced Life Support (ALS) and Basic Life Support (BLS) patients when Fire Department personnel require additional transportation resources. Because the City has an existing contract with Care Ambulance, the City may be able to administratively offer to Care the ability to provide this back-up support. After the three items above are completed, schedule the transportation services portion of this decision for a City Council meeting. If the City Council decision is to have City personnel provide transportation services, then an appropriate transition period from Care Ambulance to City personnel and a new billing company will be needed. The CEO further recommends that the City Council authorize staff to immediately complete the following: 4. Proceed to select a preferred rescue ambulance manufacturer to purchase six new vehicles. Given the cost of these units, this decision will come back to the City Council in a few months; 5. Proceed with implementing the new model in phases and utilize two temporary rescue ambulances and reduce the number of daily personnel with the approval of the Interim Fire Chief and CEO. This will not require any layoffs due to the number of vacancies in the Department and it will significantly reduce the use of overtime and may increase the safety of personnel who would be required to work less overtime. This action is already in progress (See transition matrix in Attachment 8); Proceed to transition from a six station model to a five station model. This action would close Station 6. The data clearly demonstrates in the OCFA study and the Interim Costa Mesa Chief's study that Station 6 is very inefficient and that the deployment system only requires five total stations. It will likely take six months before all of the 140 3 steps are completed with the transition and then Station 6 would close. During this time, City Staff will schedule meetings with any community business partners or groups that would like more information and detailed statistics about the Station 6 closure. In addition, Staff will proceed to study the long-term or build -out needs of the South Coast Metro area and closely watch the response statistics to ensure quality service is maintained for this area. 7. Proceed to obtain bids to reconstruct Station 4 to accommodate the length of the Tiller Truck. The exact cost is unknown but this reconstruction could be a one-time cost of $100,000; and 8. Proceed to make the other detailed changes as described in Attachment 1 Finally, the CEO is recommending that the City Council review and support the following key Fire Department Reorganization Initiatives, several of which will require an appropriate meet and confer process with the Costa Mesa Firefighters Association and the Costa Mesa Fire Management Association. For purposes of this report, it should be assumed that all of the items below will require meet and confer with the associations and the recommendation concepts will not be implemented until appropriate. Based on preliminary discussions and analysis, each recommendation and an action step to Council consideration: 11l* r711 Table A includes a response from the CEO for implement the change all provided for City H Recommendation CEO Action Step Response 1. Implement Emergency Vehicle Strong Fire Department staff will coordinate with Public Preemption (EVP) to facilitate Support Works staff to study and design a system to faster city-wide emergency deploy appropriate measures to provide the response times. least amount of impact to traffic flow patterns. Consultant assistance may need to be hired by staff to complete the necessary studies. This will require action by the City Council at a later date. 2. Implement capital improvements Support Many of the fire stations are in need of capital to various fire stations as well as improvements. For years, the funding has not other one-time budget needs as been available to make some larger capital outlined in Attachment 4. The improvements as well as some aesthetic cost of the items listed on improvements to kitchens and living quarters. Attachment 4 for FY 2013-2014 Included on the list is several security related is $191,440. improvements. The recommendation is to approve all of the improvements listed on Attachment 4. 3. Approve the Fire Department's Support The CEO is cutting the vast majority of FY 2013-2014 budget requests new/increased budget requests for on-going for some new and on-going services from all departments for the FY 2013 - costs for the City. The new on- 2014 budget. Attachment 4 includes a few going costs will be $32,500. requests for increasing the base budget of the See the bottom of Attachment 4. Fire Department and are pending final review of the entire budget by the City Council, these listed are being recommended for funding. H 4. Study the apparatus needs of Strong A study will be conducted to determine the the Fire Department and explore Support apparatus needs of the Fire Department. the need to purchase Consultant assistance may need to be hired to replacements and/or surplus complete the study. older apparatus, 5. Implement a study to analyze Support Traditionally, four personnel have been used on the effectiveness of utilizing a apparatus like a Tiller Truck. A study will be three person paramedic completed that can explore whether it is assessment unit model on the appropriate to staff this apparatus with three Tiller Truck. personnel. 6. Annually deposit $500,000 in an Delay Fire Station 1 is in need of replacement at some interest bearing account for the point in the future. The CEO's initial eventual replacement of Fire recommendation was to proceed with this Station 1. recommendation but with the CaIPERS Board recommending a 50% increase in rates over the next 6 years, implementing this recommendation may not be financially feasible. See Attachment 5. 7. Authorize the increase in on- Strong Additional personnel with paramedic duty paramedic personnel from Support certification should improve the response to 10 to 13 per day. medical emergencies in the community. The on-going cost of this will be $187,000 per year. 8. Implement a study that analyzes Strong Costa Mesa is fortunate to have many the fire department and City's Support agencies and events that bring tourism, role in requiring organizations to entertainment and educational benefits to the provide mandatory paramedic community. These agencies and events also support specific to large events require more medical support. Consultant that occur in Costa Mesa so as assistance may need to be hired to complete to not strain existing required life the study, safety support. 9. Update Fire Station alerting Strong Study this new technology and how it can be system to expedite personnel Support used to alert stations faster of upcoming calls readiness (improve turnout for service. Consultant assistance may need to times). be hired to complete the study. 10. Authorize the study of a possible Strong Further study the potential of shared services in Joint Powers Authority with Support the future. Consultant assistance may need to surrounding agencies for shared be hired to complete the study, services regarding fire dispatch, mutual aide, etc, 11. Provide funding for upgraded Strong Study this new technology and how it can be routing/mapping and mobile Support used to alert stations faster of upcoming calls GPS software, for service. Consultant assistance may need to be hired to complete the study, 12. Continue to study the need to Strong This process Is already underway. retrofit the Tiller Truck with the Support capabilities to pump water or foam. 13. Continue to study innovative Strong Is there different equipment or vehicles that use technologies that have the Support more innovative technology that could benefit potential to provide 21st century Costa Mesa and provide a safer service's life saving techniques for the Consultant assistance may need to be hired to benefit of Costa Mesa residents. complete the study, 14. Study the concept of requiring all Support If approximately 70% of our calls for service are new hires to be paramedic medical aid/rescue calls, then should all sworn certified. Study the concept of Fire Personnel be expected to maintain all personnel being paramedic paramedic certification? What are the pros and trained. This will require cons of this concept? Would some personnel discussion and negotiation with lose their skills if not exercised regularly? fire labor associations. Consultant assistance may need to be hired to complete the study. 15. Study the personnel needs of Strong _ The Fire Department has been operating with a The administrative division of the Support part-time Interim Fire Chief and an Acting Fire Department. Deputy Fire Chief. A study is needed to determine the appropriate administrative management personnel needed to manage the Department. Could services be shared with anothera enc ? 16. Study the concept of when a fifth Support A study could help determine the appropriate rescue ambulance is needed in times for the City to implement a fifth paramedic the community. When the Fire van into service. Consultant assistance may Department increases staff to need to be hired to complete the study, manage a heavy workload then study the possibility of having this shift of paramedics be staffed fora period of less than 24 hours to reduce costs. 17. Study the concept of Support A study can determine if a reserve firefighter establishing a reserve firefighter program would be beneficial to Costa Mesa. program. The Police Department Consultant assistance may need to be hired to utilizes reserves to provide complete the study valuable assistance to the City. ALTERNATIVES CONSIDERED: The City Council could decide to implement all or select specific recommendations for implementation; The City Council could determine that additional research is needed along with additional outreach on these issues prior to making any decision; and Additional studies can be conducted on specific service areas to determine if additional efficiencies can be achieved. FISCAL REVIEW: Attachment 7 is a complete analysis of the financial impact from the implementation of the recommendations. This includes the reduction of staffing of 12 full-time personnel, costs to purchase new apparatus and equipment as well as one-time capital improvement costs and on-going operational costs. The total savings for FY 2013-2014 Is $15,022 and the on-going savings is $1,838,962, Attachment 5 of this report is a five year projection of Fire Department costs related to CalPERS. These increasing costs are not included in the savings numbers presented above, �� 6 LEGAL REVIEW: The City Attorney's Office has reviewed this report and agrees with the representations. Although the Interim Fire Chief has met several times with the boards of the fire labor associations, the operational changes may require additional meet and confer sessions. CONCLUSION: The recommendations above represent many significant changes to the organizational structure of the Fire Department. If the recommendations are approved, staff will proceed to enhance communication to help ensure the effective implementation of the changes. Regular updates will be provided to the City Council and community regarding the progress of the reorganization. 74*1 /. Y4 NOMAS R. HNTCH Chief E e live Of icer '"TI40MA8 FVDIJARTE City Attorney rREVIEWED BY: TOM ARNOLD Interim Fire Chief 4/ff44M 11 :• •. DirectorFinance and IT ATTACHMENTS: 1 Interim Fire Chief Memo 2 Options 2 and 3 of OCFA Proposal 3 Map of Costa Mesa 4 Cost For Recommended Reorganizational Improvements 5 Five -Year Prosection of PERS Costs 6 Time of Day Calls For Service 7 Detailed Financial Analysis 8 Transition Matrix Z 7 ATTACHMENT CITY OF COSTA MESA FIRE DEPARTMENT INTEROFFICE MEMORANDUM TO: THOMAS R, HATCH, CHIEF EXECUTIVE OFFICER FROM: TOM ARNOLD, INTERIM FIRE CHIEF DATE: APRIL 19, 2013 SUBJECT: RESTRUCTURE ALTERNATIVES ANALYSIS BACKGROUND In May of 2012, 1 presented a proposal to Council to restructure the Fire Department in a way that would provide better service to the community at a reduced cost. That proposal outlined the following: • A reduction in the number of fire stations from 6 to 5 • A reduction in the number of fire units from 7 to 5 • A reduction in the number of firefighters per day from 29 to 27 • The addition of 5 rescue ambulances that would transport patients to the hospital with existing staff The reduction of personnel and the recovery of the costs for providing emergency transportation would reduce the overall cost of operating the Fire Department and provide an improved level of service for the community. Recently, you asked me to develop for Council's consideration an alternative to the plan proposed in May 2012. Further, you requested a comparison of the original proposed plan, an alternative plan and the Orange County Fire Authority (OCFA) proposal referred to as Option 3. As a result, the Fire Department staff considered many alternative models, taking into consideration the pros and cons of each. An alternative plan was developed that reflects the intent of the original proposal, but reduces the resources and •therefore, the cost. This analysis includes a comparison of the Current, Proposed, Alternative, and OCFA Option 3 Models (see Attachment A), Page t of 7 U ATTACHMENT CURRENT MODEL The Department provides emergency response to medical, fire, rescue, and hazardous materials emergencies with five medic engines, one tiller truck, and one quint (a combination engine and truck) from six stations. All of these units are staffed with four personnel and are referred to as fire units. Paramedics respond to medical emergencies on the medic engines, along with a private ambulance. When the paramedics need to take the patient to the hospital, they ride with the patient in the private ambulance and the medic engine follows to retrieve equipment and personnel. The Current Model provides: • 6 fire stations • 5 medic engines (with paramedic teams) • 1 tiller truck • 1 quint • 1 command unit • 29 personnel per day Pros • Meets the 4 minute travel time standard for most parts of the city when all units are available • Meets the Effective Response Force (EFR) time standards for the vast majority of incidents • Provides 5 paramedic teams in the City • Requires very little automatic aid for paramedic teams Cons • Extends return to service time for medic engines when paramedics go to the hospital • Reduces cost recovery when paramedics do not provide transportation • Requires Paramedics to always respond with a fire unit • Requires fire units to always respond out of city for medical automatic aid requests • Requires more fire units to respond to fires, rescues, and medical emergencies to assemble enough personnel than the other models • Requires a higher overall cost to operate the Fire Department in comparison to the other models PROPOSED MODEL The Proposed Model Improves service, is more efficient than the Current Model, and reduces the Fire Department's operating costs. It fundamentally restructures the way the Department provides service. Instead of paramedics responding on four -person medic engines, they would respond on two -person rescue ambulances. The staffing on the engines would be reduced to three persons and remain more readily available for other emergencies when the rescue ambulance transports the patient to the hospital. Paramedics would provide all emergency medical transportation to the hospital and costs would be recovered through a private billing company, Costa Mesa residents transported by Department rescue ambulances would not be billed for costs not covered by insurance. The Department would continue to contract with a private ambulance provider for backup. Page 2 of 7 ATTACHMENTI To accomplish this and still reduce the number of personnel, the Department would close the Metro Station (6) and replace the engine at the Placentia Station (4) with the tiller truck currently stationed at the Park Station (3). The three engines, one tiller truck, and one quint, would eventually be staffed with one paramedic, making them Paramedic Assessment Units (PAU's). The Proposed Model provides; • 5 fire stations • 3 engine PAUs • 1 tiller truck PAU • 1 quint PAU • 5 rescue ambulances (with paramedic teams) f 1 command unit • 27 personnel per day Pros • Improves response times in comparison to the Current and OCFA Option 3 Models • Increases service to the community in comparison to the Current Model and OCFA Option 3 Models • Improves efficiency in comparison to the Current and OCFA Option 3 Models • Increases the number of response units from 8 to 11 in comparison to the Current and OCFA Option 3 Models • Improves return to service time for all fire companies in comparison to the Current and OCFA Option 3 Models • Provides a fire/paramedic assessment unit and rescue ambulance in every fire station • Prevents most residents from incurring emergency medical transportation costs • Maintains the same number of paramedic teams as the Current Model • Reduces the number of fire units required to respond to incidents • Reduces the need to send fire units out of city for medical automatic aid requests • Reduces the overall costs for operating the Fire Department in comparison to the Current and OCFA Option 3 Models Cons • Closes the Metro Station (6) • Relies on other agencies to maintain response time standards in some areas • Relies on other agencies for more fire units in some instances • Reduces the number of firefighters on duty each day • Requires capital expenditures to implement Page 3 of 7 (Dq ATTACHMENT ALTERNATIVE MODEL The alternative to the Proposed Model is to reduce the number of rescue ambulances from 5 to 4 and staff a fifth rescue ambulance during projected peak activity hours. The days, hours, and location of the fifth unit will be determined by the fire management team, The Placentia Station (4) would be staffed with a tiller truck PAU and a crossed staffed engine. The Department would continue to contract with a private ambulance provider for backup. This is the most efficient model and provides the greatest overall cost reduction, The Alternative Model provides: + 5 fire stations • 3 engine PAUs • 1 tiller truck PAU • 1 quint PAU • 4 rescue ambulances (with paramedic teams) • 1 command unit • 25 personnel per day Pros • Improves response times in comparison to the Current and OCFA Option 3 Models • Increases service to the community in comparison to the Current and OCFA Option 3 Models • Improves efficiency in comparison to the Current, Proposed, and OCFA Option 3 Models • Increases the number of response units from 8 to 10 in comparison to the Current and OCFA Option 3 Models • Improves return to service time for all fire companies In comparison to the Current and OCFA Option 3 Models • Provides a fire/paramedic assessment unit in every fire station • Provides a rescue ambulance in 4 of the 5 fire stations • Prevents most residents from incurring emergency medical transportation costs + Reduces the number of fire units required to respond to incidents • Reduces the need to send fire units out of the City for medical automatic aid requests * Reduces personnel expenditures in comparison to the Current and Proposed Models • Reduces overall costs for operating the Fire Department in comparison to the Current, Proposed, and OCFA Option 3 Models Cons • Closes the Metro Station (6) • Reduces the number of paramedic teams from 5 to 4 • Removes a paramedic team from the Placentia Station (4) in comparison to the Current and Proposed Models • Reduces some cost recovery in comparison to the Proposed Model • Relies on other agencies to maintain response time standards in some areas Relies on other agencies for more fire/rescue units in some instances Page „4 of 7 ATTACHMENT • Reduces the number of firefighters on duty each day • Requires capital expenditures to implement ORANGE COUNTY FIRE AUTHORITY (OCFA) OPTION 3 MODEL This option was part of a proposal from the Orange County Fire Authority (OCFA) to provide fire/rescue/emergency medical services to the City, It was the option that had the least number of personnel and, therefore, provided the highest reduction of personnel costs. This option closes a station, retains two medic engines, replaces two medic engines with PAU engines, replaces one medic engine with a quint PAU, eliminates a tiller truck, and adds two medic vans. It did not include emergency medical transportation. The OCFA Option 3 Model provides: • 5 fire stations • 2 medic engines • 2 engine PAUs * 1 quint PAU • 2 medic vans • 1 command unit • 23 personnel per day Pros • Reduces personnel expenditures in comparison to the Current, Proposed, and Alternative Models • Reduces capital outlay in comparison to the Proposed and Alternative Models • Reduces maintenance costs in comparison to the Proposed and Alternative Models • Improves the return to service time for 2 fire companies Cons • Closes a fire station • Reduces overall effectiveness in comparison to the Current, Proposed, and Alternative Models • Reduces the number of paramedic teams from 5 to 4 • Creates longer overall response times than the Proposed or Alternative Models • Creates longer paramedic team response times than the Current, Proposed, and Alternative Models • Provides a fewer number of response units than the Proposed and Alternative Models • Creates longer out of service times when medic engine paramedics go to the hospital • Requires residents to pay for private ambulance transportation • Provides reduced cost recovery in comparison to the Proposed or Alternative Models • Relies on other agencies to maintain response time standards in some areas • Relies on other agencies for more fire units in some instances • Reduces the number of firefighters on duty each day • Requires capital expenditures to implement Page (5 of 7 ATTACHMENT CONCLUSION The Proposed Model would provide the best level of service for the community and a total net positive change to the cost of operating the Fire Department. The Alternative Model would provide nearly all of the benefits of the Proposed Model but in a more efficient manner and with an additional total net positive change to the cost of operating the Department. In both the Proposed and Alternative Models, the provision of transportation by city paramedics will provide a new revenue stream that can be utilized to fund capital projects (i.e. replacing and restoring aged fire stations), equipment purchases and pay down the Fire Side Fund, The OCFA Option 3 Model provides a lower level of service and is the least effective and efficient of the three models. RECOMMENDATION While the Proposed Model provides the best level of service, it is my judgment that the differences in the Alternative Model can be mitigated with service and data driven practices, developed and implemented by our fire managers. The combination of the efficiencies that can be realized and good management, make the Alternative Model, the model of choice. The Fire Department will also explore the feasibility of further modifications of the Alternative Model, as data is collected relative to the effectiveness of this Model. A closer examination of issues, such as a 3 -person Tiller Truck and 3 -person Medic Engines, will be looked at more carefully once the department has an opportunityto debrief the effectiveness of a new fire service delivery model. Page 6 of 7 ■ n b, a Q D u m o 10 c 6 M Q 'mv 'imv "'� o Zvi "'Laa iT a a •° m a a U m 1O O Q W Y2 a w G N H m H LL H a u v a m• C .m,. C 7 m •Y .,T = = Q= Q= a ✓� ' O E C C N 2 t a0 M,1 W' a 'ecn v r. ut ao M H i3 m u m u m u m u a d 0 � C Lb.O t7i a E E E E= E '� W w O v G Q v C Q v C Q v c Q Q O V vl ut 'LL 3 E� ��°{' SO d b0 a to a bA a aA a a m U ° ro vl b0 W W u W uW W u �_ U N vi in vUi of vt C' H H m _ cNi c� a "O v,. W C 00 N Q O] a Q •�Cp a W W W F^ W O ,G t/1 N E U u u u E u U LL j E t V w L �. v a av o O �- O M v P aM d0 bag s, p tD G J OH' i�ce+r .'a• r• G CC C w I +• c a .0 m m r 'C r m a V 'G o 6 2 Q 2 a Z C9 a da' ,Z.J ATTACHMENT2 Orange County Fire Authority Option 2 In Option 2, an Engine and Paramedic Van are located at Stations One, Two and Five, allowing for coverage when a unit is on hospital follow up, and an additional full Medic Engine at Station Three, Station Four is a Paramedic Assessment Unit (PAU) Truck. This option allows for the closure of Station Six. Pages I of 2 OCFA Option 2 Royal Palm Station — 1 Engine PAU (3) Medic Van (2) Baker Station — 2 Engine PAU (3) Medic Van (2) Park Station — 3 Medic Engine (4) Placentia Station — 4 Truck -Quint /PAU (4) Civic Center Station — S Engine PAU (3) Medic Van (2) Battalion Chief (1) Metro Station — 6 Closed Response Units in the City 9 Daily Staffing 24 Pages I of 2 ATTACHMENT Orange County Fire Authority Option 3 In Option 3, an Engine and Paramedic Van are located at Stations One and Five, allowing for coverage when unit is on hospital follow up, and an additional full Medic Engine at Station Three and Six. Station Four is a Paramedic Assessment Unit (PAU) Truck. This option allows for the closure of Station Two. Page 2 of 2 OCFA Option 3 Royal Palm Station — 1 Engine PAU (3) Medic Van (2) Baker Station — 2 Closed Park Station —3 Medic Engine (4) Placentia Station — 4 Trucl luint /PAU (4) Civic Center Station — 5 Engine PAU (3) Medic Van (2) Battalion Chief (1) Metro Station — 6 Medic Engine (4) Response Units in the City 8 Daily Staffing 23 Page 2 of 2 ATTACIUvENT 3 -90 16 9M WS 10 Legend Costa Mesa Stations Newport Seach Stations QCFA Stations Care Ambulance St.t[.ns City Boundary ATTACHMENT4 SCHEDULE OF PROPOSED BUILDING MODIFICATION PROJECTS / CAPITAL IMPROVEMENTS / ONGOING COSTS ASSOCIATED WITH THE FIRE DEPLOYMENT PLAN TOTAL FIRST-YEAR COSTS $ 223,940 1 of 1 05/01/2093 9 COST DESCRIPTION Minor Building Modifications Fire Station #1 $ 2,600 Replace carpet in day room. $ 3,000 Replace parking lot lighting (back). Fire Station #3 $ 9,500 Add security screening fence for rearyard; materials only. $ 800 Installation of built-in shelves for storage in old phone booth; materials only. Fire Station #4 $ 3,500 Replace sliding glass door in day room. $ 2,200 Replace missing/broken blinds in day room. $ 540 Install privacy glass coatlnq on apparatus floorwindows. $ 8,500 Replace HVAC ducting In training room. Fire Station #4 Tower $ 10,000 Repair spawling concrete landings. $ 8 000 Replace corroded metal doors 5 doors and frames). Fire Station 45 $ 3,800 Replace missing/broken blinds and screens. $ 1,000 Install carpet in Captain's bunkroom. Capital Improvements and Capital Equipment $ 38,000 Fire Station #4 replacement of emergency enerator $ 100,000 Retrofit Fire Station #4 to accommodate Tiller Truck SUBTOTAL $ 191,440 Annual On -Goin Costs $ 10,500 ePCR hardware and software upgrade $ 10,000 5% increase for paramedic supplies $ 12,000 Medical supplies and equipment increases SUBTOTAL. $ 32500 TOTAL FIRST-YEAR COSTS $ 223,940 1 of 1 05/01/2093 9 City of Costa Mesa Reorganization of the Fire Department 5 year projection of PERS Costs 12-13 13-14 14-15 15.16 16-17 17-18 PERS Rate Increases 6.19% 1.90% projected 2.00% projected 2.00% projected 1.00% projected Increase In PERS Cost 802,949.17 268,078.72 280,540.60 285,863.30 109,690.25 1,747,122.04 Attachment 5 ATTACHMENT 2012 CMFD Time of Day - Calls for Service ,c 200 — 100 # s � na rz 3 'M 41: n'PAmnR n °i'PA .i �, .n..."n m n Sq $$ o 0 0 $ o a ATTACHMENT7 At a Glance - Financial Analysis The Alternate Model proposes reducing staffing by 12 full-time personnel total (four (4) per shift) and adding four (4) rescue ambulances in order to provide a portion of the City's emergency transportation services. The Alternate Model results in: A reduction of $1,838,962 in expenditures annually through the following changes: o Staffing: reduction of six (6) fire captains ($1,035,948), reduction of six (6) fire engineers ($981,299), and addition of paramedic assignment pay for nine (9) fire fighters ($187,285);' o Maintenance and operations: reduction in utilities expenses from closing Station 6 ($15,000), reduction in replacement and maintenance costs for one (1) engine ($150,000), addition of replacement and maintenance costs for six (6) medic units ($156,000); A one-time capital outlay of $1,600,000 to provide transportation, which includes: . o The costs of six (6) new rescue ambulances and their equipment: ■ Six (6) rescue ambulances, using two (2) as reserves ($1,434,000); ■ Six (6) gurneys ($90,000); • Communication equipment for the four (4) frontline rescue ambulances ($76,000). Other FY 13-14 costs: • A total of $223,940 in proposed capital improvement projects (See Attachment 4): o The expansion of Station 4 (approximately $100,000);2 o One-time building modification/capital improvement projects ($91,440); o Annual on-going supplies costs ($32,500). The combination of the changes that are proposed through the Alternate Model and the costs of the proposed capital improvement projects results in a total net expenditure savings for the first year of implementation of $15,022. Staffing numbers are based on proposed FY 13-14 employee salaries. 'This is only a tentative estimate for the expansion of Station 4. ir� cQ G Z 0 F^ rZ = F- v* W M � O d w 0 O LU CC LL m .N v w v Y n U 4 u' ¢ c D E v C ry +•' 6. c N rco tp L c ¢ �¢ o u c q.Q c `'' Huai v E.° 0,5 pro .%= a QE v` e wc° u d u a c w u O m U Q u w O❑ d L lT o F m N u m � f6 ra `—° c n� >• 4, '^ m �° aQ. s vl as �, ro v v ° c Q °.;•. r�o 'up E°= E w E v E ° vmN.LT v E o +%• c as c a ,� c¢ 0•Q Q r�. �4 '� Q W a G J 111 U ry u W L K u N J W w i•�-• W ro l.J L> vui M vui 'n CG N 0] tp y_, N N F N O N W N u C`o qj 'U➢ @ T C� C� W W p 4 01 N Q O] w Q f0 C •f0 N d UlJ C 4 m U C ;p u u o V ut M L j E N w W 0 F w N ` N S o a � N o � E c U w GaJ w W W Q N E a" C U � vt N w 4= O Eb U U W L L >_ Z 2~ 2i m C N m^ W m o o I- N c C =w ? N G N I m m e ;; � v � •y V1 I A O ,.�� C C d m o 0 •«"% •� m c � � � ui � w o > Y ro •> N yi w �n City of Costa Mesa Memorandum To: City Council e From: Claire Flynn, Assistant Development Services Director Date: May 7, 2013 Subject: Development Agreements in North Costa Mesa The purpose of this memo is to respond to a question received from the public regarding existing development agreements in North Costa Mesa, as they relate to the Council's decision on the reorganization of the Fire Department. There are Development Agreements in place which include previously -approved, unbuilt entitlements in North Costa Mesa. For example, these Development Agreements pertain to future new development at Metro Pointe, Home Ranch, Sakioka Lot 2, Segerstrom Town Center, Segerstrom Center for the Arts, and Pacific Arts Plaza. Pursuant to the Development Agreement(s), the City and the Owner agree that: 1. The consideration to be received by the City and the rights secured to the Owner hereby constitute sufficient consideration to support the convenants and agreements of the City and the Owner. 2. Unless otherwise specified in the Development Agreement, the rules, regulations, and official policies governing permitted uses, density, design, improvement, and construction are those in effect when the agreement is executed. 3. Unless otherwise specified in the Development Agreement, the development exactions or development impact fees applicable to the unbuilt entitlements are those in effect when the agreement is executed. In short, unless otherwise stated in the Development Agreement, the .Development Agreement limits the power of the City to apply newly enacted ordinances or impact fees to previously -approved entitlements where buildout is anticipated to occur in the future. City of Costa Mesa Paramedic Direct Fee Program Billing by Calendar Year�� FRF FY 14-15 Actual = $264,117.19 ALS FY 14-15 Actual = $279,901.85 MS FY 14-15 Actual = $128,937.60 January February March April May June July August September October November December Total Paid CM Cost Recovery Due CM 2012 First Responder Fee (Non -Residents) 19,939.36 21,220.60 19,447.05 18,665.53 24,375.09 20,547.43 21,377.85 21,177.88 17,659.85 21,127.24 19,102.33 18,203.43 242,843.64 242,843.64 Advanced Life Support Fee 24,397.61 15,374.03 20,180.60 22,642.71 26,834.50 16,874.47 22,630.92 23,929.42 16,055.88 21,259.41 17,454.02 24,448.22 252,081.79 252,081.79 Medical Supplies Fee (Quarterly) 24,302.85 24,938.10 28,495.50 27,261.30 105,251.85 105,251.85 2013 First Responder Fee(Non-Residents)14,479.26 23,369.97 20,621.70 19,255.31 20,856.65 16,698.60 23,716.57 21,429.97 25,863.22 19,734.02 16,133.43 12,925.21 235,083.91 235,083.91 Advanced Life Support Fee 21,719.96 20,990.53 23,921.17 16,948.81 24,367.71 18,579.71 24,668.26 20,781.34 21,349.50 27,703.92 19,776.56 18,183.41 258,990.88 258,990.88 Medical Supplies Fee (Quarterly) 26,081.55 26,081.55 27,914.70 28,041.75 108,174.00 108,174.00 2014 First Responder Fee (Non -Residents) 18,800.47 17,973.65 20,448.62 13,996.52 14,852.67 18,827.95 20,907.30 23,612.49 20,352.27 14,605.21 21,513.00 27,917.71 233,808.86 233,808.86 Advanced Life Support Fee 22,491.56 26,161.45 23,931.34 23,034.13 25,274.67 22,730.30 20,949.07 25,117.43 24,785.66 21,927.54 29,328.61 23,556.95 289,288.71 289,288.71 Medical Supplies Fee (Quarterly) 28,023.60 28,894.80 32,724.45 32,633.70 122,276.55 122,276.55 2015 First Responder Fee (Non -Residents) 20,967.89 18,729.97 26,156.08 23,673.79 22,640.96 23,039.52 22,883.11 25,477.67 183,568.99 158,091.32 Advanced Life Support Fee 18,765.76 22,367.48 18,156.48 32,392.64 21p93.33 21,460.90 20,053.75 26,053.82 180,344.16 154,290.34 Medical Supplies Fee (Quarterly) 32,071.05 31,508.40 63,579.45 63,579.45 FRF FY 14-15 Actual = $264,117.19 ALS FY 14-15 Actual = $279,901.85 MS FY 14-15 Actual = $128,937.60 $300,000M $250,000.00 $200,000.00 $150,000.00 $100,000.00 $50,000.00 $- P¢zQpca Pao za�a\� v 5i F` Total Cost Recovery Paid to the City of Costa Mesa O,n ¢S\a Qpi J,dc�. a ¢ eD ¢ Q¢5Q ¢a� yC ��t o� a� do a¢ JQQ \o -J a� apo `e tae P oca¢c Paas a\yJQQ Q`e5Q �¢ac SS 4` F PesQoca¢� Paac ea ayJQQ c F` e¢¢ cA, ¢ o� �',Zp Jat� J a` e¢\6 Qee\hoc 5°a,¢ c,¢a�� P¢zQpca Pao za�a\� v 5i F` Total Cost Recovery Paid to the City of Costa Mesa O,n ¢S\a Qpi J,dc�. a ¢ eD ¢ Q¢5Q ¢a� yC ��t o� a� do a¢ JQQ \o -J a� apo `e tae P oca¢c Paas a\yJQQ Q`e5Q �¢ac SS 4` F PesQoca¢� Paac ea ayJQQ c F` { °�rcrlktrcr t^ Aeg2ity :5'rr7rtca November 3, 2015 :A i.. r. A.... HEALTH DISASTER MANAGEMENT EMERGENCY MEDICAL SERVICES MARK REFOWITZ DIRECTOR RICHARD SANCHEZ ASSISTANT DIRECTOR TERI SCHULTZ ACTING DEPUTY AGENCY DIRECTOR MEDICAL SERVICES To: Orange County Fire Chiefs Orange County City Managers Orange County Ambulance Service Providers From: Talnmi McConnell, EMS Administr 1 Subject: Revision to Maximum Emergency Ground Ambulance Rates: Effective November 1, 2015 TAMMI WCONNELL, RN, MSN EMS ADMINISTRATOR 405 W FIFTH STREET, SUITE 301 SANTA ANA, CALIFORNIA 82701 TELEPHONE: (714) X834-3500 FAX: (714) 834-3125 This is to inform you that the Orange County Board of Supervisors approved the following revised emergency basic life support ambulance rates at its October 27, 2015 meeting, T1Ak4AkEN.��SISACtE RAZE x' Emergency BLS Base Rate Applicable for urgent or Code response at the $904,&I request of a public safety employee. Mileage - Per patient mile or fraction thereof.. $ 16.87 Oxygen (includes mask or cannula) Applicable when administered. $ 82.74 StandbyPer 15 minutes after the first 15 minutes and any $ 40.83 fraction thereof. Expendable Medical Supplies Maximum per response or ,fair market value, $ 32:66 whichever is least. The Advanced Life Support (ALS) Paramedic Assessment and Transportation rate for the Orange County Fire Authority jurisdictional areas (excepting for San Clemente, Westminster and. Buena Park) was not considered therefore, the maximum ALS fee remains $387.35. The rates are effective November 1, 2015 by Board of Supervisors' Resolution No. 15-120, If you have any questions, please contact Eileen Endo at 714-834-3507, 'rCM:ee 82483 Attachments: Board Resolution. No. IS -120 Orange County EMS Policy/Procedure 4714.00 ROCA cls me4 Los Angeles County EMS Agency BLS & ALS Base Rate Ambulance Transport Charges Averages by County CITY OF COSTA MESA FIRE DEPARTMENT EMS RATE SURVEY FOR NON-OCFA CITIES IN ORANGE COUNTY JANUARY 2016 n�ckfne� M.—Rin Hip'. j 04"010 ad, erg "Wigdgg, ME ME g ggyw I Brea None $717 $380 Emer Emer Costs recovered via pass thru from Emer. Amb. Rates for each item are the same as the Amb Amb OCHCA ground @mb rates approved by the BOS. Cosa'. W H&W I g g!, "ji P;ip! 11 afWKNInk '-Hotp IMSMOMF 7asje C e4� 11 MR9 f M-12 NIS Idsa 1 lo`''R. _IPS.Ura n, All 91111"CAM f i BLS & ALS fees waived for suscription members. Residents not suscribed to membership program are billed $300 Paramedic Assessment Fee and non-residents $350. $300 Res. Resident/non-resident claiming hardship, there are specific items that are required to be Fountain Valley $60 $350 Non- $400 Care Amb Care Amb submitted for consideration of review and write off of fees. FVFD does not charge a BLS Res. assessment fee; however, if patient is assessed and transported and are not a subscription member, they will be billed either $300 resident or $350 non-resident fee. ALS fee is $400- patient must be transported to incur a charge. up I` uI M , . RESY A[ d s'd(j, �Tn"Wp s,� Et 'i *jIR j—, IN pgwi V � �1� ill— N's Ig i 11,glM glg`��l TT 01"M N 1, E, My 115 " " "N' fl§ P $4MRPIPC�M, I 1114ifl."IM, - 'Ik� hMTNIMR Residents Residents pay a per parcel tax to provide fire -based paramedic services. 'Non-resident taxed First Responder' fee is $350; fee does not apply if you are a resident, own a business in Garden Grove $.70/$100 .0007 (300+-) $350 the City, or response was to a resident's house and the patient is a family member. of assessed prop value epes agm r jq Te u " 4a Vpw Uil -Y Laguna Beach None $387 Doctor's Doctor's Non -City residents $387.35 assmt fee if ALS service of any kind AND pt is transport; supplies$32.66 @ o eac N§ 11 A M01 1, mm 0 3 10 Elg OWN D"O '046 itl a 11 A 1, , ENUN I C q W 5 'PM "M 85H � D IMPORTER MT.- I- —Foc OWN Have a 'voluntary' subscription membership ($48) which cove d by covers any charges not a! Orange $48.00— $405 $50 8 FD Wittman insurance. Have exemption enrollments for residents who meet HUD low income criteria, are disabled, etc. Orange County Fire Departments with Ambulance Transport Service Huntington Newport Orange Costa Mesa $42,285.58 N/A N/A N/A Total EMS Runs 2014 13,505 7,571 8,034 8,450 ALS Runs 2014 5,135 4,144 3,891 3,132 BLS Runs 2014 5,1561 1,827 2,295 3656 Tota Itx 2014 10,291 5,971 6,186 6,788 Supplies - $122,276 Recovery Collected $5,132,101 $2,916,672 $2,886,695 FRF -$233.808 2014 ALS -$289,288 Subscription program $1,203,272 $240,000 $657,943 2014 Total $6,335,373 $3,156,672 $3,544,638 $645,372 MEETING DATE: JULY 21, 2015 fWad 1 ITEM NUMBER: CC -16 SUBJECT: AMENDMENT TO EXTEND TERM OF CARE AMBULANCE SERVICES AGREEMENT DATE: JULY 21, 2015 FROM: FIRE DEPARTMENT PRESENTATION BY: DANIEL A. STEFANO, FIRE CHIEF FOR FURTHER INFORMATION CONTACT: DANIEL A. STEFANO, (714) 754-5106 RECOMMENDED ACTION: Approve the attached Amendment Number Four extending the term of the Ambulance Services Agreement with Care Ambulance Service, Inc., for the continuation of emergency ambulance and patient billing services until June 30, 2016. BACKGROUND: Pursuant to California Health & Safety Code Section 1797.201, because the City of Costa Mesa has provided and/or contracted for emergency ambulance services continuously at least since June 1, 1980, the City has retained all rights, remedies, and privileges regarding the provision, administration, and operational control of all prehospital Emergency Medical Services (EMS) within its jurisdiction, including, but not limited to, emergency ambulance response and patient transport services. In accordance with its Section 1797.201 powers, on November 20, 2007, the City initiated a competitive process by issuing a "Request for Proposals," coordinated by the Fire Department, in which qualified ambulance companies were reviewed, analyzed, and compared. The Fire Department chose to use the competitive process format outlined in California Emergency Medical Services Authority Publication #141 due to its efficiency, rather than developing a new format. On July 1, 2008, the City Council accepted the proposal submitted by Care Ambulance Service, Inc., and authorized the Fire Department to negotiate an agreement for the provision of emergency ambulance and patient billing services. The City and Care Ambulance Services entered into an agreement effective on September 1, 2008, at 7:30 a.m., for a period of two years. The City and Care Ambulance Services subsequently entered into Ambulance Services Agreement to extend the services for a term of three years, to September 1, 2013. The Ambulance Services Agreement allows for extensions of the term providing that the total length of time, including the initial two-year term beginning in 2008, is no more than ten years. The City Council previously approved Amendment Numbers One through Three to the agreement, extending the agreement to September 1, 2015, at 7:30 a.m. Amendment Number Four would extend the agreement until June 30, 2016, at 7:30 a.m. ANALYSIS: From the commencement of the current agreement until the present time, Care Ambulance Service has met and fulfilled all contractual obligations and requirements. In fact, it is the opinion of the Fire Department that Care Ambulance Service has exceeded all expectations and has helped foster a partnership that has been instrumental in maintaining Costa Mesa's high-quality EMS system. Based on its performance over the past six years, Care Ambulance Service has maintained a well-managed organization staffed by dedicated personnel who care about their mission and the patients they serve. Extending the agreement to June 30, 2016 will allow for emergency ambulance and patient billing services to continue through the completion of the consultant group's report containing an objective analysis on the City's future ground transportation options, and City Council's consideration of such options. Section 5.3 of the agreement allows the City to terminate the agreement at any time with written notice to Care Ambulance Service if it is later determined that services will not be needed for the entire time period of the extension. ALTERNATIVES CONSIDERED: Because Care Ambulance Service has satisfied and exceeded the obligations, requirements, and expectations of the original Agreement, no other alternatives were considered. J6-1d1-1111:1=10TIIVTTS No fiscal review is necessary for this item. The City provides citizens emergency ambulance services via a private ambulance company business, which also handles all EMS billing services for the City. There is no direct cost to the City for selecting or using a private ambulance company to provide emergency ambulance and patient billing services. LEGAL REVIEW: The City Attorney's Office reviewed the Ambulance Services Agreement and its amendments, and drafted Amendment Number Four with the assistance of Fire Department. CONCLUSION: Based on the aforementioned reasons, the Fire Department respectfully recommends that the City Council approve the attached Amendment Number Four so that Care Ambulance Service may continue emergency ambulance and patient billing services until June 30, 2016, at 07:30 a.m. DANIEL A. STEFANO THOMAS R. HATCH Fire Chief Chief Executive Officer THOMAS P. DUARTE City Attorney Attachments: 1) Original Ambulance Services Agreement 2) Amendment Numbers One through Three 3) Amendment Number Four M Attachment 1 CITY OF COSTA MESA AMBULANCE SEkVI ES AC,R.EEMEIYT THIS AGREEMENT is made said entered into this 12th day of Aucruat , 2008 ("Effective .Date"), by and between the CITY OF COSTA MESA, a municipal corporation ("City"), and CAREAMBULANC78 SERVIC)3, INC,, a. California corporation ("Contractor"). WITNESSETH. A. WHEREAS, COSTA MESA issued "City of Costa Mesa Request for Proposals for Emergency Ambulance and Patient Billing Saavicas #1117" on Novcanb®r 20, 2067. A copy of said Request for Proposals is attached hereto and incorporated herein by reference as Exhibit "A," and is hereinafter referred to as "RFP"; and B. WHEREAS, COSTA MESA issued two subsequent addendums to the RFP on Tanuary 24, 2008, slid on February 11, 2008. Copies of the addendums are attached hereto and incorporated heroin by reference as Exhibit "H, and are limciaaatter referred to as the "Addendums." The original RTP and the addendums shall be collectively refaared to as the "RFP» C. WHEREAS, CONTRACTOR submitted a proposal dated March 17, 2608, in response to the RFP. A copy of the proposal is attached hereto and incorporated by reference as Exhibit "C," and is hereinafter referred to as the "Proposal"; and a WBERBAS, CONTRACTOR is an ambulance provider that is fully licensed and qualified to perform the work required by this Agreement and was selected by COSTA. MESA following the evaluation ofproposals submitted in response to said RHP; and E. W13Ei2EAS, COSTA MESA desires to utilize the services of CONTRACTOR to provide Basic Life Support (BLS) and ,Advanced Life Support (ALS) emergency ambulance and patient billing sea -vices in accordance with all applicablo laws, COSTA MES.A's RFP and A.ddendasms, and selected options €roma CO'NTRACTOR's Proposal; and F. WHEREAS, at its meeting of .iuly 1, 2008, the Costa Mesa City Council accepted CONTRACTOR's Proposal and authorized city staff to negotiate an Agreement for the provision of 813 and ALS emergency ambulanoc and patient billing services by CONTRACTOR. The details of dae Scope of emergency at'ubulance services to be performed by CON'1'RACT R uuader this Agreement are described in greater detail in section 2,1 of this Agreement. NOW, 7HEREFOM,, fox; and in consideration of the mutual covenants and conditions contained heroin, the parties hereby agree as follows; Ambulance PSA LO. GEl IERAA PROVISIONS 1. 1, Order of Precedence. The entire Agreement between City and Contractor shall be comprised of'the following dcutunents, listed in order of precedence, 1) This Agreezacrt (the Costa Mesa Ambulance Services Agreement); 2) The Proposal; and 3) The RFP (including the two Addendums), which are all incorporated by this reference. In the event of an inconsistency in this Agreement and any of the attached Exhibits, the terms sat forth in this Agreement shall prevail, These documents together constitute the entire Agreement between the parties with respect to aaay matter referenced herein and supersede any and all other prior writings slid oral negotiations. If there is any conflict between the terms and conditions of the above mentioned documents, the terms and conditions of this Agreement shall ,prevail over those in the Proposal or RFP, the terms and conditions of the Proposal shall govern over those in the RFP, and the Addendums.shall prevail over the RFP. Only a writing executed by the parties hereto or their respective successors and assigns may modify this Agreement 1,2. Representatives, The City Manager or his designee shall be the representative of City for purposes of this Agreement and may issue all consents, approvals, directives and agreements on behalf of the City, called for by this Agreement, except as otherwise expressly provided in this Agreement. Contractor shall designate a representative for purposes of this Agreement who shall be authorized to issue all consents, approvals, directives and agreements on behalf of Contractor called for by this Agreement, except as otherwise expressly provided in this Agreement. 13. .Project Managers. The Costa Mesa Fire Department (CMFD) EMS Coordinator shalt be the Pxoject Manager designated by the, City to work directly with Contractor in time perfonnance of this Agreement. Contractor shall designate a Projecan A Mager who shall represent it and be its agent in all consultations with City during the term of th s Agreement. Contractor or its Project Manager shall attend and assist in all coordination meetings called by city. 1.4.Notices. Any notices, docurnsuts, correspondence or other communications ooaceraing this Agreement or the work hereunder shall be made in writing and nmay be provided by personal delivery, facsimile or mail and sb.all be addressed as set forth below, Such communication shall be deerned served or deli -vexed: a) at 'the time of delivery if such communication is sent 'by personal delivery; b) at the tune of transmission if such cornmunieetion is seat by facsimile; and c) 48 hours after deposit in the U'.& Mail as reflected by the official Tr,S, postmark if such communication is sent through regular United States mail, IF TO CONTRACTOR: Care Ambulance Service, Tie, 1517 W. Bramderm Corot Orange, CA 92868 . Tel: 714-288-3800 Pax: 714-288-3802 Attn: Rick Richardson IF TO CITE'': City of Costa Mesa 77 Fair Drive Costa Mesa, CA 92626 Tel; 714-754-5155 Fax: 714-734-4944 Attn; EMS Coordinator Ambulance PtJA r c. -Drug -free oPlcpjane Palicv, Contractor shall provide a drug-free workplaoe by oornplying with all provisions set forth in City's Council policy 100-5, attached hereto as Exhibit "D" and incorporated herein by reference. Contractor's failure to conform to the requirements set forth in Council Policy 100-s shall constitute a material breach of this Agreement and shall be cause for imnmedlate termination Of this Agreement by City, 1.6, !ttorneys' Fees. In the event that litigation is brought by any party in connection with this Agreement, the prevailing party shall be entitled to recover from. the opposing party all costs and expenses, including reasonable attorneys' fees, incurred by the prevailing party in the exercise of any of its rights or renmadies hereunder or the enforcement of any of the terms, conditions, or provisions hereof. 1,7. Qove=ine LaLr. This A,gzeement shall be governed by and construed under the laws of the State of California without giving effect to that body of laws pertaining to conflict of laws, In the event of any legal action to enforce or interpret this Agreement, the parties hereto agree that the sole and exclusive venue shall be a court of competent jurisdiction located in orange County, California. 1.8. Assignment, Contractor shall not voluntarily or by operation of law assign, transfer, sublet or encumber all or any past of Contraotor's interest in this Agreement without City's prior written consent, Any attenrpted assignment, transfer, subletting or enoumbrance shall be void and shall constitute a breach of this Agreement and cause for termination of this Agreement, Regardless of City's consent, no subletting or assignment shall release Contractor of Contractor's obligation to perform, all other obligations to be performed by Contractor hereunder for tile term of this Agreement. 1.9. hidemnificatipn and Hold armless. TO the fullest extent pemxnitted 'by law, Contractor shall protect, defend., indemuify and hold harmless City and its elected and appointed officials, officers, and ernployecs, from any and all claims, liabilities, expenses, including attorney fees, damage to property or injuries to or death of any person or persons or damages of any nature including, but not by way of limnitation, all civil claims or rvorl<ers' compensation claims arising out of or in any way connected witlm the intentional or negligent acts, error or omissions of Contractor, its employees, agents or subcontractors in the performance of this Agreement. 1,10. kdepei2dent t"orrNraatar, Contractor is and shall be acting at all times as ao independent: enntraotor and not as an employee of City, Contractor shall secure, at its expense, and be responsible for my and all payment of Income 'fax, Social Security, State Disability Insurance Compensation, Unemployment Compensation, and other payroll deductions for Contractor and its officers, agents, and employees, and all business licenses, if any we required, in connection with the semvices to be performed hereunder, 1. T 1. PERS Eliibili Indemniftcation. In the event that Contractor or, any employee, agent„ or subcontractor of Contractor providing sorvioes under this Agreemoot claims or is determined by a court of competent jurisdiction or the California Public Employees Retirement Systom (:PERS) to be eligible for errrollmoat in PERS as an, e;mployoe of City, Contractor shall indemnify, defend, and hold harmless City for the paymont'of any employee and/or employer Arnbulartce PPA contributions for PERS benefits on behalf of Contractor or its employees, agents, or subcontractors, as well as for the payment of any penalties and interest on suoh contributions, which would otherwise be the responsibility of City. Notwithstanding ally other agency, state or federal policy, rule, regulation, law or ordinance to 'the contrary, Contractor and any of its employees, agents, and subcontractors providing service under this Agreement shall not qualify for or become entitled to, and hereby agree to waive any claims to, any compensation, benefit, or any incident of employment by City, including but not limited to eligibility to anroll in PERS as an employee of City and/or entitlement to any contribution to be paid by City for employer contribution and/or employee contributions for PERS benefits. 1,12., has actions. The ZMS Coordinator, or any other person designated by the Fire Chief or City Manager, shall have the authority to inspect all facilities, properties, vehicles, documents, and records of any type of data storage means furnished or prepared by Contractor or any of its subcontractors in •tlae course of performance of this Agreement. City shall also be entitled to receive copies of any documents or records it may request upon reasonable notice to Contractor. 1.19. Public Records Act Disclosure, Contractor has been advised and is aware that ail reports, documents, information and data including, but not limited to, computer tapes, discs or files furnished or prepared by Contractor, or any of its subcontraetors, and provided to City may be subject to public disclosure as required by the California Public Records Act (California Government Code Section. 6250 at. seq•). Exceptions to public disclosure may be those documents or information that qualify as trade searets, as that term, is defined in the California. Goverraront Code Section 6254:7, and of which Contractor informs City of such trade secret. The City 'will endeavor to maintain as confidential all information obtained by it that is designated as a 'trade seerot. The City shall not, in any way, be liable or responsible for the disclosure of nny trade secret including, without limitation, those records so marked if disclosure is deemed to be requited by law or by order of the Court. 1.14. Responsibility for Errors, Contractor shall be responsible for its work and results under this Agreement. Contractor, when xequested, shall furnish clarification andior explanation as may be required by the EMS Coordinator or other City -designated representative, regarding any services rendered under this Agreement at no additional cost to City. In the event that an error or omission attributable to Contractor occurs, then Contractor shall, at no cost to City, provide all necessary paperwork regarding Contractor professional services necessary to rectify and correct the matter to the sole satisfaction of City and to participate in any meeting required with regard to the correction. 1,15, Contractor will not employ any regular employee of City while this Agreement is in effect without Prior approval by the Fire Chief, 1.16. Coats, Eaoh party shall bear its own costs and fees incurred in the pxopars tion and negotiation of this Agroomeat,and in the performance of its obligations hemmdex except as expressly provided herein. Arnbutance PSA 1,17. N2 Third Panyty Bene,�hts, This Agreement is entered into for the sole benefit of City and Contractor and no other parties are intended to be direct or incidental beneficiaries of this Agreemont, and no third party shall have any right in, under, or to this Agreement, 1.18 Ilea 'aa s. Paragraphs and subparagraph headings contained in this Agroemeat are included solely for convenience and are not intended to modify, explain, or to be a full or accurate description of the content thereof and shall not in any way affect the meaning or interpretation of this Agreement. Cortstruction. The parties have participated jointly in the negotiation and drafting of this Agreement. In the event an ambiguity or question of intent or interpretation arises with respoot to this Agreement, this Agreement shall be construed as if drafted jointly by the parties and in accordance with its fair meaning, There shall be no presumption or burden of proof favoring or disfavoring any party by virtue of the authorship of, any of the provisions of this Agreement. 1.20. Amendments. Only a writing executed by the parties hereto or their respective successors and assigns may amend this Agreement. 1.21. VJaiyex. The delay or failure of either party at any tim. (, to require performance or compliance by the other of any of its obligations of agreements shall in no way be deemed a waiver of those rights to require such pezHbxmance or compliance. N?o waiver of any provision of this Agreenimt shall be effective unless in writing and signed by a duly authorized representative of the party against whom enforcement of s waiver is sought. The waiver of any right or remedy in respect to any occurrence or event shall not be deemed a waiver of any right or remedy in respect to any other occurrence or event, ,or shall any waiver constitute a continuing waiver. 1,22. Severability. If any provision of this Agreement is determ ned by a court of competent jurisdiction to be unenforceable in any circumstance, such determination shall not affect the validity or errforceabihty of the xamruning terms and provisions hereof or of the offending provision in any other circumstance. Notwithstanding the foregoing, if'the value of this Agreement, based upon the substantial benefit of the bargain for any party is materially impaired, which determination as made by the presiding court or arbitrator of competent jurisdiction shall be binding, then both parties agree to substitute such pxovision(s) thrm,eb good faith negotiations. 1,23. Counterearts. This Agrooment may be executed in one or more counterparts, each of which shall be deemed an original. All counterparts shall be construed together and shall constitute one agreement, 1.24. Corpgrata Aixthorlty. The persons executing this Agreement on behalf of the Parties hereto warrant that they are duly authorized to execute this Agreement ou behalf of said parties and that by doing so, the parties hereto are formally botuad to the provisions of this Agreement. y Ambulance PSA 1.25. Reeods and�(�dits, Records of Contractor's services relating to this Agreement shall be maintained in accordance with, generally recognized aecoauating principles and shall be made available to City for inspeotlon and/or audit at mutually convenient tinges tbxcughout the term of this Agreement (including any extensions), and for a period of three (3) years after the Agroernent is terminated for any reason. Contractor shall also follow and is subject to the -record and audit requirements set fortis in the :RFP. 2.0, EMERGENCY ,4lYM LANCE SERVICES PROVIDED 1St,'' CONTRACTOR 2.1. ,Boone of Emergig-cy Ambuanee Services. During the term of this Agreement cad any extension, Contractor shall provide the BLS and ALS emergency ambulance services in .the City of Costa .Mesa (the "Services"). The Services provided by Contractor under this Agreement shall be performed in accordance with the terms of this Agreement, the tat= of the City's RFP (Exhibit "A" and Exhibit 11S311) and in Contractor's Proposal (Exhibit "C"). 2.2. 1nter_Anener Cozrinr� icationslz Paee 18 Item V A cl, The on -duty field supervisor shall be equipped with bath a mobile and a portable 800 MHz radio that enables him/her to cormnunieats directly with CMFD field personnel at all times• 2.3. Data Collection and RPporKi na (RS 1' Page 19, Item V A 9 a). Contractor small not be required to provide "Transfer of Care Tirane" or "At Patient Time" as part of the data reporting requirements listed in the original UP, 2.4. Additional Vel,4cle Equip_ Z CUR Page 20 Item V B.S.a.). Contractor shall equip all four CMFD ambulances (3 primary, 1 roaerve) with both an on -board 800 MHz radio, and at least one portable 800 A/Mz radio for the crew to carry. 2.5• Required Medicalvent() RFP Page 21 Itetrt V 13 6 a). CN91) has replaced all FernoTrac Adult Flare Traction Splints with the 'Sager Model 5304 Form III Bilateral splints. Therefore, all CMFD ambulances shall be equipped, with Sager Model S304 Foran SII Bilateral splints. 2.6. Facility Furxusll� atnd InventQMARP—2-a-ge 7_2 Stern V.C•2.c . Each ambulance station shall be ftuxaished with a television that has both DVD and VHS playback capability, which may be used for both education and entertainment purposes. 2.7. FuiLlislaffigs and Inventory (RFP Page 72 Std V.C.2 dl, Each ambulaaoe station shall maintain a library that includes the following: (a) Manufacturer instruction manuals for EMS equipment on ambulance. (b) Current Orange County EMS Agency Treatment Guidelines manual. (0)Primary paramedio textbook currently used by Saddleback College. P. 1 rimary EMT textbook currently used by Saddleback College. (e) 2005 American Kogit Association ECC Guidelines. (7 Current Orange County Thomas Guide map book. (g) Journal of Emergency Medical Services (JEMS) magazine subscriptdon: Arnbul. ce ?3A 2,8, a is ,inks and l tverltory (RFP gage 23 item VC 7.e). Each ambulance station shall be equipped with a computer system, including a printer, with high-speed Internet access, Adobe Acrobat Reader software, mad Microsoft Word software, Each Costa Mesa Ambulance Operator will have an e-mail address that slhe can access at his/her assigned ambulance station, and to/from which the EMS Coordinator may send/receive e-mails directly. Each Costa Mesa Ambulance Operator shall check hislher e-mail in -box at least once per 24- houx shift. E-mails from tine EMS Coordinator shall be read immediately or as soon as practical, and responded to Promptly when requested. 2.9.ersoiural Onalifications (RFP Page 23 Iter Vr.D.l.U. Contractor may staff any CMFD ambulance with an employee who is not an authorized emergency ambulance driver, with the caveat that all four CMFD ambulances shall be staffed by at least one quallfad and authorized emergency ambulance driver at all times, 2.10. Roster (RFP Page 13 , Ttem V.AM. In addition to the roster information already specified in the RFP, Contractor shall indicate whether each Costa Mesa Ambulance Operator is an authorized emergency ambulance driver or not. 2.11, '1?axsanrxal ebals (RIP Pace 23, ltezn tI.D.2.g�. Contractor shall have tine option of keeping emergency driver safety course completion documentation for Costa Mesa Ambulance Operators at its headquarkexs or other designated facility, so long as the documentation is available fox inspection by the EMS Coordinator, the on -duty CMFD Battalion Chief, any CM'PD member designated by the Fire Chief, or any person designated by the City Manager. 2.12. Medical Examination R14F Pa a 24,_Ttem V.DD D, Contractor shall not be required to perform a restixxg 12 -least electrocardiogram on pre -hire EMT candidates. 2,13. Time Standards�RFp Pase 2g, Iteza V. .3 . Cot°.traotox shalt meet all greuaad ambulance time standards at a compliance rate of at least 93%'(fractile), rather than the 90% rate specified in the original RFP. 2.14 Negithhisurance Portabilit_aald Accgtintabi ity art CH7p A The parties agree .that each is a Covered Entity as that tans is defined in HIPPA, 4$ CFR. Part 160.103. Each has an independent obligation to maintain the confidentiality of protected health information of persons who are provided medical services by Crty, Contractor or both. `therefore, the parties have not and need not enter into a Business Association Ag:eeruent, and each will endeavor w maintain the goxlfidentWity of any protected health information that tis obtained front any patient treated by City and/or Contractor. 2,15. P' .essiox r cticos, All Services to be provided by Contractor pursuant tb this Agrcemexrt shall be provided by personnel experienced in their respective fields said in a manner consistent with the standards of care, diligence, and skill ordinarily, exercised by professional contractors in similar fields and circumstances in accordance with sound professional practices and as explavaed in the RFP. Contractor also warrants that it is £arrtiliar with all laws that may affect its performance of this Agreement and shall advise City of any changas in any laws that may affect Contractor's performance of this Agreement. Aml,mlance FSA 2,16, Warranty, Contractor warratats Haat it shall perform Services required by this Agreement in compliance with all applicable ,Federal and California employment laws including, but not limited to: laws related to minimum porus and wages; occupational health and safety; fail employment and employment practices; Health Insurance Portability and Acoottatability Act (HIPAA); workers' compensation insurance and safety in omployinen't; and all other Federal, State, and local laves and ordinances applicable to the services required under this Agreement. Contractor shall indemnify and hold harmless City from and against all clairns, demands, payments, suits, actions, proceedings, and judgments of every nature and description including attorneys' fees and costs, presented, brought, or recovered against City for, or on account of any liability 'under any of the above-mentioned laws, which may be inouxred by reason of Contractor's performance under this Agreement, 2,17, Noir-discrimination. In performing this Agreement, Contractor shall not engage in, nor permit its agents to engage in, discrimination in employment of persons because of their race, religion, color, national origin, ancestry, age, physical handicap, medical condition, marital status, sexual gender ar sexual orientation, except as permitted pursuant to Section 12940 of the Government Code, 'Violation of this provision may result in the imposition of penalties referred to in Labor Code, Section 1735, 2.1 S. Delegation and Assi nrnent. This is a personal service contract, and the duties set forth herein shall not be delegated or assigned to any person or entity without the prior written consent of City, Contractor may engage a subcontractors) as perrxdued by law and may eraploy other personnel to perform. services contemplated by this Agreement at Contractor's sole cost and expense. 3.4." PATIENT BILLING SERVICE PROVIDED BY THE' CONTRACTOR 3.1. Scope of Patient Billing Services. Contractor shall provide the patient billing services described in the .RYT (PST pages 32, 33) and Addendums attached, hereto as Exhibit `13,".acrd incorporated herein by reference and Contractor's Proposal. 3.1 No Corxlpensation to Contractor�om City, (a) Contractor will not be compensated by the City, for its Services under this ,Agreement, Subject to the terms and conditions of this Agreement, Contractor will be compensated solely by billing patients, both residents and non-residents, for ambulance -related services provided by Contractor in the City according to the Ground Emergency Ambulsmoe Service Rates established by the Orange County Board of Supervisors (orange County .EMS Agency Policy *720.00, Section 312). (b) City assrma.es no financial liability for the cost of sexvices to be provided 'to patients pursuant to this Agreement, including financial liability for the costs o:fdryrnns (non -transports). Amb,alaxtce PSA (c) .Pursuant to Title 42 United States Code Sections 1,320•a•7b(b), as consideration for Contractor's agreement to provide billing services for City, City shall provide Contractor with tho use and support of dispatching services necessary to fulfill the obligations of this Agreement. The parties acknowledge that the total value of the services rendered by Contractor to City for billing services end the value of services rendered by City to Contractor under this Agreement for dispatching services axe impractical to determine with any reasonable degree of specificity, but are believed to be equivalent. Consequently, the parties agree that the value of the services each party rendors to the other under,this section shall be deemed equivalent and neither peaty shall owe -the other party any further monetary consideration, 3,3, Zine Department bees, Contractor shall bill, collect, and reimburse to City the following Fire Departrnont fees identified in this section 3.3 ("Fire Department Fees"), The Fire Department fees shall only be billed to persons who are not residents of Costa Mesa, as detarmined by the patient's residential address, Fire Department fees are subject to futrrxe modification as determined by the City, and Written notice of any such fee changes shall be given' to Contractor by City. 'The Fire Department fees to be billed by Contractor are as follows: (a)it t Resnender Fee, A fee of $260,00 will be charged to all nonresident patients who are transported by ambulance. This fee is it tended to help offset some of the response -related costs borne by City, including the dispatch and response of 'Fre appamt s and professional EMS responders, in addition to all pxehospital emergency medical assessmentanal ttaatrmnt performed on scene by CMFD personnel. 1, Contractor shall identify, code, bill and collect all response fees on behalf of City for E1vtS response services rendered by the Costa Mesa Fire Department. Such billing shall be conducted on a separate bill from Company's ambulance transport bill and shall include the, City of Costa Mesa logo and taxpayer identification aurnber. 2. Contractor shall ensure that all amounts billed and collected on behalf of. city are separately identified within Ilia accounting records in sufficient detail to allow fox verification and audits by City, and that such records will be retained for the current year of Operation and for the preceding six (6) years. Contractor shall establish a separate jail -4t billing agency tnrst or checking account for the deposit of all response fees collected ou behalf of City. Contractor shall, on or before the close of businaae on the last day of every calendar month, remit all funda collected on behalf of the City miring the immediately preceding calendar month. Ambulance PSA (�)S (Adm ad iFe art Fes, A Fee of $160.00 will be oharged to all non-resident patients who are transported by ambulmoe with paramedic escert because their medical condition warrants ALS level assessment and/or treatment. This fee is intended to help offset some of the costs borne by City for providing Contractor paramedics so that Contractor has the ability to transport patients requiring ALSdevel care. Contractor shall, on or before the 0,1080 of business on the last day of every ealeaaclar month, remit —with a separate cheek all ALS fee :Funds collected during the immediately preceding calendar month. 3.4, 5rr Rei urseu ae t, Contractor shall reimburse City 118.15 for oaoh patient transported by ambulance, regardless of what Contractor actually collects from the patient. This reimburscraaent is intended to help offset some of the costs borne by City for expendable medical supplies used during patient care. Contractor shall, on or before the close of business on the last day of every third calendar .month, remit, with a separate check, all supply reimbursement funds collected during the immediately preceding three (3) calendar months. 3.5. J3illraa Exen 'ons Rage 33 Item VI,134 b,). Contractor may bill any Patient in law enforcement custody or othoxwise legally detained by power of government who is transported by ambulance. 3.6. A dditio al Services, Contractor shall not receive compensation for any services provided outside The scope of Services described in this Agreement (including the attached Exbjbits) unless City,. Prior to Contractor performing the additional services, approves such additional services in writing, It is sp5c0cally understood that oral requests and/or appxovale o£ such additional services or additional compensation shall be barred and are unenforceable, 4.0. TBM OF PTiRYORMANCD+ 4,1. C_ omme oament pad Cgmpl®tion nP I The pro[-assional Services .to be performed pursuant to this .Agreement shall conamenaa on September 1, 2008, at 7:30 a.m, Vellum to cor mance work in a -timely manner and/or diligently pursue work to completion during the Tenn of this Agreement may be grounds for termination of this Agreement. 4.2, R�cusabla Delays. Neither party shall be responsible for delays or lack of performance resulting from acts beyond the reasonable control of the party or parties• ExOmptions to ambulance response time standards may be granted at the sole discretion of the FMS Coordinator upon request by Contractor ill tho following situations: (a) Any condition, such as weather, so severe as to impair the ability of -the ambulance crew to meet the time standards without driving at a speed that is greater than is masonabie or prudent under the conditions, and/or in a manner that: does not afford due regard for the safety of others, (b) In times of natural or mora -nada disasters, which have been declared by tlxe appropriate governmental agency, ambulance response time standards 10 Arxtbulazxe PSA may be presirmed waived unless told otherwise by the t Coordinator Or other CMl!I) Chief Officer, acid until such time as the disaster is mitigated and normal operations are restored. 5.0, TERM AND TERMINATION 5.1, Tern', The terse of this Agreement shall commence on September 1, 2008, at 7;30 a.m., and continue for a period of two (2) pears, ending on September 1, 2010, at 7:30 a.m., unless previously terminated as provided herein or as otherwise agreed to in writing by the parties (the "Initial Term"). 5.2., Bxtea'siOn o£Term At the expiration of the Initial Term, and at the expiration of any subsequent terse (if any), Contraotor may request City to extend the Agrsemea't for an additional 2 -year term. In no event shall this Agreement last more than a total of ten (10) years, including the Initial Term and any extensions thereto, 5,3, Notfce a TerrWagion. The City reserves and has the right and privilege of canceling, suspending, or abandoning the execution of all or any part of the work contemplated by this Agreement, with or without cause, at any dine, by providing written notice to Contractor, The termination of this Agreement shall be deemed effective upon receipt of tlaa notice of termination. In the event of such torminatioo, Contractor shall immediately stop renderirg services under this Agroam6nt unless directed otherwise by the City. 5,4, oa ants. h' the event of tessa'ination of this Agreement, all documents prepared by Contractor in its performance of this Agreement including, but .not .limited to, finished or iiiih niched design, development and construction docuunents, data studies, drawings, maps and reports, shall be delivered to the City within ten (10) days of delivery of termination notice to Contxactor, at ho cost to City, .Any use of ut'oompleted documents without specirc written authorization from Contractor shall be at City's sole risk and without liability or legal expense to Cor..tractor. G.O. INSURANCE 61 Confrollinr Insuranceravisi ns. Tho insurance provisions delineated in this Agreement supersede any insurance -related provisioaz of the Original RPP (inoluding RFP Pages 14-16), addandums, and/or Proposal 6.2. Minix' run Scope aaad units of Insurance. Contractor shall obtain and xnainrain during the life of this Agroornent all of the following insurance coverages: (a) CamprOhmslve general liability, inclu.d.ing premises -operations, products/cora'pleted opexatiom, broad form property damage, 'bl ecet contractual liability, indepandent contractors, personal i¢ijury with a policy limit of not less 'than Tluee Million Dollars ($3,000,000,00) per occurrence, If the policy carries an arn'ual aggregate, it shall be in an 11' Ambulance PSA anwunt not less that, Six Million Dollars ($6,000;000,00). (b) Automobile liability for owned vehicles, faired, and non.-cwmd vehicles, with a policy limit of not less than Three Million Dollars ($9,000,000.00) per occurrence, If policy carries an annual aggregate, it shall be in amount not less than Six Million Dollars ($6,000,000,00) • (c) Workers' compensation insuranea as,required by tlse State of California (d) Ambulance Medical Malpractice Insurance ("E&0") liability insurance with policy limits of not less than Three Million Dollars ($3,000,000.00) Per policy terns, If policy carries an annual aggregate, it shall be In an amount not less thein Six Million Dollars ($6,000,000.00) per ooeurrenm Such insurance coverage may be combined with either the general or automobile liability coverage required above. However, if the insurance coverage is so structured, the combined Coverage shall be in an amount not less than Five Million Dollar -s ($5,000,000.00) per occurrence, with at, annual aggregate of not less than Tart .Million Dollars ($10,000,000.00)• Contractor shall obtain and maintain, said D&O liability insurance during the life of this Agreement and for three years after carnpletion of the work hereunder. 6.3, Endorsements, The Comprehensive genezal liability insurance policy shall contain or be endorsed to Contain the following provisions: (a) Additional insureds: "The Czty Of Costa Mesa and its elected and appointed boards, officers, agents, and employees are additional insureds with respect to this subject project and contract with City," (b) Notico: "Said policy $hall not terininate, nor shall it be cancelled, nor the coverago.reduced, until flzrty (30) days altar written notice is given to City." (C) Other insnrrarnce; "Any other znsMance maintained by the City of Costa Mesa shall be excess and not contributing with the insurance provided by this policy." 6.4•, errs cafe o Tr�surance. Contractor shall provide; to City certificates of nsurance showing the insurance coverages and required endorsements described above, in a form and content approved by City, pr*to performing any services under this Agreement• 6.5. Non -Linn tine. Nothing in this Section shall be construed as l.imitirag in any way, the indemnification provision contahied in thus Agreement, or the extent to which Contractor naay be held responsible for. payments Of damages to persons or property, 12 .Ambulance P50A IN WITNESS WHEREOP, the parties hereto have caused this Agreeanont to be executed by and through thein• respective. authorized officers, as of the date first above written, CITY OF COSTA MESA, A attunicipal corporation Mayor of C,IT`Y the City Of Cdgt a Mesa CARE AMBULANCE SERVICE, INC, Signature Name and Title ' Sncia[ Seaau•ity or Taxpayer ID Number Date, Date; _ iL APPR VLD AS TO FORM: Cit Atorney �— Date: Y APPROVED AS. TO SURANCE; Risk agetnear _ — Date: %2 P APPROVED AS TO CONTENT, EMS Coordinator .`" ATTEST: 13 JUI. F'01 -Cl x CK Date: _ 3 3�0& Ambulance ESA 9 EXHIBITS EXHIBIT" A: RFP (attached) EXHIBIT B: ADD ENDUMS (attached) EXHIBIT." C: PROPOSAL (attached) EM-11BIT D: CITY COUNCIL POLICY 100.5 (see 'below) EXHIBIT E: CERTIFICATES OF INSURANCE (attached) 14 A.xx bulaace PSA DRUG-FI2P WOR.ICPLACE QQi�If, BEP 18-S 89 I l af3 Under the Federal Drug -Free 'Workplace Act of 1988, passed as part of omnibus drug legislation enacted November 18, 1986, contractors and grantees of Federal funds inust certify that they will Provide drug-froe workplaces, At the present tune, the City of Costa Mesa, as a sub�tee of Federal Rinds under a variety of programs, is required to abide by this A.c8 granThe City Council has expressed its support of the national effort to eradicate di -ug abuse through the creation of a Substance Abuse -Committee, institution of a City-wide D.A.R.R program in all local schools andother activities in support of a drug-free commurrity. This policy is intended to extend that effort to oontractors and grantees of the Cit in the workplace, y Of Costa Mesa in the elimination of dangerous drugs PUitP S.E It is the purpose of this Policy to: 7. Clearly state the City of Costa Mesa's commitment to a drug-free society, 2. Set forth guidelines to ensure that public, private, and nonprofit organizations receiving funds L-om, the City of Costa Mesa share the cohnnlituunt to a drug-free workplace. POLICY The City .Manager, under direadon by the City Council, shall take the neressary steps to see that the following provisions are included in all contracts and agreements entered into by the City of Costa Mesa involving the disbuxsernent of Ainds• 1, Conkxaatax oz 5ixb-grantee hereby certifies that it will provide a drug••free workplace by: a. Publishing a statement notifying employees that flys unlawful rnanufaoture, distribution, dispersing, possession, or use of a cotutrolled substance is pxahbited in Contractor's and/or sub -grantee's workplace, specifically the job site or location included in this contract, and specit ing the aotions that will be taken against the employees for violation of such prohibition; 'l5 Ambulancce PSA. DATE DRU-P'RP�EWO.PXPLACE I 0.5 I8-8 89 I2of3 a Drug -Free Awareness Program to 1, The dangers of drug abuse in tine workplace; 2. Contractor's and/or sub_graatee',s policy of maintaining a drug-free workplace; 3. Any available drug counseling, rehabilitation and employee assistance programs; and 4• The penalties that may be imposed upon employees for drug abuse violations occurring in the workplace; C, Making it a requirement that each eanployee to be engaged in the pe,*rmance of the contract be given a copy of the statement required by subparagraph A; d. Notifying the employee in the statement required by subparagraph 1 A that, as a condition of employment under the contract the employee will; I. Abide bythe terms of the statement; and 2. Notify the employer of aany criminal drug statute conviction for a violation oecurri.ng in the workplace no later than five (5) days after such conviction; e. Notifying the City of Costa Mesa, Within ten (10) days after receiving notice under subparagraph 1 D 2 from an employee suG1'4 conviction; or other -wise receiving the actual notice of £ Talcing one of the fallowing actions within thirty (30) days of receivingnotice under subparagraph 1 D 2 with respect to an employee who is so convicted: I. Taking appropriate personnel action against such a1n employee, up to and includingterrnination; or 2. Requiring su.cla empioyeo to participata satisfactaxily in a cir zg abu,so assistance or rehabilitation program approved for such purposes by a. 1~ederal, State, or local health agency, law enfcarcennent, or others appropriate agency; 1.6 Azrrbulance PSA DATE ER DRUG-MBEWORKPLACE E 100 8 18.8-89 13 of 3 g, Maizing a good faith effort to maintain a drug-free worleplace througlx implementation of subparagraphs 1 A thrcugh 1 F, inclusive 2. Contractor and/or subgrantee shall be deemed to be in violation of this Policy if the City of Costa ,Mesa determines that; F, Contractor and/or sub -grantee has made a false certification tinder. paragraph 1 above; b. Contractor and/or sub -grantee has violated the certification by failing to carry out the requirements of subparagraphs l A through 10 above; Q, Such number of employees of Contractor and/or subgrantee have been convicted Of violations of orhmnal drug statutes for violations 000urring in the workplace as to indicate that the cantractar and/or sub -grantee has failed to mala a good faith effort to provide a drug-frae workplace, 3. Should any contractor and/or sub -grantee be deemed to be in violation of this Policy pursuant to the provisions of 2 A, B, and C, a suspension, termination or debarment proceeding subject to applicable Federal, State, and local lows shall be conducted. Upon. issuance of any final decision under this section requiring debarxuent of a contractor and/or srab-grantee, the conixactor and/or sub -grantee shall be ineligible for award of any contract, agreement or grant foam the City of Costa Mass for a period speoifed in the decision, not to exceed five (5) years. Upon issuance of any final decision, recominer?dan.g against debarment of the contractor and/oz stAb,grantee, tlza contractor and/or subgratatae shall be eligible far compensation as provided by law, 17 Arnbulance PSA Attachment 2 AMENIDMENT NUMBER ONE TO AMBULANCE SERVICES AGREEMENT This Amendment is made and entered into this 1 at day of September, 2013, ("Effective Date") by and between the City of Costa Mesa, a municipal corporation ("City") and Care Ambulance Service, Inc„ a California Corporation ("Contractor") WEEREAS, Contractor and City entered into an agreement on September 1, 2010, for Basic Life Support (SLS), Advanced Life Support (ALS) and patient billing services (the "2010 Agreement"); and WHEREAS, the term of Contractor and City's 2010 Agreement is scheduled to expire on September 1, 2013; and WHEREAS, Contractor and City now wish to amend the Agreement to extend the term of the Agreement as permitted by Section 5.2 of the 2010 Agreement, NOW, THEREFORE, for valuable consideration, the receipt and sufficiency of which is hereby acknowledged, the Parties agree as follows: 1. Paragraph 5,1 shall be amended to read, "This Agreement is extended and the extension shall commence on September 1, 2013 at 7:30 a.m. and continue for a period of one (1) year, ending on September 1; 2014 at 7:30 a,m, unless previously terminated as provided herein or as otherwise agreed to in writing by the parties." 2. All terms not herein defined shall have the same meaning and use as set forth in the Agreement, All other terms, conditions, and provisions of the 2010 Agreement not in conflict with this Atmendment, shall remain in full force and effect. IN WITNESS WHEREOF, the Parties hereto have set their hand by their duly authorized representatives as of the day and year first above written, SIGNATURES 02V NEXT PAGE CITY OF COSTA MESA, A municipal corporation i Mayor Date: ( 0I2 0 1 c CARE ANMULANCE SERVICE, INC, Date: O1 )-z 6t '7.-U3 Signatdii Name and Title Social Security or Taxpayer ID Number �="v A�,f V=3� CAS \ AS TO CONTENT: ect Date: _� I � zo Zc13 APPROVED S TO FORM: Date: (�� �� CitAornevy - -� AMENDMLi NT NTIM13FR TWO TO AMBULANCE SPRVICES AGREEMENT This A IOndinent is made and entered into this I" day of September, 2014 ('Effective Late") by and between the CITY OF COSTA MESA, a municipal corporation ("C"ity") and CARE AMBULANCE SERVICE, INC;,, a California corporation ("Contractor,,), WHEREAS, City and Contractor entered into an agreement on September 1, 2010, for C:antractor to provide Basic Life. Support (BLS), Advanced Life Support (ALS) emergency ambulance services,, and patient billing services in the City; and WHEREAS, on September 1, 2013, the parties entered into Amendment Number One to the Agreement to extend the Agreement term as permitted by Section 5',2 of this Agreement; and WHEREAS, the parties desire to enter into this Arnondmem to further extend the Agreement tetra as polmitted by Section 5.2 of the Agreement, which allows for extensions providing that Hie total Agreement lasts no more than ten ,years. NOW, THEREFORE, the parties agree as follows: I, The term of the Agreement set forth in Section 5, 1, as amended by Amendment. Number One, is extended, and the extension shall cn'minence on Septctrtber 03 2014, at 7,30 a.m. andend on Septmber 17, 2014, at 7:30. a,m, 2, All Other tuns, conditions, and provisions of the Agreement not in conflict with this Amendment shall remain in full force and effect, IN W`CMESS WHEREOF, the parties hereto have set their hand by their duly authorized represcntutives as of the day and year First above written. CITY OF COSTA MESA, Amuoic pal corporation ,of k xecutive O,[kl'nez° CARP AMBULANCE S..MV'ICE, INC:, Signatc T Name audTide CITY COUNCIL AGENDA REPORT MEETING DATE: August 3, 2010 ITEM NUMBER: SUBJECT: Advanced Life Support (ALS) Cost Recovery Program DATE: July 20, 2010 FROM: Fire Department PRESENTATION Mike Morgan, Fire Chief BY: FOR FURTHER INFORMATION CONTACT: Mike Morgan, 714-754-5106 •LI II _►�� •i Adopt resolution that implements Advanced Life Support (ALS) Cost Recovery Program to maintain current level and quality of prehospital Emergency Medical Services (EMS) provided to Costa Mesa residents, without placing any additional financial burdens on Costa Mesa residents, under the following terms and conditions: 1. Costa Mesa residents will not be required to pay any costs for EMS that are in addition to whatever they would be paying under the current EMS billing system (i.e., Costa Mesa residents will not be subject to any additional costs due to implementation of this program). 2. Costa Mesa residents will continue to be exempt from paying the $275 first responder charge (only non-residents are billed for this). 3. Care Ambulance Service, which performs all EMS billing for the City per contract, will be authorized to begin billing the private insurance companies, Medicare, or Medi -Cal, of all resident and non-resident patients, a $300 ALS transport charge. 4. Care Ambulance Services will waive all patient co -pay and deductible charges of Costa Mesa residents that are specific to the ALS Cost Recovery Program. 5. Care Ambulance Service will waive the $300 ALS transport charge for all Costa Mesa residents who do not have any form of medical insurance or coverage. 6. Residents will not have to do anything to obtain a waiver: All waivers will be automatically reflected in the billing statement mailed by Care Ambulance Service, which will be an amount reduced according to the amount waived. 1 BACKGROUND: Care Ambulance Service performs all EMS billing for the City per contract. Because Care Ambulance Service is currently not authorized to bill Medicare, Medi -Cal, or the private insurance companies of residents for ALS transport, the City is in effect subsidizing these entities and losing a substantial amount of potential cost -offsetting funds in the process, to the detriment of Costa Mesa residents and the EMS system that they depend on. Prehospital EMS is a highly specialized field of medicine, and is thus constantly changing as improved technologies and treatments are developed (e.g., 12 -Lead EKG, Transcutaneous Pacing, Intra -Osseous Infusion, Capnography, Stroke Triage). There are necessarily costs associated with these new technologies and treatments, including continuous education and training, and quality assurance and control mechanisms. It is therefore imperative that the City provide reasonable cost -offsetting measures to ensure that Costa Mesa residents continue to receive the standard of care in the treatment of life-threatening or life -disabling illness and injuries. A further, more detailed discussion of both the billing process and level of Prehospital EMS is available on the City Website from the City Council Study Session of July 13, 2010. ANALYSIS: The City's goal in implementing the ALS Cost Recovery Program is to maintain the current level and high quality of prehospital EMS provided to Costa Mesa residents without placing any additional financial burdens on Costa Mesa residents. This program achieves that goal because it allows for an increase in revenue to provide needed funds to offset at least some of the costs of maintaining a modern EMS system, but without subjecting Costa Mesa residents to any additional costs. Under the current EMS billing system in which Care does not bill the private insurance companies, Medicare, or Medi -Cal, of Costa Mesa residents, the City's total estimated revenue from the ALS transport charge is $51,000 annually ($185 ALS charge x 688 non-resident transports @ 40% collection rate). However, under the proposed plan, the City would receive $338,000 annually ($300 ALS charge x 2818 resident and non- resident transports @ 40% collection rate), which represents an estimated net increase of $287,000 in additional cost -offsetting funds that are needed to ensure that Costa Mesa residents continue to be protected by a modern, state-of-the-art EMS system. ALS CHARGE COMPARISON OF OTHER CARE CONTRACT CITIES: $355.75 Orange County Fire Authority (22 member cities) $350.00 Anaheim $350.00 Buena Park $350.00 Garden Grove $343.25 Los Angeles County Fire Department (80 member cities) $343.25 Montebello $343.25 Santa Fe Springs 4 $325.00 Fountain Valley $300.00 Costa Mesa - PROPOSED $185.00 Costa Mesa - CURRENT ALTERNATIVES CONSIDERED: Qualified staff from both Costa Mesa Fire Department and Care Ambulance Service have thoroughly researched and structured this program to achieve the stated goals of increasing needed EMS cost -offsetting funds without subjecting Costa Mesa residents to any additional financial burdens. Because these goals are achieved with the proposed ALS Cost Recovery Program, no other alternatives were considered. FISCAL REVIEW: While there are no indirect costs for implementation of this program, it will allow the Fire Department to retain the position of Emergency Medical Services Coordinator which was proposed for elimination from the FY 2010-11 Operating Budget. This position is important not only in terms of the provision of EMS training, materials and supplies but oversight of the ambulance services contract and billing. Retention of this position will cost $142,725.00 with projected net savings (projected revenue minus position cost) of $195,275.00. LEGAL REVIEW: The City Attorney has reviewed the program as proposed and has concluded that the City may lawfully adopt the cost recovery program. The City Attorney has reviewed the Resolution and approved it as to form. Care Ambulance Service is the legally recognized EMS billing entity for the City per contract, and is thus authorized to modify EMS billing at the direction of the City Council. CONCLUSION: There are many costs associated with maintaining a modern EMS system that is capable of continuous adaptation to new and improved emergency medical technologies and treatments. The proposed ALS Cost Recovery Program will enable the Fire Department to continue providing Costa Mesa residents the highest quality EMS according to the standards of care and to the level that they deserve and expect, by billing medical insurance providers directly and without any additional costs to residents. Accordingly, the City Council is requested to adopt the resolution that implements the ALS Cost Recovery Program as proposed. MIKE MORGAN Fire Chief KIMBERLY HALL BARLOW City Attorney 3 ATTACHMENT: 1 Resolution to Implement the Advanced Life Support Cost Recovery Program DISTRIBUTION: City Manager City Attorney Deputy City Clerk Staff File Name Advanced Life Support Cost Recovery Program Date 7-23-10 Time 11:30 am IR RESOLUTION NO. 10- A RESOLUTION OF THE CITY COUNCIL OF THE CITY OF COSTA MESA, CALIFORNIA, TO IMPLEMENT THE ADVANCED LIFE SUPPORT COST RECOVERY PROGRAM. THE CITY COUNCIL OF THE CITY OF COSTA MESA HEREBY RESOLVES AS FOLLOWS: WHEREAS, the provision of Emergency Medical Services (EMS) is a critical function of city government that directly impacts the lives, health, and safety of all Costa Mesa residents; and WHEREAS, there are necessarily costs associated with maintaining a modern EMS system that is capable of adaptation to continuing improvements in medical technologies and treatments so that Costa Mesa residents receive high quality EMS according to the standards of care and at the level they deserve and expect; and WHEREAS, the Costa Mesa Fire Department and Care Ambulance Service, which performs ambulance and patient billing services for the City per contract, have developed an Advanced Life Support (ALS) Cost Recovery Program that will generate an estimated additional $287,000 annually in needed cost -offsetting funds without any additional costs to Costa Mesa residents; NOW THEREFORE, BE IT RESOLVED, that Care Ambulance Service is hereby authorized to implement the ALS Cost Recovery Program by raising the $185 ALS transport charge that is currently billed only to non-residents to $300, and by billing the medical insurance provider (e.g., private insurance company, Medicare, Medi -Cal) of residents a $300 ALS transport charge; and BE IT FURTHER RESOLVED, that Care Ambulance Service will waive any and all direct ALS transport charges, including ALS co -payment differences, for all Costa Mesa residents such that they will not be subject to any out-of-pocket expenses under the new ALS Cost Recovery Program that are in addition to whatever they would be paying under the current EMS billing system. PASSED AND ADOPTED this 3rd day of August, 2010. Allan R. Mansoor, Mayor ATTEST: Julie Folcik, City Clerk STATE OF CALIFORNIA ) COUNTY OF ORANGE ) ss CITY OF COSTA MESA ) APPROVED AS TO FORM: Kimberly Hall Barlow, City Attorney I, JULIE FOLCIK, City Clerk of the City of Costa Mesa, DO HEREBY CERTIFY that the above and foregoing is the original of Resolution No. 10- and was duly passed and adopted by the City Council of the City of Costa Mesa at a regular meeting held on the 3rd day of August, 2010, by the following roll call vote, to wit: AYES: COUNCIL MEMBERS: NOES: COUNCIL MEMBERS: ABSENT: COUNCIL MEMBERS: IN WITNESS WHEREOF, I have hereby set my hand and affixed the seal of the City of Costa Mesa this 3rd day of August, 2010. JULIE FOLCIK, CITY CLERK (SEAL)