Boardman Fire Department Ambulance Feasability Analysis February ‘1, 2009Ambulance Proposal Executive Summary Fetruary , 2008 Mission Statement ‘The goal of Boardman Fire Department is to improve emergency medical care provided to the Boardman community by the fire department through; quick response times, large staff of qualified EMT and Paramedics, and reduced costs to Boardman residents. Strategy To accomplish our goal, the fire department will: *" Reorganize staffing responsibilities to accommodate both fire and EMS responses. * Utilize pre-existing certified EMT and Paramedic personnel to respond to medical emergencies in Boardman Township and to transport patients to our local hospitals. "Purchase the necessary equipment to accomplish our goal. * Provide for continuity of trained personnel through hiring practices and continuing education. + Make improvements to the services provided for both fire suppression and emergency medi care as permitted by increased revenues. ! Preliminary Observations Boardman Fire Department has been studying the possibility of providing a fire department based ambulance service to the community for several years. As we drew close to a legitimate debate of the facts and the procedures necessary to make this project successful early in 2008, our financial difficulties pre-empted all further discussions. ‘Thanks to the passage of the levy in November 2008, we saw the return of firefighters from layoff status enabling our department to provide sufficient personnel to propose this new ambulance service. We have renewed our efforts to present to the Trustees and the community the information that we have developed. Through many hours of work and a cooperative effort by many members of Firefighter's Local 1176 and myself, we have updated our information and put together an informative package for your consideration. (Our efforts fit in with a Township mandate in the form of a community master plan. Our committee has held numerous meetings to update our information. We met with several community leaders with intimate knowledge of the ambulance and EMS industry for their advice and counsel. We have met, with appropriate vendors to not only provide the letest costs for our project but to further educate us on ‘matters concerning EMS care. ‘The decision to move forward on a new and challenging project can be a difficult one. This project will require us all commit to an initial investment in equipment and other financial obligations with the expectation of, atleast, an even return on our investment with the hope for a very positive revenue stream for the fire department. We do not expect to move this project forward on blind faith. There are certain historical statistics that support our recommendation to proceed with the expectation of successful results. For example, we know that in the years 2005, 2006, and 2007 private ambulances transported 1800, 1772, and 1817 patients to area hospitals from our emergency medical calls, We know that in 2008 Howland Fire Department billed 1600 patients and collected $514,950.00. Liberty Fire Department transported approximately 950 patients and collected $207,000.00. Last year the Beaver Township ambulance transported approximately 400 patients to area hospitals and profited over $100,000.00. We have been advised by third party billing companies and local fire departments that the average collected per patient billed is between $325.00 and $350.00 per patient.‘The Boardman Fire Department administrative staff met and was challenged to rethink traditional response protocols. We were able to agree upon new protocols that will not only continue to provide quality fire protection for the community but to also allow us to offer an improved emergency medical service to our citizens. Our new protocols allow us to propose the implementation of this new service using current staff members only and our current facilities. No increase of the department personnel or facilities is required to implement this proposal. Expansion of services will be fully dependent on the success of this service as a positive revenue stream, This project which offers an improved service to our community is also important to each of us as the nation faces tough economic times. It has become increasingly difficult for our area private ambulance ‘companies to remain financially stable. We have alrcady seen one of the primary providers succumb to financial difficulties. It is in our community’s best interest to provide a fire department based ambulance service to Boardman Township. I believe that our strength is in a large staff whose duties can be adjusted to permit the addition of this new service. As the private ambulances have made adjustments to tougher economic times, we have seen ambulance staffing levels changed whereby we must wait for Paramedic assistance to arrive via a supervisor's car. Private ambulance staffing reductions have resulted in an increase in extended response times to calls in Boardman Township. We are now seeing more frequently, the need to call on Beaver Township on a mutual aid basis to cover us for an ambulance transport. It would be prudent to take a proactive approach to our community's mecical transportation needs than to react and scramble iff another private ambulance in our area fails. Now is the time to explore this new and potentially rewarding project. Implementation Procedures ‘There are numerous considerations that must be addressed achieve our goal. We must plan for each of the following: 1. The fire department administration must provide an Operational Plan that encompasses both fire suppression operations and emergency medical/ambulance procedures using both current personnel and fire department facilities so as to minimize the start up costs of the new service. ‘Communications personnel may need to be certified in Emergency Medical Dispatching. 2. We have developed a list of equipment required to perform this new service. We must plan for the maintenance and financing of such equipment. A Type I ambulance or better is, recommended. a. Basic ambulance supplies $12,000.00 b. Heart monitor $17,000.00 c. Drugs $1,000.00 4. Ambulance $70,000.00- $150,000.00 3. We must provide for the efficient collection of fees for our services. Without knowledge of bill collections, Medicare and Medicaid requirements and fee structures, we recommend the use of a third party billing agency. This agent will assist in the development of a fee schedule and provide documentation and accountability for auditing. We may set as a goal to eventually make collections in-house. a. It is estimated that a Boardman Fire Department ambulance will only be able to respond to a maximum of 75% of all EMS responses. There are numerous simultaneous emergency medical calls each year. A three year average of patients transported to area hospital is 1763. 75% of 1763 is 1322 patients. If we were to collect an average $325.00 per patient billed X 1322 = $429,650.00 before billing fees. Billing fees could be 7.5% or $32,000.00. 4, The firefighters Collective Bargaining Agreement will require certain adjustments to provide structure and guidance on new operating procedures. A new job description for Firefighter/EMT has been developed. Items for consideration:Choice of duty station (bidding) Overtime callout procedure Wages & Salaries Maintaining certification ‘Assignments and scheduling EMS Supervisory rank g. Staffing requirements 5. Itis unlikely that Boardman Fire Department will be able to respond to every medical emergeney in the Township, therefore an agreement will need to be reached to provide us with a backup ambulance service. This backup agreement may be with a single private ambulance service or with public service transportation providers. 6. We must provide for training and the continuity of certified personnel. This can be accomplished through- a. Requiring new candidates to be certified paramedics prior to employment b. Provide options for current employees to become paramedic certified . Calculate potential overtime costs for employee training both new and for continuing education 4. Paramedic classes would be available through YSU by attending in college classes or through in-department classes. 7. AnEMS/Ambulance program Supervisor is essential to the success of this program. ‘We must determine a list of phased improvements to services and benefits. a. Initially appoint an EMS Supervisor, purchase an ambulance and support equipment and supplies, choose a third party billing agency to collect revenues. b. Phased in benefits, compensation, manpower and equipment should be determined. Such considerations can include: incremental compensation increases, training opportunities, collect revenues in-house, ALS equipment for all three stations, add an ambulance to the fleet with accompanying personnel. 9, We must have a qualified Medical Director to provide oversight and guidance and to provide medical protocol orders. 10, How will insurance requirements change? According to Trent Cailor there will only be a small net effect to our insurance premium. 11. Study historical data and peer comparisons. peaege Potential Expenditures Present and Future Ambulance $150,000.00 EMS Equipment — $30,000.00 Maintenance $5,000.00 Finance Charges Drug License 150.00 Drug Cabinet Training (New) Training (CE) Overtime Costs EMS Supervisor Insurance $300.00 ALS pump $60,000.00 2°, Ambulance $150,000.00 EMS Equipment $30,000.00 Fire PersonnelConsideration #1- Operational Plans "Ambulance Operational Plan «Fire Suppression SOP’s «EMD Requirements ‘The operating guidelines for fire and ambulance response must be developed hand in hand. At this time, it is my intention to provide ALS ambulance service to Boardman Township utilizing exis facilities and personnel. If and when the ambulance service proves to be successful and profitable, excess fuunds will be used to improve both fire ané EMS services. ‘The Township has expressed the desire to keep all thrce fire stations opened which requires a minimum of 10 firefighters on duty. Two of our shifts are staffed with 11 personnel and a third with 12. This variable provides several staffing possibilities. Vacations scheduled and report off will dictate manning levels. Manning Level 1: With eleven or twelve firefighters per shift the staifing will be as follows: Station 71: Engine 71 Medic 71 Command 795 Five or six fire personnel Station 73: Engine 73 Three fire personnel Station 74: Engine 74 ‘Three fire personnel Operationally, the officer in charge will be assigned to 795, the Command Vehicle while the remaining four o five firefighters at Station 71 will be assigned; two or three to Engine 71 and two to Medic 71. Manning Level 2: With a minimum of ten firefighters per shift the staffing will be as follows: Station 71: Engine71 Medic 71 Command 795 Four fire personnel Station 73: Engine 73 Three fire personnel Station 74: Engine 74 Three fire personnel Operationally, the officer in charge will be assigned to 795, the Command Vehicle while the remaining three firefighters at Station 71 will take either Engine 71 or Medic 71 depending on the nature of the emergency. When operating in Manning Level 1, we will be able to conduct business as customary for both fire related and emergency medical responses. Stations 73 & 74 will continue to answer First Responder calls as in the past with Medic 71 providing ALS support and transport. EMS responses in Station 71 territory will be governed by the nature of the call. The medic unit may respond alone unless additional manpower is required on a particular call. For MVA’s in Station 71 territory, both Engine 71 and Medic 71 will respond. Medic 71 will be equipped the multipurpose hydraulic tools for MVA responses. A backup Code 4 will be called as needed. When operating in Manning Level 2, the three person duty crew at Station 71 will operate on the basis of responding with the vehicle (Engine 71 or Medic 71) based on the nature of the call, with certain exceptions. For example; Medic 71 will respond to all medical emergencies in 71 territory and for transportation and backup as required for Station 73 & 74 medical responses. Engine 71 will respond to all major structure fires in the Township. Stations 73 & 74 will respond into Station 71 territory for all other fire related responses that are not major structure fires. Stations 73 & 74 will continue to answer First Responder calls as in the past with Medic 71 providing ALS support and transport.EMD requirements: The Boardman Township communications center staff has the following considerations for dispatching and ambulance; should they become certified in Emergency Medical Dispatching to so that the ALS staff makes appropriate responses to emergencies? ‘After communication with Maggie McGee, the 911 County Director, about our concems, she emailed other professionals in her field. The VP of NENA (National Emergency Number Association) said that there is no requirement by the State of Ohio to have communieations personnel trained in EMD prior to dispatching an ambulance. ‘The Associate Director of the National Academics of Emergency Dispatch also said that Ohio does not mandate EMD certification.Consideration #2 Equipment Equipment lists and costs Repairs and maintenance Financing Drugs, Storage and Licenses Attached are lists of basic equipment, heart monitors, supplies, drugs as well as ambulance pricing research. Generally average costs appear to include: + Basic ambulance supplies $12,000.00 ‘© Heart monitor $17,000.00 * Drugs $1,000.00 «Ambulance $70,000.00- $150,000.00 We must have our ambulance inspected by The Ohio Medical Transportation Board. The Ohio Ambulance Licensing Board is responsible for the identification, inspection, and licensure of ambulance services. The Board sustains its operations through annual license fees of $100.00 per ambulance. We will have to provide for secure storage for narcotic drugs. A minimal investment in a secure storage cabinet will be made. Our current drug license is at minimal cost but only includes oxygen, saline solution and sterile water. Additional drugs will increase the drug license but aa. What Type of Ambulance Should We Purchase? One of the many important decisions that we must make is to choose and ambulance. ‘Type I Ambulance- has a pick up truck chassis with a square box mount as the patient care compartment. This tends to be wide and roomy inside. Type II Ambulance- is a highly modified van ona van chassis. The roof is raised for EMS care. When the chassis wears out the entire unit must be replaced. Interior space is very limited. Type II Ambulance- has a van chassis with a square box mounted as the patient care compartment. ‘The compartment can be mounted to a new chassis if it should wear out. These offer the most interior room and are the easiest to work out in. The chass's is heavier duty than the Type [ and will hold up longer for the number of responses made in Boardman Township. Medium Duty Ambulance- an ambulance of heavier duty design than a Type Ill. This ambulance will have more compartment space available than other type ambulances which may be desirable to carry firefighter bunker gear and hydraulic rescue tools. We will be exploring ambulances of all types but initially believe that we would be best suited to purchase either a Type II] or Medium Duty ambulance due to space available and durability.‘Consideration #3 Professional Billing (Third Party Billing) = Third Party Collections = Fee Schedule = Revenue Projections "Eventual goal of in-house collections? Third party billing will provide collection expertise that we may not initially possess. The billing ‘company will help us to set a fee schedule, certify with Medicare, collect fees and provide documentation and accountability for auditing. AA fire department committee has reviewed revenue projections and preliminary billing fees from ‘numerous third party billing companies. We have narrowed the billing companies down to four which we are in the process of face to face interviews to determine; cost of services, data collection and submission procedures, fire department fee schedules, collection policies, and delinquent account policies. Two companies have been interviewed. In general, the following information is available: * Boardman Township will transport between 1600 and 1800 patients to the area hospitals annually, * With one ambulance in service, Boardman Fire Department will not be able to transport 100% of the patients, therefore cannot expect to collect all fees that may be available. Some percentage less than 100% can be estimated. For discussion purposes I am using 75% of all patients in Boardman Township as a potential revenue source. This estimate may still be high. Itis also clear, that if the service becomes profitable, the excess funds can be utilized to acquire additional resources (equipment and personnel) allowing us to capture a higher percent of available revenue. = Revenue projections have been estimated anywhere from $200,000.00 to $900,000. Each of these revenue projections takes into account the ability to collect payments. Some estimates are very conservative in the ability to collect while others assume a more aggressive or successful ability to collect revenues. It would appear that even the most conservative estimates provide us with the ability to provide the service and at least break even after paying for equipment purchases. + Two billing companies estimate, based on collection history of other clients, the fire department should average $325.00 per transport. This takes into account soft billing for residents, Medicare payments, non-payments and service fees. 75% of 1700 patients is 1275 patients X $325.00 = $414,375.00 = Beaver Township transports approximately 400 patients to area hospitals and profits $100,000.00 annually. * So far, one company bills 7.5% of all collected revenues while the other charges us $35.00 for ‘each response submitted whether payment is collected or not from the patient. Once company will allow us to submit patient data utilizing our existing Firehouse software, while the other, a this time, is primarily accepting duplicate copies of all run response data sheets. It is estimated that a Boardman Fire Department ambulance will only be able to respond to a maximum or 75% of all EMS responses. There are numerous simultaneous emergency medical calls each year. A three year average of patients transported to area hospital is 1763. 75% of 1763 is 1322 patients. If we were to collect an average $325.00 per patient billed X 1322 = $429,650.00 before collection fees. Collection fees could be 7.5% or $32,000.00.Fee Schedule At this time, one billing company suggests we bill as follows: Basic Life Support (BLS) '$500.00- $550.00 Advanced Life Support (ALS) $600.00- $650.00 ALS II $700.00- $750.00 Mileage @ $12.00 per mile. ‘These are reported to be average rates for their current client base. I recommend that we utilize professional billing services for a one to two year period so that we can determine the feasibility of in-house collections which will involve an understanding of Federal Medicare and Medicaid billing requirements.Medicount Management Corporation (Cincinnati, Ohio) Require a two year agreement but with a 90 day termination clause Von Lehman and Assoc. for SAS70 audits 30 staff members Their business only entails billing for amtulance responses and motor vehicle accidents. The law says we may “forgive” billing for residents for costs above insurance coverage. An uninsured resident can be written off. Collection agencies are an option for bad debts. We can choose to soft bill local businesses if we choose. They experience a collection rate of 60 10 65% ‘They average $325.00 per all patients billed. Medicount can either be the receiver of all checks forwarded for payment or we can forward all checks that are first sent to us. Will provide all necessary training so that we understand the documentation and billing requirements. They will help us design the fee structure. They will help us with the Medicare and Medicaid credentialing process which takes several months for approval. Their fee would likely be 7% the first year then 7 14% thereafter. Can accept patient data on Firehouse software format Can log onto their website to view data both clients and patients Locally used by: Howland, Liberty, Warren Township, Bristol, and Champion. Ohio Billing Solutions (Bolivar, Ohio) Require a 24 month agreement Currently serve 90 clients. ‘Their only business is billing for ambulance responses. 22 staff members Currently 90% of run submissions are on hard copy. They will conduct training so they we may lear proper documentation. They handle all Medicare and Medicaid denials and appeals. All money comes to us first. One time set up fee of $795.00. Their fee is $35.00 per claim submitted whether collected or uncollected. Can provide a listing of recommended collection agencies. ‘They recommend a billing schedule of: BLS $510.00 ALS $850.00 ALS2_ $900.00 Miles $11.00 References are listed as: Bazetta Township, City of Marion, and City of Green. Quest Billing (Austintown, Ohio) Currently collect for only one fire department and two ambulance companies Will assist with Medicare and Medicaid credentialing Suggest all reports sent on paper, will look at receiving accounts through Firehouse Will train personnel on documentation Will provide reports as we require; weekly, monthly, annually May be able to provide access to their software so that we can view our account ‘Says that most calls will be ALS billed ‘Want to bill every one at least once with more aggressive with non-resident Will advise on collection agencies available All money collected will get sent to us first= Would attempt to collect for MVA’s = Fee would be 6.85% with a $395.00 startup fee Enhanced Medical Billing (EMS) Eastern, Pennsylvania * 1 year contract Serves 115 agencies in 7 states with mostin Pa. 97% of agencies are fire based ambulance EMS Full training services offered No start up fees Have an 800 customer service number All payments go to Enhanced first Weekly or monthly reports issued, depending on what we require Should be able to work with Firehouse software, but will accept faxed reports Says that they know that the Ohio Inspector General approved of subscription services for residents Encourages MVA charging = Fee will be 7.5% for 1000 to 1499 submissions and 8% for 500 to 999 submissions = BLS fees range from $400-$600 and ALS ranges from $700-$1000 with mileage at $11 per mile and upwardConsideration #4 Changes to the Collective Bargaining Agreement = Changes will be required to our current CBA. = A Job Description must be developed for Firefighter/EMT A Job Description is attached, ‘There will be certain sections of the collective bargaining agreement that must be changed or re- negotiated to permit the smooth operation of an ambulance service. 1, Choice of duty station for fire suppression personnel different from EMS personnel 2. Choice of duty station for EMT & Paramedic personnel different from fire suppression personnel 3. Overtime callout (different list for callout for EMS duty) (Can stil be on fire suppression list for callout) Seniority (Remains the same but will have seniority within the EMS category??) ‘Temporary assignments (If a person is assigned to ambulance, he cannot fill in an out of rank opening??) Trade of shifts (I assume with out restriction or regard of shortage caused by trade) ‘Wages & Salaries (One of anticipated benchmark improvements. No increase unless profitability reaches certain thresholds and other goals.) 8. Maintain Certification as is required for First Responder 9. EMS supervisory rank (This is a must and should be included in the rank requirements) 10. Staffing requirements for the ambulance. = All paramedics will respond to emergencies from Station 71. -OR— * Distribute paramedics to all three stations; Station 71- ALS ambulance, Stations 73 & 74 ALS pumpers. ye ae Report writing responsibilities will be included in the job description.Consideration #5 Back up Ambulance Service Enter into agreement with a single private ambulance service = Enter into agreement with one or more public service ambulance providers Currently Boardman Township has a Memorandum of Understanding with the two best available ambulance services in Mahoning County; Rural Metro Ambulance and Clemente Ambulance. It would bbe beneficial to enter into agreement with one of these two companies to provide all backup responses to Boardman Township. The emergency medical calls that would likely be available when the fire department is unable to respond should be sufficient to provide an adequate call volume to make it desirable enter in agreement to be our back up provider. ‘This agreement would only consist of calls that Boardman Fire Department is unable to answer and would be no guarantee of call volume. At such time as Boardman Township was able to respond to a larger call volume, if and when additional resources are added (ambulance and personnel), the back up requirements would be reduced accordingly. Another option is to enter into agreement through an Automatic Response agreement with a neighboring community or the formation of an EMS District. In either case, nearby communities would provide back up coverage to District member at times when their ambulance was unavailable.Consideration #6 Training & New EMS Personnel * We must consider how we will continue to provide qualified EMS personnel + Require new firefighter candidates to be Ohio certified EMT/Paramedics prior to employment. * Provide a means for current employees the ability to be trained and certified as, EMT/Paramedies if they choose. * Costs must be established for; initial paramedic classes, ongoing continuing education and subsequent overtime costs that may occur. ‘The State of Ohio Ambulance Licensing Board requires through the Ohio Revised Code #4765.43 that the ambulance staff be at least two EMTs-Basic, EMTs-Intermediate, or EMTs-Paramedic. Currently, Boardman Fire Department has on staff 9 certified EMT/Paramedics. This includes Lt. Bill Glaser. An additional firefighter will soon complete a Paramedic course bringing the total of fire suppression Paramedics available to nine or three per shift. In addition, there are 6 certified EMT personnel as follows; 3 firefighters, 2 Lts., and 1 Captain. Educational requirements for each certification level are as follows: * First Responder 40 hours with 15 hours of CE required every three years EMT-Basic 130 hours with 40 hours of CE required every three years EMT-Intermediate 130 hours but hours being revised with 60 hours of CE/3 yrs EMT-Paramedic 1000 hours with 92 hours of CE required every three years Paramedic Education Options: 1. YSU offers an on campus class which is three semester courses. You must be enrolled as a full time student. Three semester are approximately $3,500.00 (January of 2008) to total$10,500.00 plus book at $600.00- $700.00. Estimated total cost $11,200.00. 2. Off campus classes held at our location. Location must be State recognized as a training site in order to obtain State certificate. (Southwoods?) This would be a two semester course. The course fee would be approximately $3,500.00 per semester plus books. Total estimated cost would be $7,700.00. Must have between 12 and 20 students to offer class. Discussion: Its estimated that less than a dozen current Boardman Firefighters may be interested in a full Paramedic certification. If Paramedic classes are offered to current firefighters, then there would have to be an agreement on work schedules and class schedules as well as overtime to cover shortages while personnel are in class. If there is eventually a pay differential for Paramedic service, then it is reasonable to expect non-paramedic firefighters to seek certification to be able to attain the higher pay rates. A simple survey of personnel can identify those who may be interested in future Paramedic education. There will be ongoing costs for continuing education. The cost to cover shortages while personnel are attending CE classes may exceed the actual cost of the CE. Every effort would be made to bring CE classes into the department to avoid overtime costs. This is currently how we handle ongoing education for First Responders. However, itis unlikely that all required classes can be brought into the department and overtime costs may occur. The potential cost for overtime to cover CE must be considered in the liabilities against our earned revenues.Consideration #7 EMS Supervisor = A person with a supervisory rank must be provided to oversee the ambulance program. ‘Our department responds to approximately 2400 medical responses each year. This is approximately 73% of our calls for service each year. Three quarters of the department's activities involve emergency medical care. Boardman Fire Department needs # person to manage our EMS and ambulance services. ‘© The EMS Coordinator will manage the ambulance service including monitoring the billing, process. © Our expenses in EMS supplies and equipment approaches $10,000.00 each year. Our supply inventory must be constantly monitored to assure that these supplies never run low. Orders for supplies must be submitted every other week. © The disposal of bio-hazardous medical waste must be monitored for compliance with safety standards. © Our EMS liaison has traditionally served as the Township Infectious Control Officer who assists employees with the reporting of exposure to body fluids of another person. Currently Stephanie Landers is serving as the ICO. | would recommend that a fire department EMS Coordinator take over this position. ‘* We must adhere to HEPA standards to assure the privacy of patient information and the safe storage of such medical records. ‘* The medical run sheets must be constantly monitored to assure that procedures are being followed and to assure the quality of patient care. ‘© The certification of our personnel is monitored to provide reminders of upcoming expiration dates so that re-certification paperwork is submitted on a timely basis. Each year, the application for our drug license must be re-submitted. Fit testing is conducted annually for a medical filtration mask worn by our personnel, Classes for continuing education and AED refresher classes must be provided throughout the year. ‘Online continuing education hours must be monitored. Standard Operating Procedures for emergency medical response must be reviewed and updated regularly. I recommend that we establish the position of an administrative position of Captain whose duties ‘would be to supervise all Boardman Fire Department EMS activities as outlined above. This person ‘would work a 40 work schedule and report direct to the Fire Chief. This person would have authority to promulgate EMS SOP’s and enforce their adherence. The EMS Supervisor would not be a line of succession for a fire suppression Assistant Chief. This position is essential to the success of the program! This is an additional paid position and the cost of this employee would have to be considered against potential ambulance revenues.Consideration #8 Phased Improvements Based On Financial Benchmarks = Phased in improvements to the EMS services and compensation should be planned * Phased improvements should be linked to identified financial benchmarks Boardman Fire Department is proposing to implement an ambulance service for the Boardman ‘community. In order to accomplish this goal, it is understood that we propose to offer a high quality service with certain concessions to compensation and to certain operational procedures. To clarify, the firefighters are willing to proceed with this project which has additional job performance requirements. ‘These added performance requirements are customarily compensated. Boardman firefighters have agreed to forcgo additional compensation initially but the Township must be willing to consider incremental compensation improvements if and when the service shows positive revenues. Likewise, the Boardman Fire Department Administration has chosen to modify response procedures to facilitate the implementation of an ambulance service. Again, itis reasonable to expect that if and when the ambulance service shows positive gains, that manpower be added to resume previous response procedures and improve both fire and EMS responses to the community. Initially we propose to the following: 1. ALS equipment for all three fire stations Appoint an EMS Supervisor Purchase an ambulance and appropriate equipment and supplies Choose a third party billing agency to collect revenues Finance the equipment No discussion on training new Paramedics for at least one year ayaen Phased improvements to benefits, compensation, manpower and equipment may include: ‘+ Incremental compensation increases for EMT and Paramedic staff + Discussion on offering training to Boardman fire personnel who desire Paramedic certification. Number of students could be limited by financial benchmarks. Collections of revenues accomplished in house Add an additional ambulance to the fleet Add personnel to the fire department (recall laid off personnel, all three are Paramedics) Improvements to software (number of licenses, Enterprise)Consideration #9 Medical Director = A qualified Medical Director must oversee our EMS care and provide Medical Protocol Orders Every agency, whether public or private, must have a Medical Director to provide certain requirements by law. A Medical Director will provide the following: * Medical Protocol or orders under which all personnel operate * Signing of Drug Licenses * Oversight and Quality Checks for all response activities which includes a review of each run sheet for quality assurance. = Education Recently, each fire department member took a written exam to demonstrate their knowledge of Medical Protocol Orders for each person’s level of EMS certification. Each person tested out on their level which included First Responder, EMT and Paramedic. Currently, Lt. Bill Glaser is holding discussions with the Medical Director Dr. Allisa Roberts and her nursing assistant Sheila Doan concerning including both EMT and Paramedic protocols for use by Boardman firefighters. Dr. Roberts is in charge of the Emergency Department for St. Joseph's Hospital in Warren, Ohio and also works out of the Boardman St. Elizabeth emergency room. She has made herself available to ‘many of our area agencies as a Medical Director free of charge. In many instances, private ambulance services and public fire agencies must pay for this service by a qualified doctor. At this time, we are blessed that we have this service for free. Although, I do not anticipate a {ee to be paid for Medical Director, it may be a necessity in the future.Consideration #10 Insurance Coverage * With the addition of an ambulance service to the fire department responses, what, if any, increases can we anticipate in liability insurance? In discussion with Trent Cailor, he believes that the only added cost will be several hundred dollars to add an ambulance to the insurance coverage. However, he will check with OTARMA to make sure his position is correct. (1-29-09).Consideration #11 Historical Stats In 2007: 1817 of 2440 patients were transported to area hospitals or 75% of all patients. Patient transportation destinations: 1, St. Elizabeth Hospital (Main Campus) (698 patients transported 2. St. Elizabeth Hospital (Boardman Cempus) 494 patients transported 3. North Side Hospital 260 patients transported 4, Tod Children’s Hospital 4 patients transported 5. Beeghly Medical Center 252 patients transported 6. Salem Community Hospital 3 patients transported SOOPER ESE EEEESHEEEETESEEEEE EEE EE SSE ERTIES STEER TERETE EE EHEESORHHEEEEE In 2006: 1772 of 2393 patients were transported to area hospitals or 74% of all patients. Patient transportation destinations: 1. St. Blizabeth Hospital (Main Campus) 699 patients transported 2. St. Elizabeth Hospital (Boardman Campus) 310 patients transported 3. North Side Hospital 313 patients transported 4. Tod Children’s Hospital 14 patients transported 5. Beeghly Medical Center 326 patients transported 6. Salem Community Hospital 3 patients transported LIER OLEH reer ree erreeneiennesiesenienine® In 2005: 1800 of 2399 patients were transported to area hospitals or 75% of all patients. Patient transportation destinations: 1. St. Blizabeth Hospital (Main Campus) 586 patients transported 2. St. Elizabeth Hospital (Boardman Campus) 374 patients transported 3. North Side Hospital 348 patients transported 4, Tod Children’s Hospital 27 patients transported 5. Beeghly Medical Center 329 patients transported 6. Salem Community Hospital 3 patients transportedgoose Study Feasibility Study: Ambulance Service As Provided By Boardman Fire Department In April of 2006, Boardman Township Trustees requested a study to determine the feasibility of providing an ambulance service to the Boardman community as provided by Boardman Fire Department. To gather information, I interviewed the Fire Chiefs of three local Fire departments who provide ambulance service: ‘* Acting Chief Tim Thompson, Howland Fire Department © Chief Mike Durkin, Liberty Fire Department © Chief Keith Barrett, Brookfield Fire Department In addition, | interviewed two Fire Chiefs outside of our immediate area: © Chief Jim Whitworth, Miami Township Fire Department (Cincinnati area) © Chief John Sabo, Plain Township Fire Department (North Canton area) asked each some key questions to include: © Size of department © Make up of department; paid, part time, volunteer © Size of community Number of EMS runs annually as well as number of patients transported © Cost of equipment ‘Number of ambulances needed to serve the public Approximate annual income from service delivered Annual cost to provide the service delivered Billing methods ‘The following is a summary of the departments interviewed: © Howland Fire Department has 25 FT, 15 PT, & 15 Vol firefighters. They have four ambulances in their fleet. Three of the ambu'ances are manned by duty personnel and the fourth by Volunteers from off duty tone out. Duty personnel include the FT and PT firefighters. Their three fire stations each have an ambulance and a fire truck. There are two men assigned to each station. The type of incident dictates which vehicle they use to respond. In 2005, they billed 1600 patients $770,000.00 and collected $431,000.00. Residents are only billed what their insurance will pay while non-residents are fully billed. They use a billing company to collect fees and the billing company will get 7-8% of the collected money as their fee. ‘© Liberty Fire Department has 17 FT, 7, PT, & 4 Vol firefighters. Two ambulances operate from the Main Station and they have one satelite station. Four personnel work from the Main Station while two work out of the satellite station. Annually they transport 800-900 patients. Each year they collect between $200,000.00 - $220,000.00. The profit about $20,000.00 from. the service each year. They use a billing service. They also use the “first callout” system whereby they respond with either an ambulance or pumper depending on the nature of the emergency. They use the figure of $340.00 as the amount collected per patient on average. Using their figure, they estimate that Boardman would collect approximately $544,000.00 based on our average of 1600 patients sent to hospitals annually. UsMy Documents\B.F.DVAdministratve¥F easily Study Ambulance doc‘© Brookfield Fire Department has 7 FT, 25 PT, & 12 Vol firefighters. They operate with two ambulances in service from two fire stations and have one reserve ambulance. They deliver approximately 900 patients to area hospitals from emergency responses. In addition, they are also in the transport business. They transported 750 non-emergency patients to medical care facilities on transfers. They collect $400,000.00 annually from these services. They DO NOT collect from residents but do collect from non-residents. They use a local person for billing. ‘© Miami Township Fire Department has 44 FT & 25 PT firefighters. They DO NOT collect from residents but do collect from non-residents. They collect approximately $100,000.00 from nan-esidents who sesnun! for 35% of ll EMS rans. They re faded mostly om local tax levies specilieally passed to support the ambulance service. © Plain Township Fire Department has 30 FT & 30 Vol firefighters; however they are phasing out Vols and switching to Part Time personnel. They have five fire stations; however, three are manned by duty crews while the other two are Vol fire stations. Each of the duty fire stations have an ambulance and a pumper and they also operate on the “first callout” system. In addition they have three reserve ambulances. They only bill non-residents and collect approximately $150,000.00 - $180,000.00 from the non-residents. Otherwise, their fire department is primarily funded by fire levies which bring in 6 million dollars annually. They use a billing service for collections. They experience 3000 EMS calls each year with 33% of. the calls non-resident. ————r— As I questioned the Chiefs, I was able to determine that an ambulance can cost anywhere from $60,000.00 on the low end up to $180,000.00 with about $85,000.00 - $100,000.00 being the average price paid for an ambulance. The cost to equip each ambulance can cost in the area of {$24,000.00 - $100,000.00 depending on items purchased. The average life expectancy of an ambulance was considered to be about five years with the more expensive vehicles providing up to cight years of service. The start up costs for a fleet of three ambulances could take five years to recoup. There are other costs involved to inclvde; collection fees, liability insurance, vehicle and equipment repairs, maintenance plans, daily supplies, pay differential, cost of Medical Director, and personnel training. Summary: Thave concluded that each of these communities have established a thriving ambulance service based on one of two principles; either they are able to afford the manpower because they are supported by part time personnel who are not receiving fringe benefits or they are primarily funded by tax levies. Boardman Township would need at least three ambulances to provide service to all of the 1600 patients that are sent to area hospitals each year (as estimated by the five Fire Chiefs interviewed). Fewer ambulances would mean thet we would lose some of the ambulance trips to backup agencies. If Boardman Township would attempt to provide an ambulance service utilizing full time firefighters cross trained as paramedics and as a separate service, itis estimated that we would need at least 18 -21 personnel. The estimated income of approximately $500,000.00 would support only six firefighters which would then in turn only provide enough personnel for one ambulance. The fees collected by only one ambulance would then not support the six men needed for this limited service. Start up costs could easily surpass $500,000.00 not including the overtime and tuition costs to cross :rain personnel as paramedics. But the number of firefighters that could be supported would be less as we would be required to pay down the debt from equipment and vehicle purchases from the ambulance income. In other words, as a LUaMy Documentsi8.F DVdminitratve\Feastilty Study Ambulance doo.stand alone service, an ambulance service canno: support itself nor provide added monies for the General Fund. Are there alternatives? Yes as follows: ‘An ambulance service as described above using a mix of full time and part time personnel. An ambulance service operated totally separate from the fire service with full time and part time personnel. ‘A levy offered to support an ambulance service. Bid ail Township EMS responses by one provider with a fee to Boardman Township for the sole privilege to respond. Provide bay and quarters for private ambulance company/s with a service fee for use. ‘ALS Pumpers (Advanced Life Support). This alternate solution assumes that the ‘Township is only interested in providing a better level of care to the community than is currently provided and not interested in t-ansporting. The cost to provide this service ‘would have to be born by Boardman Fire Department budget. It would include the cost of ‘ross training personnel to the paramedic level and start up costs for Advanced Life Support equipment, supplies, and drugs. The initial start up cost could be in the area of $100,000.00. The advantage to this system is that fire personnel are already strategically located to provide 4 minute responses throughout Boardman Township. ALS pumpers responding to our emergency calls would be able to provide the highest level of care quicker than our rotation ambulance companies can provide. Lastly, the Trustees may consider a professional study to determine a cost benefit analysis of ambulance service in the Township. I have one proposal to provide this service and other competitive proposals can be obtained if desired. A study can be accomplished for under $5,000.00 or as litle as $1,500.00 if local personnel are able to provide research data. I would be glad to work with the Trustees on any of the alternate proposals for service. Jim Dorman LUtMly DocumensiB.F DVidministrativeFeasibity Study Ambulance. doo