Managing the Future

September 23, 2009

Basic Life Support (BLS)Basic Life Support (BLS)Sudbury established ambulance service 1976Emergency Medical Technicians – Basic

(EMT-Bs)Statewide Protocols

Bandaging, stabilizing, transportingCardiac defibrillationEpinephrine – Epi PenGlucose, albuterol

Advanced Life Support (ALS)Advanced Life Support (ALS)Emerson started ALS service in 1982One of 23 hospital-based servicesEmergency Medical Technicians – Paramedic

(EMT-Ps)Statewide Protocols

Intubation, 12 lead cardiac monitor, Intravenous (IV) fluid replacement, 44 medications, advanced assessments

Loss Leader

Sudbury RunsSudbury RunsBLS = 988 (2008) @ $576.07 per runALS = 385 (2008) – adds $108.03

Cost of service ranges from $250 - $26539% of calls are ALS

56% of ALS calls are billable 46% of billable calls are Medicare (101 calls)

Total Sudbury Revenue for FY09 = $354,367.52

Emerson HospitalEmerson HospitalFY07 loss on operations $8.7 million (Boston

Globe 3/21/08)ALS loss at least $100,000 per yearNo more loss leaderContinue ALS operations until September

2010

Central Middlesex Emergency Central Middlesex Emergency Medical Services Collaborative Medical Services Collaborative

(CMEMSC)(CMEMSC)

Established September 200813 Emerson service communities (with

Emerson as member)Purpose – Design replacement regional ALS

delivery system

Central Middlesex Emergency Central Middlesex Emergency Rescue Authority (CMERA)Rescue Authority (CMERA)

Bullet Point 1 - Governing body of regional ALS service

Bullet Point 2 - Centralized dispatch for “all-in” communities

Bullet Point 3 - Vendor-provided regional ALS serviceBullet Point 4 - Centralized billingBullet Point 5 - Development of local fire-based ALS

service buttressed by regional backup

Governing Body

Executive board (including 3 member Fire Chiefs)

Set rates, reimbursementSelect vendors (with member approval)Establish regional rules

Centralized DispatchALS vehicles GPS equippedChoose closest responseValid data collectionData analysis and continuous improvement

Manage by measuring

Vendor-Provided ALS Service

Initial system ALS provider“Scaffolding” - provide backup to local, fire-

based ALS servicesTrainingQA/QI – Quality Assurance/Quality

Improvement

Centralized BillingCommon rate

Medicare + 200%Essential to fund system

Bill for AssessmentsALS service 30% of runsAssessments additional 30% of runs

Expertise in billing under new paradigm

Development of Local, Fire-Based ALS Services

Each community that desires will establish local, fire-based ALS system (Wayland model)

Local ALS vehicles will be available for regional dispatchRegional reimbursement will go to local ALS

provider ($400)Closest vehicle dispatched

Regional ALS provider will “plug holes” with dynamically deployed ALS truck(s)

Service Participant Agreement(“All-In”)

Abide by the rules established by the CMERA governing board. This board will be made up of three Fire Chiefs periodically elected by CMERA members from CMERA participating towns.

Pay $450 (or other fee as may be voted on by CMERA) to the CMERA system per ALS service or assessment incident. ($400 for the ALS vendor; $50 for CMERA.)

Conduct all billing through the CMERA selected billing vendor.

Service Participant Agreement(“All-In”)

Utilize the CMERA established billing rate or other rate that may be voted on by CMERA in the future. This is presently Medicare + 200%.

For those towns with no local fire-based ALS service -Direct all requests for ALS service through the

CMERA ALS dispatch center.

Service Participant Agreement(“All-In”)

For those towns with local fire-based ALS services, Make their ALS units available for regional dispatch.For regional dispatch, accept $400 as the regional

reimbursement for services.For local dispatch in the member's community,

Charge CMERA rate (presently Medicare + 200%) which will be kept by the local community.

Alert central dispatch of local response and provide essential data for effective central record keeping.

Install a GPS tracking device on ALS participating ambulance for use by CMERA in tracking and dispatching ALS calls. Installation, maintenance, and tracking costs to be paid by the

regional ALS vendor. Each community will have remote access to GPS tracking

system.

Selectmen ActionsSelectmen ActionsEndorse immediate increase billing rate to

Medicare + 200% (previously voted)Provides funding for SFD ALS service

development Increase revenue

Offsets decrease in January 2010 Medicare rates

Vote to be “All-in”