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Orange County Emergency Transportation Services

Orange County Emergency Transportation Services. Presented to the Board of County Commission October 9, 2007. Presentation Outline. Introductions TriData: Emergency Transport Study Rural Metro Presentation Board Action. Presentation Outline. Introductions

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Orange County Emergency Transportation Services

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  1. Orange County Emergency Transportation Services Presented to the Board of County Commission October 9, 2007

  2. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  3. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  4. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  5. Presentation on the EMS Transportation Study Orange County, Florida October 9, 2007 Dr. Harold C. Cohen

  6. What was TriData asked to do? • Review EMS in the geographical area served by the Orange County Fire Department (OCFRD) and Rural Metro Ambulance (RMA). • Evaluate OCFRD’s ability to provide EMS transport services in the stated area. • Analyze other EMS models to determine strengths and weaknesses.

  7. What was TriData asked to do? • Provide a fully loaded cost accounting approach that included the American Ambulance Association (AAA) model and the International Association of Fire Chiefs (IAFC) model. • Determine the options available to Orange County for ambulance transportation in the RMA geographical area.

  8. Current EMS Transport Service Areas

  9. Process and Methods • Risk and demand analysis • Inter-jurisdictional comparisons • A review of EMS models • A comparison of three EMS revenue/costing models • Identification of organizational implications • Options and recommendations

  10. What were our key findings? • The current OCFRD/RMA model is redundant. • OCFRD is capable of assuming EMS transport in the area served by RMA. • The current contract performance requirements are unclear, making performance measurement and enforcement difficult.

  11. What were our key findings? • RMA’s service to the City of Orlando is efficient and should continue. • RMA does not respond to all requests 100% of the time. • OCFRD’s take over of EMS transportation could generate additional revenue by FY 2009.

  12. What choices does Orange County have? • Option 1: Continue the public/private partnership. • Option 2: Upon expiration of RMA’s contract, have OCFRD assume EMS transportation in RMA’s unincorporated Orange County area by January 1, 2008 • Option 3: Extend RMA’s contract at least July 1, 2008, at which time the OCFRD would assume EMS transportation in the former RMA area.

  13. Option 1: Public/Private Partnership • Negotiate a contract that has clearly defined performance and enforcement parameters. • Whatever is negotiated should be enforced! • Provide for strong oversight by the Orange County EMS Office.

  14. Option 1: Re-bid issues • Could not be accomplished by January 1, 2008. • May lead to unhealthy competition that could effect emergency and non-emergency services. • System size precludes most commercial EMS agencies from bidding.

  15. Option 2: OCFR to takeover RMA area on January 1, 2008 • The transition will be rushed. • May lead to an implementation schedule that is less efficient. • Does not allow RMA time to make adjustments for a new operational model.

  16. Option 3: OCFRD to takeover RMA transport area on or after July 1, 2008 • This is the most viable option for all constituent groups. • OCFRD will have the opportunity to plan for the most efficient transition of service. • RMA will have lead time to make operational adjustments.

  17. What will OCFRD need to make this plan operational? • Three additional full-time rescue units (Stations 72, 42, and 51) • Four additional peak-load units, in-service from 10 AM to 10 PM. • Two covering the first due areas of Stations 30, 40, 41, 42, and 43 • Two covering the areas of Stations 50, 51, and 53

  18. What will OCFR need to make this plan operational? • 44 additional personnel (worst-case scenario) • Possible negotiation of a 48-hour shift to cover peak-load units • All personnel should continue to be dual-role/cross-trained for fire and EMS • Rescue units should be equipped to perform multiple EMS and fire functions as is presently the case

  19. Additional full-time rescue units

  20. Additional Peak-Load Units

  21. Benefits to Orange County • Faster response times for EMS service • A consolidated/organized approach to EMS delivery • The ability for Orange County to realize a positive cash-flow

  22. Financial Benefits to Orange County

  23. Conclusion • Option 3 is the best choice. OCFRD should take over the area currently served by RMA on or after July 1, 2008. • OCFR will need three additional full-time rescue and four peak-load units. • OCFR will need a maximum of 44 additional personnel. • Significant revenue enhancements should occur in FY 2009.

  24. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  25. Presentation to Orange County Board of Commissioners October 9, 2007 Presenter: Robert “Boo” Heffner, President West Emergency Services Group, Rural Metro Corporation

  26. Rural/Metro Central Florida Division CFL PRESENCE • CON Emergency – Orange County • CONs Non-Emergency – Orange, Osceola, Seminole STAFFING • Employs 137 EMTs and 115 Paramedics • Maintains a Fleet of 45 Ambulances 911 SERVICE IN 2006 • Responded to over 72,000 requests for service • Transported nearly 47,000 patients of which 21,000 were in Orange County.

  27. Contract History & Payer Mix • Served Orange County and the City of Orlando for OVER 25 Years without public subsidy. • The October 2002 contract prescribed the following reductions in Rural Metro territory: • 1) 10/2002 Station 58 or Hunter’s Creek • 2) 10/2003 Station 59 Meadow Woods • 3) 10/2004 Station 54 Sea World

  28. Operational Performance The current contract requires Rural/Metro to arrive on scene within 10 minutes 90% of the time.

  29. Operational Performance In 2006, OCFR transported 392 patients in Rural/Metro territory due to system overload. • 392 of 32,814 requests for service is 1.19% • 392 of 20,628 transports is 1.90% In 2007, through September 30, OCFR transported 153 patients in Rural/Metro territory due to system overload. • 153 of 22,014 requests for service is 0.69% • 153 of 14,521 transports is 1.05%

  30. Financial Facts Rural/Metro’s publicly audited financials show that ACTUAL cash collections are far below projected collections in the TriData “pro-forma” Expense data cited in the TriData “pro-forma” are far below RMA’s ACTUAL per transport costs. RMA TriData Eg. Supplies per transport $15 $5 Fuel per transport $3.60 $0.60 Unit Hours (payroll) 55,000 20,616

  31. Patients First • In 2007 RMA waited “On Scene”: • More than 10 minutes about 60% of the time. • Less than 4 minutes about 10% of the time. • On average, for all calls, about 12 minutes, 42 seconds. Medical Director protocols currently allow first-responders to transport if the acuity of the patient warrants. In 2006, OCFR exercised that protocol roughly 200 times.

  32. Non-Emergency Ambulance Transportation in CFL Significant Partnerships Include: • Orlando Regional Healthcare • St. Cloud Regional Medical Center • South Lake Hospital • Numerous Skilled Nursing Facilities

  33. Track Record of Successful Partnerships in Emergency Transportation • San Diego Medical Services Enterprise • Salem Medical Services Enterprise (Oregon) • Seattle-Tacoma, Washington • Aurora, Colorado • County Service Area 17 – Southern Californian Coast

  34. Recommendation • The TriData report does not adequately explore alternatives. • Response information cited in the TriData report conflicts with Rural/Metro’s audited response reports as submitted monthly to the Office of the Medical Director. • Significant property tax reduction proposals have yet to be resolved leaving impact on local services unknown. • Clear conflict exists between Rural/Metro’s publicly audited financials and TriData’s “pro-forma” assumptions. • Given these circumstances, it is recommended that the Rural/Metro contract to be extended to 12/31/2008, allowing sufficient time to reconcile facts, explore alternatives, and conduct an RFP for services.

  35. Presentation Outline • Introductions • TriData: Emergency Transport Study • Rural Metro Presentation • Board Action

  36. Board Action Three Options: • Continue current public/private EMS Transport model • Allow expiration of the current contract with RMA • Extend the existing provider contract with RMA for a specific time period

  37. Orange County Emergency Transportation Services Presented to the Board of County Commission October 9, 2007

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