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Agenda 10/27/2015 Item #16E6
10/27/2015 16.E.6. EXECUTIVE SUMMARY Recommendation to approve a Certificate of Public Convenience and Necessity for non-emergency inter-facility ambulance transports to Just Like Family Concierge Medical Transport Services, LLC., for the purpose of providing post-hospital and inter-facility medical ambulance transfer services. OBJECTIVE: To proceed in the best interest of the public health, safety and welfare by granting a Certificate of Public Convenience and Necessity-Class 2, Advanced Life Support(ALS) post-hospital, inter or intra-facility ambulance transports to Just Like Family Concierge Medical Transport Services LLC. Hereinafter referred to as"Just Like Family." CONSIDERATIONS: On July 31, 2015 the Collier County's Bureau of Emergency Services received an application from Just Like Family Concierge Medical Transport Services LLC. for a Certificate of Public Convenience and Necessity (COPCN) to provide Class 2 (post-hospital inter-facility medical transfer services) ambulance transportation within Collier County. Staff and the Public Safety Authority (PSA) have reviewed the application. During the August 12, 2015 PSA meeting both Ambitrans, a currently licensed Class 2 COPCN holder, and Just Like Family spoke and addressed comments and questions from the PSA. The PSA voted to recommend approval of the COPCN, and a letter from the Chairwoman of the PSA is attached. The PSA vote was 3 in favor and 1 against with one member absent. On September 22, 2015 the Board granted the fourth annual renewal certificate to Ambitrans Medical Transportation Services Inc. of Charlotte County (Ambitrans), which has provided similar services in Collier County since January 2011. Ambitrans is in good standing with the Emergency Medical Services Division and no complaints have been elevated to the Chief of Emergency Medical Services or the Director of the Bureau of Emergency Services. It is the opinion and findings of the Bureau of Emergency Services that this service is necessary and practical to provide additional medical transportation options to patients being transferred from hospital- to-hospital, hospital-to-home, or transport for clinical procedures, etc. It is reasonable to expect the services of an additional provider will assist in the anticipated future demands of the pace of the expanding number of nursing homes, rest homes and skilled care facilities as well as overall population growth. The expansion of additional non-emergency ambulance vehicles should reduce wait times for facilities and their patients during discharge and further reduce the calls for non-emergency service transport placed upon County EMS. Since Ambitrans began operating in Collier County, EMS has experienced a significant decrease in non-emergency transport requests, allowing it to focus on its pre- hospital emergency medical delivery. County EMS expects further reduction in non-emergency transport calls for service with the approval of this COPCN in light of the growth of additional facilities and beds. Just Like Family has reported its readiness to purchase Federal Department of Transportation Specification Standard KKK-A-1822-E type ambulance vehicles. Since the vehicles are not yet in service at the company's local office, the Board's permit and certificate which are part of the approval would be contingent upon receipt of the vehicle identification numbers (VIN) which are part of the annual permit signed by the Chairman. Additionally,the applicant reports that it will have its first ambulance operational within 90 days, and further requests authorization to place(2)two additional ambulances in service as part of this COPCN annual certificate. Staff supports the request. Accordingly, the maximum number of vehicles authorized for the annual permit is three(3).The Ambulance(VIN'S)will need to be reported to the County for permit modification prior to being placed in operation. Just like Family reports it will hire local Florida certified Emergency Medical Technicians and Paramedics who will operate under a medical protocol approved by Dr. Robert Tober. Dr. Tober serves as the Medical Director for Collier County Emergency Medical Services/Board of County Commissioners. The County Attorney has made recommendations below regarding Dr. Tober's association with Just Like Family. Packet Page-1202- 10/27/2015 16.E.6. Neither Collier County, nor the Sheriff's 911 Center, receive or track such calls for non-emergency inter- facility service made between a hospital, nursing home, or doctor's office, etc. All estimates for calls for service are compiled from data provided by Ambitrans and from the infrequent request for inter-facility transports to Collier County EMS when 911 is contacted for the dispatch of a Collier County EMS ambulance. Staff's broad estimates suggest that approximately 6,000 transports are typically handled by a Class 2 Certificate holder on an annual basis from current facilities in Collier County. A broad estimate of the over 500 beds reported in permitting for local construction could generate an additional 100-200 annual convalescent transports in the near future as additional facilities become operational. Staff does not have information as to the timing of bed's and facility openings as referenced above. As a result of the market- place nature of the additional facilities and beds, the convalescent transport estimates are rudimentary at best. The County has no obligations to compensate a private ambulance provider for any services, nor does the County receive any revenue from service delivery by a private ambulance provider. Should the Board approve an annual Class 2 Certificate of Public Convenience and Necessity to Just Like Family the following provisions of the Certificate are recommended requirements: 1. Just Like Family's COPCN shall be authorized to begin services upon the County's receipt of its Ambulance vehicle's VIN numbers and the Permit is recommended to be signed by the County once the information is received. Just Like Family shall begin its operation with (1) one ambulance within 90 days and be approved to make operational up to a total of (3) three ambulances within this annual permit. 2. Staff is recommending the initial COPCN application to expire on November 1, 2016. 3. Just Like Family's COPCN shall be required to be renewed annually. Its renewal application is to be received by the County no later than 90 days prior to its expiration. 4. Just Like Family will be required to work closely with Collier County EMS, Collier County Sheriffs 911 dispatch personnel, local licensed facilities and other responders to ensure that their entry into local and regional inter-facility ambulance transportation is properly coordinated and services appropriately represented. Collier County EMS shall be allowed to conduct any reasonable inspections or site visits and receive in a timely manner any statistical call volume information needed to evaluate services,monitor complaints and address any quality of'care issues. FISCAL IMPACT: This redistribution of non-emergency transports to Ambitrans and Just Like Family would allow for increased utilization of Collier County EMS for the escalating emergency scene calls for service. Staff deems the increase in emergency vehicle availability for its core mission worthy of this effort. There is no increase to the Collier County EMS budget for this Class 2 COPCN if approved. The Board shall also recognize and accept the $250 application fee within Fund 490. GROWTH MANAGEMENT IMPACT: There is no Growth Management Impact resulting from this action. LEGAL CONSIDERATIONS: This item has been reviewed by the Count Attorney. Article 10 of Dr. Tober's contract with the County expressly allows him to be employed in any other capacity such as serving as a medical director for any other emergency medical service which is lawfully licensed by the County and the State. Accordingly, Dr. Tober may continue to serve as the Medical Director for the applicant and County if the certificate is granted. Dr. Tober's notice to the County is attached, as is the County Manager's consent notice to Dr. Tober. Additionally,regarding the consideration of this item,Ordinance No. 04-12, Section 7 states: Packet Page -1203- 10/27/2015 16.E.6. "The Board of County Commissioners shall not grant a certificate unless it shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied: A. That there is a public necessity for the service. In making such determination, the Board of County Commissions shall consider,as a minimum,the following factors: (1) The extent to which the proposed service is needed to improve the overall Emergency Medical Services(EMS)capabilities of the County. (2) The effect of the proposed service on existing services with respect to quality of service and cost of service. (3) The effect of the proposed service on the overall cost of EMS service in the County. (4) The effect of the proposed service on existing hospitals and other health care facilities. (5) The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the local area to adequately staff all existing services. (6) That the applicant has sufficient knowledge and experience to properly operate the proposed service. B. That,if applicable,there is an adequate revenue base for the proposed service. C. That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area." Ordinance No. 04-12, Section 8 provides: "In making the determinations provided for in Section 7 above, the Board may, in its sole discretion, appoint a Hearing Officer to hold a public hearing and to make factual findings and conclusions as a result of the hearing. Should a Hearing Officer be appointed,said Hearing Officer shall render a written report to the Board within 30 days of the hearing, which report shall contain the officer's findings and conclusions of fact, and a recommended order. The findings and conclusions of fact shall be binding upon the Board, but the recommended order shall be advisory only." With that said this item is approved as to form and legality and requires majority vote for approval. -JAK RECOMMENDATION: That the Board of County Commissioners: 1. Accepts the findings of the Director of the Bureau of Emergency Services. 2. Accepts the recommendations of the PSA. 3. Approves the Certificate of Public Convenience and Necessity for Just Like Family Concierge Medical Transport Services LLC.,for up to(3)three ambulances during this permit. 4. Authorizes the Chairman to execute the Permit and Certificate. 5. Approves a Budget Amendment to recognize and appropriate the$250 application fee. PREPARED BY: Dan E. Summers,Director,Bureau of Emergency Services ATTACHMENTS: 1)Collier County Class 2 Permit 2)Collier County COPCN Certificate 3)Just Like Family Concierge Medical Transport Services Application 4)Just Like Family Applicant Presentation PowerPoint handout 5)Public Safety Authority Letter and Enclosures 6)Dr. Tober communication regarding his association with Just Like Family 7)Correspondence from Leo Ochs to Dr.Tober Packet Page-1204- 10/27/2015 16.E.6. COLLIER COUNTY Board of County Commissioners Item Number: 16.16.E.16.E.6. Item Summary: This item requires that ex parte disclosure be provided by Commission members. Should a hearing be held on this item, all participants are required to be sworn in. Recommendation to approve a Certificate of Public Convenience and Necessity for non- emergency inter-facility ambulance transports to Just Like Family Concierge Medical Transport Services, LLC., for the purpose of providing post-hospital and inter-facility medical ambulance transfer services. Meeting Date: 10/27/2015 Prepared By Name: HeinrichsbergKathy Title: Executive Secretary,Bureau of Emergency Services 10/8/2015 4:56:44 PM Submitted by Title: Executive Secretary, Bureau of Emergency Services Name: HeinrichsbergKathy 10/8/2015 4:56:45 PM Approved By Name: pochopinpat Title: Operations Coordinator, Administrative Services Department Date: 10/8/2015 5:05:17 PM Name: KopkaWalter Title: Chief-Emergency Medical Services, Administrative Services Department Date: 10/9/2015 10:13:59 AM Name: SummersDan Title:Division Director-Bureau of Emer Svc,Bureau of Emergency Services Date: 10/9/2015 1:02:00 PM Packet Page-1205- 10/27/2015 16.E.6. Name: PriceLen Title: Department Head-Administrative Svc, Administrative Services Department Date: 10/9/2015 3:45:26 PM Name: KlatzkowJeff Title: County Attorney, Date: 10/14/2015 2:02:41 PM Name: KlatzkowJeff Title: County Attorney, Date: 10/14/2015 3:02:25 PM Name: WellsLaura Title: Management/Budget Analyst, Senior, Office of Management&Budget Date: 10/15/2015 9:50:28 AM Name: CasalanguidaNick Title:Deputy County Manager, County Managers Office Date: 10/16/2015 11:18:49 AM Packet Page-1206- 10/27/2015 16.E.6. COLLIER COUNTY FLORIDA Class "2" COPCN Name of Service: Just Like Family Concierge Medical Transport Services. LLC Name of Owner: Elisabeth Nassberg Principle Address of Service: 4500 Executive Drive Suite#205 Naples, FL 34119 Business Telephone: (239) 682-8907 Description of Service: Inter-facility for Collier County Number of Ambulances: (3) Three: See attachment: Vehicle Identification Numbers (VIN) are to be submitted to the County before being placed in operation. This permit, as provided by Ordinance No. 2004-12, as amended, shall allow the above named Ambulance Service to operate intra-facility and out of county transports for a fee or charge for the following area(s): Collier County for one year from the date executed hereon, except that this permit may be revoked by the Board of County Commissioners of Collier County at any time the service named herein shall fail to comply with any local, state or federal laws or regulation application to the provisions of Emergency Medical Services. Issued and approved this day of , 2015 ATTEST: BOARD OF COUNTY COMMISSIONERS DWIGHT E. BROCK, CLERK COLLIER COUNTY, FLORIDA .Deputy Clerk Tim Nance, Chairman Approved as to form and legality: Jennifer A. Belpedio Assistant County Attorney Packet Page -1207- {'�� 10/27/2015 16.E.6. I.) " 2 ., Co. .••• 0 U") ...44 0 "."‘ 0 = •..* Ct •.- 1.) ..- 0 >, 5 t) .... 0. = . -.7. vs c to. C...) •-- > t a) .a, C.) .. ce3 C) .cn r9 C) ct- CA 2 "j a 0 .0 a (0' , (..) 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"," = .... —• 0_ --, Packet Page-1208- 10/27/2015 16.E.6. cqncierge July 31, 2015 Mr. Dan Summers Collier County Emergency Management 8075 Lely Cultural Parkway Naples, FL 34113 Re: Application for Certificate of Public Convenience and Necessity- Class 2 ALS Transfer Dear Mr. Summers, Enclosed please find the Just Like Family Concierge Medical Transport, LLC application for a Certificate of Public Convenience and Necessity (COPCN) Class 2 ALS Transfer. Just Like Family Home Care has been serving Southwest Florida since 2006. The locally owned company is dedicated to helping people remain active and independent by providing quality caregivers and nurses to clients needing assistance in their daily lives. As the largest provider in the area, the company now services almost two hundred clients and provides referrals to over four hundred health care providers per year. In 2014, we opened Concierge Transport Services, when it was recognized there was a significant need for dependable transportation for clients who are unable to drive, or who prefer the benefits of a customized transport service. Concierge Transport Services currently provides three vehicles in Collier County to assist with the needs of clients requiring wheelchair and stretcher non-emergency transports, and five additional luxury vehicles for trips to the doctor, the airport or around town. All of our vehicles are new, with top of the line handicap accessible accommodations. It is our intent to obtain a COPCN to capture a specific segment of the post-hospital market by adding the ability to transport patients in the routine and emergency setting. One of the many Concierge Transport Services differences is the drivers, EMT's and medical professionals we have on staff. We pride ourselves on the impact they make in their uniform, their pleasant attitude, qualifications and experience. We have Emergency Medical Technicians (EMTs) and Paramedics on staff and always utilize two attendants on a non- emergency stretcher transport to ensure safety, with one person in the back with the patient. We have a great rapport with the hospitals and facilities in our area, and in just over a year have become the preferred provider for most. We hope you will consider our application and make a recommendation to the Board of County Commissioners that our service is not only needed,but necessary. As a local resident of Collier County, and someone who is passionate about servicing the community, I want to help service the local residents safely. I want to free EMS to deal with true ALS emergencies and 911 calls. 4500 EXECUTIVE DR. SUITE 205. NAPLES, FL 34119—239.652.8907 - info @jifcmt.com Packet Page-1209- 10/27/2015 16.E.6. With the tremendous growth in Collier County just this year, I know this service is needed. I can help with faster discharges, which in turn will also help with faster admissions. In the end, everyone is happier. If after reviewing this information you have any further questions, or need any additional information, please feel free to call me at (239) 682-8907. Thank you in advance for your time. Very ly yo I4d0 'sa∎etl 4 as berg • Owner Concierge Medical Transport 2 Packet Page -1210- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER An applicant for a certificate shall obtain forms from the department to be completed and returned to the division administrator. Each application shall contain: 1. The name, age, and address of the owner of the ambulance or ALS Operator, or if the owner is a corporation, then of the directors of the corporation and of all the stockholders holding more than 25% of the outstanding shares. For governmental units, this information shall be supplied for members of the governing body Owner Name and Age • Elisabeth Nassberg, 40 years old Address • 4500 Executive Drive Suite #205 Naples, Florida 34119 See Appendix A 2. The boundaries of the territory desired to be served. We wish to serve Collier County with post-hospital medical transfer services for routine and emergency ALS and BLS patients. 3. The number and brief description of the ambulances or other vehicles the applicant will have available Just Like Family Concierge Medical Transport Service plans to purchase Type 11 ambulances (Appendix B) based on the Board of County Commissioners approval of this COPCN request. Our plan is to place these unit's in service 24 hours a day, seven days a week within a short period of time after the COPCN is granted. More units will be added as the demand for their use increases. These unit's will be permitted with the Florida Department of Health, Bureau of Emergency Medical Services as ALS ambulances. 3 Packet Page -1211- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER 4. The address of the intended headquarters and any substations Just Like Family Concierge Medical Transport's corporate office is located at: 4500 Executive Drive Suite # 205 Naples, FL 34119 5. The training and experience of the applicant. Just Like Family Home Care has been proving private duty home care providers to the Collier County community since 2006. Since 2014, Concierge Transport Services has been providing non-emergency wheelchair and stretcher transport services handling over 1600 transports already since its inception. Owner: Elisabeth Nassberg, Owner of Just Like Family Services, has worked in the private duty home care industry for 17 years providing referrals of qualified nurses and home care aides to seniors. In order to diversify her home care business, she has continued to service the community by opening Just Like Family Concierge Transport Services in 2014, when she saw the tremendous need for quality transportation options for her almost two hundred clients in our local area. (Appendix C) Medical Director: Robert B. Tober, will serve as the Medical Director of Just Like Family Concierge Medical Transport, LLC. As Medical Director of Collier County EMS Dr. Tober is knowledgeable of the laws regarding Basic and Advanced Life Support and the regulations that impact the post hospital transportation industry. (Appendix D) Medical Transport Director: Steven Epright, Concierge Transport Services Medical Transport Director has served for 26 years with Collier County EMS. Steve has served in the capacity of FTO, EMS Training Officer where he worked hand in hand with the Collier County Medical Director in the development of Quality Assurance and the development continuing education programs for EMS. Steve also served as an EMS Battalion Chief for 12 years and is a state certified All Hazards Operations Officer. He has had a total of 38 years of experience in the EMS and Fire Service fields. (Appendix E) 4 Packet Page -1212- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER 6. The names and addresses of three Collier County residents who will act as references for the applicant. (Letters available in Appendix F) Allan Weiss, MD, FACP, FACR NCH Healthcare System 350 Seventh Street North ■ Naples, FL 34 102 Gary B. Price: Fifth Avenue Advisors 3003 Tanuanir Trail N. Suite 410 Naples, FL 34103 Chick Hcithaus: SCORE Counselor 2384 Kings Lake Boulevard Naples, FL 34112-5306 Dexter Patton: BSN, CCM, MBA Director of Case Management, NCH Healthcare System 350 7'h Street N Naples, FL 34102 Jimmy Dascani: CEO Landmark Hospital Naples, FL 34110 5 Packet Page -1213- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER 7. A schedule of rates which the service intends to charge. Code Service Description Rate A0428 Basic Life Support Rate (Non-emergency) $ 395.00 A0429 Basic Life Support Rate (Emergency) $ 425.00 A0426 Advanced Life Support (Non-emergency) $ 395.00 A0427 Advanced Life Support (Emergency ALS Level 1) $ 500.00 A0433 Advanced Life Support (ALS Level 2) $ 725.00 A0434 Specialty Care Transport Rate $ 900.00 A0425 Mileage (Per loaded mile) $ 10.00 A0999 Oxygen $ 45.00 8. Such other pertinent information as the administrator may require. No additional information was requested from the administrator at the time of submission. 9. An application or renewal fee of$250.00. (Exception Collier County EMS). (See Appendix H) 10.Financial data including assets and liabilities of the operator. A schedule of all debts encumbering any equipment shall be included. (See appendix I) 6 Packet Page -1214- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDICES: A. ARTICLES OF CORPORATION JUST LIKE FAMILY MEDICAL TRANSPORT B. AMBULANCE SPECIFICATIONS C. RESUME ELISABETH NASSBERG D. RESUME DOCTOR ROBERT TOBER E. RESUME STEVEN EPRIGHT F. RECOMMENDATION LETTERS • Allen Weiss, MD, NCH Healthcare System • Mr. Gary B. Price, 5th Avenue Advisors • Mr. Chick Heithaus, SCORE • Mr. Dexter Patton, NCH Healthcare System • Mr. James Dascani, Landmark Hospital G. COPY OF CHECK TO BCC H. PROFIT & LOSS STATEMENTS • Just Like Family Home Care • Just Like Family Concierge Transport Services 7 Packet Page-1215- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDIX A: ARTICLES OF CORPORATION JUST LIKE FAMILY MEDICAL TRANSPORT SERVICES 8 Packet Page -1216- 10/27/2015 16 E 6 APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Electronic Articles of Organization .152800m5-17 IvilaLz 158e: oiA5m Florida LimiteFor d Liability Company Se . Of' tate tburch Article 1 The name or the I.imited I taint io Company is II:ST I.1k1.: FA\Ill Y c-oNcIERcie N11:131CAL TRANSPORT SLR\ICES. IC Article 11 •rhe street address at the prim:Mid orrice or the I.iinited I olti It Campans is -1500 ENECI DRIVE St TIT N.'PEES. FI ;4119 Ihe address al the Ennited Eiabiht.s Company Is 4500 EXECt"TI\I' DRIVE St TIT"20!. !S.\PLI.:S. Fl 341 Article III 'I he name and I.:londa street address or the registered agent is JIFF NOV vr i 'SQ. 1415 PAN-1111'R I ANT SI'ITI:327 .VS. I a9 I It be,,named i..'eu..te and I■I ,rce-. fir 111Q ahoy,:tt1ttltd linntdd hahilit■• corn pan at the place designated in this eertilicate. I hereh!. accept the appt)iniment as registered agent sad agree to Het in ans cap tc,IN I farther agree iu e‘attpl■ nith the ratwistons of all tdanstd$: rdlatint.t crud propdt and..aattpldic pertorniunce of ins datt,, amt.! I ant littniliar with and accatta the 4114:annuls cit on rdt.ntd.,4■-a-1 uueutl Itotn.turod Aectit tiisillIttin... .11,1 F t\ VII'. FSL). 9 Packet Page-1217- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Article IV L15000086517 ilie name and address of persons s t authorized to manage 1.1.C: Ma E 115 2015M Title: MGR See. Of State ELIS.-WL:TI1 NASSl3LRU tburch 4500 ESECI-FIVE DRIVE.SLID:=2u5 NAPLES. Fl.. 34119 Signature of member or an audio':tied representative Electronic Simtaturc:JEFF Nt)\.\1-I. FSQ. 1 ant the member or authorized representative submitting these.krticles of Organization and allinn that the duets stated herein are trite. I am aware that bole inli+rmauon submitted in a document to the Department of State constitutes a third degree felony as provided liar in s.ti17.155. P.S. I understand the requirement to tile an annual report hem eet January 1st and May 1st in the calendar year urination of the 1.1C and every year thereafter to maintain"active"status. 10 Packet Page -1218- 10/27/2015 16.E.6. APPLICATION ION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDIX B: AMBULANCE SPECIFICATIONS '" S Sy ,ay.S k,-s' y4 + Pn �_'�C't"f , �L � _0;!i z4—IN•f'i'yi� <er ..sfi' S 7 ��Ig'' a` h ' Y k '14s E67{ }a'/r 1 bUp Sr_+W- s r f'J .' a M. , nlledlc a _ra ; r, 1111:::::::.'''''''f'''''- f J... . ..r• ¢; i'73*.,.„,„,..,., ,,,P''... ,: .xr aJj 11 Packet Page -1219- err 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY ` CLASS 2 ALS TRANSFER APPENDIX B:AMBULANCE SPECIFICATIONS f. -ti p :aC.7 1 11 Packet Page -1220- „.... .. . 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER TYPE II SPRINTER ‘. 5731\TER 2590 3.0 PIERCEDES DISH „ ..., . . • . . ... 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Aimik APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDIX C:RESUME ELISABETH NASSBERG 15863 DELASOL LANE NAPLES, FLORIDA 34110 PHONE (239) 248-3186 • ENASSBERG cLJLFSERVICES.COM e L ISA TI-f NASSg ERG • PROFESSIONAL EXPERIENCE 2015-present Concierge Medical Transport Naples,FL Owner 2014-present Concierge Transport Services Naples, FL Owner 2006-present Just Like Family Home Care Naples,FL Administrator/Owner • Opened nurse registry in May 2006 • Handle all day to day activities including patient referrals, registering caregivers,accounts receivable,accounts payable, hiring and training staff • Keep up to date on all state rules and regulations to keep license current and in compliance 1996-2005 Levin Home Care Nurse Registry Delray Beach,FL Vice President of Finance, Alternate Administrator, Office Manager • Managed all daily operations of the nurse registry including taking client intakes, registering Home Health Aides and Certified Nurse Assistants according to the state of Florida, and supervising administrative and office staff • Set billing rates for clients and pay rates for registered nurse assistants • Implemented new systems for billing and payroll • Handled all reporting of new clients and revenue, and verified all payments from billable parties • Performed all human resource functions for three offices and twenty three employees including payroll,health insurance,401K • Processed all accounts payable for the operating costs of the office • Created a Comprehensive Emergency Management Plan for the Policy and Procedures Book • Updated the Policy and Procedures book with any new rulings or requirements according to A.H.C.A. • Educated and trained administrative and office staff on the rules of A.H.C.A , 13 Packet Page -1222- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER and any amendments to the Florida Statutes for Nurse Registry 1993-1996 Hunt Union,SI_'NY Oneonta Oneonta, NY Student Manager, Video Store • Opened and managed student video store for attending college students including stocking movies, billing student accounts, promoting the store, and collections • Planned events for incoming freshman orientation programs including a job fair to recruit students • Expanded video store to renting video games and selling previously viewed movies which increased profit more than twenty percent 1992-1996 State University of New York at Oneonta,Oneonta,NY B.S.Business Economics • 14 Packet Page -1223- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDIX D: RESUME DOCTOR ROBERT TOBER Updated Curriculum Vitae-April 2015 Robert Boyd Tober, M.D.,FACEP 121 Goodlette Road. N,Naples, Fl 34102 Contact Information: 239-649-0343- Home Fax 239-403-2600- Wound Center 239-403-2602- Wound Center Fax 239-450-5375- Cell Phone Email: rbtobermd@yahoo.com Personal: Born: September 20, 1946,St.Louis, Missouri Married: December 6, 1987, Gail Lorrainne Tober Hobbies: Bicycling, Flying, Exercise Education: Undergraduate:St. Louis University-BA History 1969 Graduate: St. Louis University Medical School 1975 Post-Graduate Internship 1975-76 Jewish-Barnes Hospital of St. Louis EM Training Program 1976-78 St.Johns Mercy Medical Center and Trauma Center Hospital appointments: 1978-Present Naples Community Hospital & North Collier Hospital 1986-10/31/03 Chairman, Department of Emergency and Ambulatory Medicine 15 Packet Page -1224- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER NCH Healthcare System 2003-Present Appointed Medical Director NCH Wound Healing Centers 1986-Present University of Miami Medical School Faculty Appointment 1986-Present University of Miami Governing Board on EMS Education Community Appointments/Positions February 3, 1979 Initiated ALS EMS System Collier County Florida 1979-Present Medical Director Collier County EMS February 1, 1986 Chairman, Dept.of Emergency Medicine NCH Healthcare January 2, 2003 Medical Director NCH Wound Healing Centers June 1, 2003 Medical Director Neighborhood Health Clinic Professional Appointments: 1984-85- Elected President, Florida Association of EMS Medical Directors 1986-Present Guest Faculty Annual Conference in Clinical Cardiology & Neurology University of Miami 1986-Present Faculty Edison Community College-Paramedic Medicine 1986-Present Affiliate Faculty American Heart Association 1993-2003- Governing Board Florida College of Emergency Physicians 1994-Present Appointed Medical Director Bentley Village Skilled Nursing Unit 1998-Present Expert Witness State of Florida Agency for Healthcare Administration 1999-2000 Elected President Florida College of Emergency Physicians 2009-Present Volunteer Faculty Department of Medicine University of Miami Community Honors: 1980- Distinguished Service Award Naples Jaycees 1994 Raymond Alexander Award for Florida EMS Medical Director 16 Packet Page-1225- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER 1999 Collier County EMS receives state honor as Best EMS System in State of Florida 2000 Collier County EMS voted#One EMS System in the Nation by: National Association of Emergency Medical Technicians and Paramedics 2001 First Annual Award: Physician of the Year NCH Healthcare System 2004 Award by Board of Collier County Commission for Heroic Actions in Punta Gorda saving the life of a 13 y/o lightening strike In the aftermath of Hurricane Charlie during thunderstorm 2009 Journal of Emergency Medical Services names Dr. Robert Tober One of top 10 Innovators in EMS 2009 Awarded Golden Stethoscope &Golden Heart Award American American Heart Association 2009 2nd-Time Recipient Raymond Alexander Award for EMS Medical Director of the Year 2009 Roy M Baker Award from Florida Medical Association for Lifetime Achievements in Emergency Medicine 2011 Naples Daily News Healthcare Physician of Distinction May 10, 2011 Board of Collier County Commission names May 10, 2011 Dr. Robert Boyd Tober Day in Collier County Dec 2012 Collier County EMS Receives National Accreditation(1 of 150 EMS Systems in the country) Clinical/Drug Principal Investigator/Publications 1982 Principal Investigator for International Study Utilizing Metoprolol For Acute Myocardial Infarction 17 Packet Page -1226- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER 1990 Co-Investigator with Dr. Everett Alsbrook-Global Utilization of Streptokinase and Tissue Plasminogen Activator in Acute MI (GUSTO World Study) 1990 Co-Investigator International Study on Infarct Survival(ISIS III World Study 1997 Principal Investigator,ASSENT Clinical Trial with TNK-tPA for Acute Myocardial Infarction 1997 Contributing Writer,Universe of Florida Patients with lschemic Stroke ("Brain Attack") Medical Practice Guidelines, State of Florida, Agency for Healthcare Administration. 2000 Initiated Code Save-A-Heart Program of Direct Infarct Angioplasty Program NCH Healthcare System 2001 Published Results of First 250 Patients Code Save-A-Heart American College of Cardiology-Orlando Lowest Mortality Reported for Acute MI in the World 2007 Adopted Compression-Only CPR Resuscitation Collier County in Conjunction with Dr.Gordon Ewy, M.D.-Sarver Heart Institute Board Certification: 1981 American Board of Emergency Medicine(ABEM) 1991 Re-certification ABEM 2001 Re-certification ABEM 2001 Certification in Hyperbaric Medicine 2011 Re-certification ABEM Certifications: ACLS, ACLS Affiliate Faculty, PALS,ATLS, PHTLS, BTLS,APLS, HBM 18 Packet Page -1227- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Hospital Appointments: Naples Community Hospital North Collier Hospital References: Michael Gordon, M.D., FACC Director University of Gordon Center for Research in Medical Education One Grove Isle-Apartment 1803 Miami, Florida 33133 305-859-7713mgordonPmed.miami.edu Dr.James Talano, M.D.-Cardiology-Retired President Collier County Medical Society Swift Institutue 625 Tamiami Trl N Suite 201 Naples, FL 34102 (239)261-2000(Office) jvtalano @comcast.net Dr. Ivette Motola, M.D., FACEP Director Paramedic Training and EMS Gordon Center for Research Miller School of Medicine University of Miami 1120 NW 14th St Suite 1ST Miami, FL 33136 305-243-6491 ivettemotola@yahoo.com Dr John Lewis, M.D., FACEP Medical Director Department of Emergency Medicine Naples Community Hospital 19 Packet Page -1228- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER NCH Healthcare Emergency Department 350 7`h St. N. Naples, Florida 34102 Tel: 239-436-5151 johnlewis @teamhealth.com Jeff Page—Retired Chief Collier County EMS Dorian and Jeff Page 2300 Queens Way Naples, Florida 34112-5403 239-537-3145 jeffpage@centurylink.net 20 Packet Page -1229- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDIX E: RESUME STEVEN EPRIGHT Steven J. Epright, Collier County EMS Battalion Chief Retired 3570 3rd Avenue NW, Naples, FL 34120 WORK EXPERIENCE United States Navy Mobil Construction Battalion 74, 1972-1975 Captain,Chester Fire Department, Chester PA. • 1974-1984 Paramedic Training Coordinator, Delaware County PA 1884-1987 Collier County Emergency Medical Services 1987-Present, Paramedic, Training Officer, FTO, Battalion Chief Just Like Family Medical Transport Services 2013-Present Medical Transport Director EDUCATION St.James High School,Chester, PA Class of 1971 21 Packet Page -1230- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Delaware County Community College Paramedic Program 1975 Delaware County Fire School 1975 Firefighting I Philadelphia Electric Company 1975 The Firefighter&the Gas Company Delaware County Community College 1978 High Rise Firefighting Delaware Technical & Community College, Stanton, DL 1976 thru 1979 Introduction to Fire Protection Blue Print Reading Fire Hazards & Causes Fire Extinguishers &Alarm Systems Industrial Fire Hazards Fire Prevention & Inspection Fire Codes & Ordinances Chemistry of Hazardous Materials Fire Investigation & Legal Problems Organization of Fire Protection Administration 22 Packet Page-1231- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Water Supply Analysis & Hydraulics Fire Systems Graphics Fire Department Teaching Methods &Techniques Fire Insurance Water Suppression Systems General Chemistry Organic Chemistry Fire Department Personnel Management Fundamentals of Plant Safety State of Florida Firefighter July 1998 #91907 Disaster Response & Recover Operations G-385 FL DCA Division of Emergency Management July 1999 Emergency Response to Terrorism National Fire Academy October 1999 CAMEO Windows EPA, January 2000 Hazmat Treatment Protocol's Train the Trainer Pembroke Pines Fire Rescue March 2000 23 Packet Page-1232- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER EMS & Hurricane Response Role of the Fire Service in Disaster Response Statewide Disaster Planning Governors Hurricane Conference 2000 ICS/EOC Interface Course G-191 FL DCA Division of Emergency Management June 2000 Hurricane Planning G-360 FL DCA Division of Emergency Management June 2000 Rapid Response Team Orientation G635 FL DCA Division of Emergency Management July 2000 IS-195 Basic Incident Command Emergency Management Institute September 1999 I-200 National Incident Management System Train the Trainer National Wildfire Coordinating Group November 2000 24 Packet Page-1233- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Emergency Medical Concepts for WMD Incidents Texas A&M University October 2001 ICS-700 National Incident Management System August 2005 Intermediate Incident Command System, ICS-300 June2006 Advanced Incident Command System, ICS-400 July 2006 1-800 National Response Plan Emergency Management Institute May 2006 IS-00701.a NIMS Multiagency Coordination System (MACS) November 2010 IS-00704 NIMS Communications and Information Management November 2010 NIMS ICS All Hazards Position Specific Operations Chief(OSC) Course L-958 Division of Emergency Management February 2012 Hazardous Materials First Responder Hazardous Materials EMS Responder I Southwest Florida LEPC October 2001 ICS-700 National Incident Management System 2005 25 Packet Page -1234- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Governors Hurricane Conference 2006 IMT Type III Positional Training-Introduction to Liaison Officer Implementing Florida Fire Chiefs State Emergency Response Plan First-In Recon Implementing Search & Rescue Rapid Assessment G-250.7 FL DCA Division of Emergency Management May 2006 PROFESSIONAL MEMBERSHIPS National Registry of Emergency Medical Technicians Florida Association of Professional EMT's& Paramedics International Association of Fire Chiefs Florida Fire Chiefs Association DISASTER EXPERIENCE Wade Dump Fire (EPA Superfund Site), February 1978 Corinthos Explosion with 11,000,000 gal crude oil spill, January 1975 Mutual Aid, Hurricane Andrew, Homestead, FL 1992 EMS Chief in coordination with DEM ESF 8 Firestorm 98 Flagler County Collier County EMS Medical Liaison , Miller Fire, April 2000 Collier County EOC Experience Hurricane Georges 1998 Hurricane Irene 1999 TS Harvey 1999 26 Packet Page-1235- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Hurricane Charley 2004 Hurricane Francis 2004 Hurricane Ivan 2004 Hurricane Katrina 2005 Hurricane Wilma 2005 SIGNIFICANT ACCOMPLISHMENTS • Recipient of The International Association of Firefighters Award for Valor on two separate occasions for the rescue of citizens trapped in a dwelling by fire. • Served on several committees which were instrumental in developing a Emergency Medical Services Comprehensive Plan for Delaware County, Pennsylvania • Served as a member of the Pennsylvania Emergency Health Services Council on the Committee on Training Standards • Establishment of the first Quality Assurance System for Collier County Emergency Medical Services Department • Establishment of Continuing Education Policy for Collier County Emergency Medical Services Department • Implementation of the first Collier County Emergency Medical Service Department Data Collection System • Complete revision of Medical Protocol for the Collier County Emergency Services Department • Nationally Registered Emergency Medical Technician- Paramedic since 1978-2000 • Developed the original Standard Operating Procedure for the Special Operations Unit. 27 Packet Page -1236- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER • Developed the original Medical Protocol for Hazardous Materials and WMD for the Special Operations Unit. • Developed the equipment list and assisted in the development of a State Grant that Collier County received for Special Operations. • Developed and implemented the Collier County EMS Incident Management Protocol which brought us into compliance with State and Federal standards. • Responsible for the specifications and purchase of Personal Protective Equipment for the entire EMS organization. • Authored the Operational Agreement between the City of Naples and Collier County BCC, which has served as a model for all operational agreements in place today. • Attached to Florida Department of EMS (ESF-8) and served as EMS Chief at the Flagler County fires in 1998 • 2000 Author Collier County Emergency Medical Services Hurricane Preparedness Plan • 2000 Author Collier County EMS ESF-9 Response Plan • Named to the Florida Committee involving accreditation for all of Florida's Type III All Hazards Incident Management Teams 28 Packet Page -1237- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDIX F: RECOMMENDATION LETTERS ALLEN WEISS MD PRESIDENT AND CEO OF NCH HEALTHCARE SYSTEM MR. GARY B. PRICE, 5TH AVENUE ADVISORS MR. CHICK HEITHAUS, SCORE COUNSELOR MR. DEXTER PATTON , DIRECTOR MEDICAL OUTCOMES/CASE MANAGEMENT NCH HEALTHCARE SYSTEM MR. JAMES DASCANI, CEO LANDMARK HOSPITAL OF SOUTHWEST FLORIDA 29 Packet Page -1238- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Ni tl to rro!anm 14 tI\JII.. Illl 11tr)qx Wt taws! .wWth'Nw.115 1100 p4 r. Ldr..tl i41C: '•r 'fl p Healthcare a-a:.,7100 System lstnc1,lei t •Fu Wlaou 11 flu}'C'autat.r. "f'aln:t;:t 17..lin isf rrapor.?nr Ilem/Ai which is a.yrntsinr,tritnsp:i tntltal;aid pritwf nursing,husinres in Stro'riwe I hlo.tda t.1at Ilan supplied c>.cnlnlary,:crviar thr Vl H I lcahhl.:ec Stxtcl*t tier the pxt::tv)'cn°• 1 Have s,n.,ihtst till:udkatl:CS ti N(.11 w•itrt have tit 1I17.iti.t:n1 Li5e f w^'t!M lur itu.luplc or Lana gcnr) It;v.St.>:I:.a11U31,onna_}Lrul I;0111:c`i. .hTr I Ike T rmfJ1.71m.1•:fcs.1cs so 4Ck'1 set\fa:CS In tint'11 '.111 11M r\<•H xni vtu i0:.ss5.unity. At 411 sintc../uir l,rirr rani/t'pers:uulcl htv<.heel; curpIl•rly p )tcsinna,comps-lent acid 031inQ in Iact id np,crvu:as'n t\t'I I putt imp; I fin,ny rhn:c is always.Ml'.Il pG[tor S nnsumr.s H:IV1,.i•multiple ransIK11intnln irptioth hit nest-rac!peacr passer:Li v,;11 tic' f t all c,nx:.r-crt 11 I ran pm';1Jn any ltnihcr s :1>?x li for best /ikr•f'u.ut71 plrane let Ile kus s•:. ke;pcc:fuIIy, A1`:en Mir. s,MBA Mil,1.M'I'.FAt'k I'tt t':r and I f'O 30 Packet Page -1239- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Fifth Avenue Adv sora Mr.Leo Ochs May 13,2015 Collier County Manager 3299 Tamiaml Trail East,Suite 202 Naples,FL 34112-5746 Dear Leo, It is my pleasure to write this letter in support of Elisabeth Nassberg and her efforts to apply for a COPCN. I have met with Mrs.Nassberg and was impressed with her plan to provide another valuable solution for medical transportatbn in Collier County. We certainly have a growing need in Collier County to have affordable and safe options to transfer our citizens. Mrs. Nassberg,has grown her company exponentially over the years which continues to provide increased employment opportunities for the area.She has also been a consistent philanthropic leader,which is evident from her personal dedication to supporting the community.Her projects include creating Senior Citizen annual charity programming and sponsoring the American Heart Association for the last three years. Thank you and your staff for allowing Mrs.Nassberg to present this concept to the Board. Please feel free to contact me anytime if you have any questions. Sincerely, Gary B.Price Partner,Fifth Avenue Advisors fw' :'t t r.h...':t'E?1:}'a,>'JC;tr':i4;. t.r J;F ._ ,. ... '.t4N11.".(.M:'.'r•`i..:l...'. f§i�S '�,. 31 Packet Page -1240- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER J.C."Chick'Heithaus 2384 Kings Lake Boulevard Naples, FL 34112-5306 May 14,2015 Leo Ochs Collier County Manager 3299 Tamiami'frail East,Suite 201 • Naples,Fl. 34112-574(i Dear Leo, Elisabeth Nassberg asked me to contribute some observations relative to her company's(Just Like Family Concierge Medical Transport,LLC)wish to successfully apply for a COPCN, allowing them to expand their non-emergency transportation program and,in fact,transport clients with oxygen. Just Like Family Home Care is a local,family-owned and operated Nurse Registry.Elisabeth and her husband,Jacob,were my SCORE startup clients in 2006! They started"from scratch," having sold or borrowed against all their assets only to be abandoned at the last minute by investors they had been depending on. But now,through their hard work and dedication to fair and honest business practices,their very successful business provides referrals to professional Companions,Home Health Aides, Certified Nursing Assistants,Caregivers,Licensed Practical Nurses and Registered Nurses- ntore(Ilan 700 caregivers annually Who Visit With patients at home. Nassberg and her teatn of more than I S people focus +n getting people help last,usually within the hour, The company has won the national SCORE award for Majority Women Owned Business in 2010 and the YMCA of Naples Volunteer of the year award in 2009.Elisabeth and Jacob actively support local causes related to health,seniors and children,especially,now,on The American Heart Association and PACE Center for Girls. Recently,seeing an unmet local need,the company added the service of transportation with Concierge Transportation Services to help with non-emergency transport,errands/grocery shopping,doctor/medical appointments,hair and day spa appointments.Most current providers are just one individual owning the company and driving his own truck and does all the work,Just Like Family has a fleet and a whole crew of drivers! I know that you and the Commissioners support small,local companies and I hope you will give them whatever help you feel appropriate to get the License they seek. Very sincerely yours, Chick Heithaus SCORE Counselor 32 Packet Page-1241- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER LANDMARK HOSPITALS To whom it may concern, Just Like Family Home Care is a locally owned small business that has been providing home health care services to Collier County since 2008.In 2014,Just Like Family Concierge Transport Services was added to address the needs of patients in need of non-emergency transportation. The medical demands of our community are increasing in Collier County due to population growth and the increased medical complexity of patients and visitors.Thus,adding to the complexity of transportation logistics and increasing the need for healthcare providers and families to have additional options to prevent unnecessary and costly delays In non-emergency transport.If the additional transport services are added,the dynamics of the admission and discharge processes improve significantly for all stakeholders.The effects of having a second option may also contribute to more appropriate use of 911 services and improve EMS's ability to manage true emergencies.I am confident that having a second option In Collier County would benefit all residents and visitors,In addition to helping the local healthcare providers Improve throughput and their overall patient/family experience. Being a supporter of local small businesses,I am enthusiastically endorsing Just Like Family Concierge Transport Services to be approved by the Board of County Commissioners for a non-emergency BLS Certificate of Public Convenience and Necessity to perform BLS non-emergency ambulance services In Collier County,Florida. In general,I em In support of efforts to help local residents Ire healthier and more hAfilirg lives while promoting local business growth through the creation of jobs and opportunity.I believe this request for more choices In non-emergency ambulance service helps meet those goals. Thank you for your consideration. Jimmy Deccan Chief Executive Officer Landmark Hospital of Southwest Florida 1285 Creekside Blvd.East I Naples,ft 34108 ph:(239)478-8398 I fax:(239)529-1850 )LDascarxtrlarxlmarkhosprtals.con l www.i.anomarkhospitals.com 33 Packet Page-1242- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER JUST LIKE FAMILY SERVICES Elizabeth Nassberg 4500 Executive Drive suite#320 Naples, FL 34119 Dear Mrs. Nassberg I want to let you know how much I appreciate your service to our patients. We saw a steady increase in patient volumes over the past year and the seasonal increase this year has been the largest on record. As a result, we had an extremely heavy demand for transports and without your dedicated service; it would have been a heavy burden on our system and patients. We do anticipate continued growth in transportation services and look forward to the continued excellent service your company provides. I can say without hesitation that all services provided by Just Like Family Concierge Transport Services have been of the highest quality and have exceeded our expectations. Our discharged patients have also been very pleased with their service and care received from your staff. I have received comments from patients stating your staff is extremely professional, excellently trained and are impeccably courteous. Thank you again for helping us meet our patients needs. Sincerely, Dexter Patton, RN, BSN, CCM, MBA Director Medical Outcomes/Case Management NCH Healthcare System 34 Packet Page-1243- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER APPENDIX G: PROFIT& LOSS STATEMENTS • Just Like Family Home Care • Just Like Family Concierge Transport Services • 35 Packet Page-1244- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER Just Like Family Home Care Profit& Loss January 1 through May 1,2015 Jan 1 -May 1, 2015 Ordinary Income/Expense Income Client Fees 2,869,021.19 Total Income 2,869,021.19 Gross Profit 2,869,021.19 Expense Operating Salaries 320,593.15 Non-Personnel Operating Expenses 363,811.08 Contract Labor(caregiver services) 1,872,039.53 Total Expense 2,556,443.76 Net Ordinary Income 312,577.43 Net Income 312,577.43 Peg.1 of 1 36 Packet Page -1245- 10/27/2015 16.E.6. APPLICATION FOR CERTIFICATE OF PUBLIC CONVENIENCE AND NECESSITY CLASS 2 ALS TRANSFER 3:15 PM Concierge Transport Services 95719/15 Profit& Loss Accrual Basis April 1 through May 15,2015 Apr 1•May 15,15 Ordinary Income/Expense Income 70.799.01 Gross Profit 70,799.01 Expense Charity 200.00 Credit Card Fees 990.17 Legal Fees 1.305.00 Marketing 160.00 Payroll Service Fees 445 96 60200•Automobile Expense 14,795.60 81000•Business Ucarass and Permits 8765 61700•Computer and Internet Expenses 0.00 63300•insurance Expense 6,025.14 64300•Meals and Entertainment 45.85 64900•Office Supplies 789.38 66000•Payroll Expenses Payroll Taxes 3,557.86 Salaries 32,833.74 Total 66000•Payroll Expenses 36,391 40 66700•Professional Fees Contract Labor 5,520.00 66700•Professional Fees-Other 75.00 Total 66700•Professional Fees 5.595.00 67600•Small Toole and Equipment 924.20 66100•Telephone Expense 316.88 Total Expense 68,052.23 Net Ordinary Income 2,746.78 Net Income 2,746.78 Page 1 37 Packet Page-1246- 10/27/2015 16.E.6. ISSENVIEMBEIMMIIIIIMMOINEN MISSION STATEMENT Concierge Medical Transport will provide our community with superior, client focused t ��, transportation services. From hospital discharges, 7- transfers, skilled nursing facility appointments and others, Concierge Medical Transport will serve and meet the needs of a diverse range of Collier County's Application for Certificate of Public residents and visitors. Convenience and Necessity for Class 2 Advanced Life Support Transfer er l,`�nCl gP ALS COPCN .mod rt '-r- xx 5 x - f`} t7: AGENDA COMPANY HISTORY •Company History .iru.ier6e -rile csli ae're Company Awards and Recognition • Just Like Family Home Care has been serving Organizations and Community Involvement Collier and Lee Counties since 2006 and The Need employs more than 20 full-time employees Market Summary • Referred patients to over 400 independent Goals and Objectives contractors(Caregivers and Nurses) in 2014 Recruitment&Training Just Like Family Concierge Transport Services ..-`""` started in 2013 •Revenue ° ° - Concierge fleet now has 7 vehicles and Summary employs more thanl0 full-time employees 1 Packet Page -1247- 10/27/2015 16.E.6. ='!f' BENIMMENEEMENESEMIZESEERW AWARDS & RECOGNITION AWARDS & RECOGNITION • Business Observer 2013"40 Under 40" usrri do scor2S_O Cul l'•hond.ife 2013 SWFL Reader's Choice Award •2009 YMCA Volunteer of the Year Award for"Best Home Health Care" •2010 SCORE Majority Women Owned Business 2014 Gulfshore Life"40 Under 40" •Excellence in Industry Awards, Nominee • 2015 Nominee for"Best of the Best" for 2013 Business Expansion Award for Home Care 2013 SWFL Reader's Choice Champion Award • 2015 Nominee for"Best of the Best" for Transportation k ., i t,., �a :sir n, wT- x x !''.it° 1y� '3.' ", t .; t ,.lr•va n?°� ,t_, "i�. „5c �s'.... COMMUNITY INVOLVEMENT HEALTH-Related Organizations •Naples Chamber of Commerce • Private Care Association •The Greater Naples YMCA "°""""" C^ P •American Heart Association •C'MON Children's Museum �i1\4L12) American ST.MArnIEw^S HOUSE •CAMEO �' U Heart PACE Center for Girls at Immokalee '�S°`av°° Girls On the Run ��' Interagency SUSQnc. INTERAGENCY •Zrnli `he : aCe •Susan G. Komen xo- ure •Well Fit Girls y..e . ,,.W, per:..,,.." , ta4' NAPL-ES St. Matthew's House SCORE// The Naples Group SCORE Collier County Injury Prevention Coalition •Blue Zone /" (, Impact Initiative 1IT1Uact, initiative 2 Packet Page-1248- 10/27/2015 16.E.6. THE NEED Commentary on THE NEED •Collier County can expect an increase of almost by the Healthcare Community 30% in the next 5 years in the population "Having choice is always advantageous for consumers. There are currently 15 new Assisted Living Facilities Having multiple transportation options for nonemergency patients under construction with 1,000 beds will benefit all concerned." Dr Agee,Weiss C es+denf B CEO of NCH Healthcare System.tune 1.2075 • Landmark Hospital just opened with 50 beds •Current private service provider has realized 50% °1'{ a,t growth in three years � t, � d EMS is still handling some inter-facility transports ' 4 , ..-- ° •NCH Healthcare System plans to open new ER facility and will house 10 new physician's offices . 1 ':.i1 i .c.. f' r it p ''A ottog %' :, a„,.—.?r 2: ”",S„ .T.0 . F.r7 9k R'g3P, _t...r S..r 1M v .: i. l si.r .. x..f.^.*� . :ti '-7 n i s. Commentary on THE NEED Commentary on THE NEED by the Healthcare Community by the Healthcare Community "..We have seen a steady increase in patient volumes over the past "The medical demends.of cur community are increasing in Collier year and the seasonal increase has been the largest on record As a County due to,popn 'iv:,-H 1p, Increased medical complexity result,we have seen a heavy demand for BLS transports and expect of patients and Vi; a1.,,.. lathe complexity of transportation• logistics and increa • ro re providers and families this growing trend to n HN LBW. 9 Aro r>r,.ra.von Ha LBW c:ro+MBA Drerrr MorlAMOutcormsrCaso fd aBa M to have additional opt 1 !, f ssary and costty delays in H Hocahcalo sysr . non-emergency transpd *y"a '/y'/�' a -emmi.DesCn Ch•f eU(V * ".1.. Husrm t)f Soultnr.st Pond, ep.F ' J U R Rte' f §^ I I, ∎.•• r t�t�'y` 3 Packet Page -1249- 10/27/2015 16.E.6. �i+{� � _.� kd#`5 .:«`t 6F^'�.Ve M:F1rr+ 5 ..,.!`•' `-`-^v-. M,�S�F,.:... Commentary on THE NEED The CONCIERGE Difference by the Healthcare Community Decrease wait time for discharges and transfers, especially during peak time °Your proven business model and planned diversification will help meet ° Decrease the unlicensed transport of patients the needs of our region'' with BLS needs that are using non-emergency £ transport companies •}�a ;_,: ( t�'' — ° Help reduce extended off-load times for 911 Q . 's» "' .; ... service providers Increase overall patient satisfaction with transport services Assist the county as needed in cc�r�b ier�;; times of emergency ' T,,,, rfc �.m Y'Y +q yF , ` F� c•—.���v&. f'.s> nt�r 2, ..!...k .a r�J.'r'9s 2°t4`;Y•".. '+�' � 'i'R�; .fau�th[T�� MARKET SUMMARY MARKET SUMMARY There is only one private inter-facility service There is an unaccounted number of patients provider for BLS and ALS in Collier County inappropriately transported by non-emergency transport service companies There has been a growth of 10% over the last 5 years of annual residents Concierge Transport Services turns down at least 12+oxygen transports(BLS Transports) per There is approximately a 50% increase in week BLS and ALS transports in the last 3 years -k / 1' .`r Ort 4 Packet Page -1250- 10/27/2015 16.E.6. 0�S'r-"�'�n.�i:ti��m ���.rai,'�a'tAs� E., x xw:e,�rrx .a..�,� 7rt.Jt<�+r .d.:°�. t`�•a:_f ,n.:.,-o^,a s o RECRUITMENT 0 TRAINING Concierge Medical Transport will hire ,,,IRE F44,4 experienced EMT's and Paramedics from Collier and Lee Counties (full and part-time) +° for 8 or 12 hour shifts •We will utilize the local colleges and vocational , We will seek affiliation agreements with local schools for recruitment efforts hospitals for continuing educational purposes and utilize on-line training programs We will put in place a comprehensive in-house continual educational program car er 1 ME �F�f.cK;c,`„'#':ea*1+.,. a 7- +r S. �....� 7 R,.7,4 TRAINING REVENUE BASE We currently have contracts with many facilities Training will focus on the Medical in Collier County to provide non-emergency Protocol put in place by our transport... and these facilities have additional Medical Director needs We currently provide non-emergency transport Training will be driven by quality for local hospitals that have shown interest in assurance reviews with continuous an additional private provider to reduce wait w � evaluation time IWOOur plan is to secure new contracts with some of the new facilities being built in Collier County (over 1,000 beds) c.oncier 5 Packet Page -1251- 10/27/2015 16.E.6. SUMMARY With COPCN approval, will continue to Collier County • with quality services { U and will provide r `; facilities, hospitals and a choice for inter-facility transportation 6 Packet Page -1252- 10/27/2015 16.E.6. Collier County Public Safety Authority October 7, 2015 Dear Commissioners, The Public Safety Authority (PSA) conducted a review of the Just Like Family Certificate of Public Convenience and Necessity (COPCN) Request for Class 2 Transport for post-hospital transfers. In evaluating this request, we considered whether the standards for approval of a COPCN, as included in Collier County Ordinance 04-12, were met by this request. The PSA submitted two sets of questions to Just like Family and they responded (enclosures 1 and 2). At our September 9th meeting, Just Like Family provided a presentation and PSA members asked questions. PSA members addressed personnel issues, including paramedic and EMT training and certification, medical equipment on vehicles and vehicle inspections. The major issue discussed at the meeting concerned Public Necessity (Ordinance 04-12) - That there is a public necessity for the service." The discussion points are summarized below. • CCEMS is called to transport patients between hospitals - averaging 23 per month since January - demonstrating a need that could possibly be met by an additional private sector transporter (enclosure ib). • If CCEMS didn't provide these transports, they would have greater ambulance availability for emergencies. • If patients were transported from hospitals more quickly, making beds available faster, ambulance off-load wait-times for CCEMS could be reduced. • It was stated to the PSA that patients on oxygen are being transported in taxis or personal vehicles when they should have Class 2 transport. Post hospital counts (enclosure ib) do not capture these statistics. • Letters from hospital CEOs (Appendix F of the Just in Time COPCN Request) expressed a need for additional service. • Since private Class 2 transport is less expensive than CCEMS transport, the public would benefit if private service was expanded (enclosure la). 1 Packet Page-1253- 10/27/2015 16.E.6. • Representatives from Ambitrans, the only current Class 2 Transport Operator in Collier County, expressed concern whether there was insufficient demand for post-hospital transports to support another Cass 2 Transport operator. Ambitrans serves Southwest Florida with 26 ambulances and 200 employees. • Just Like Family said it is a small, local operator that would fill in the gap - one ambulance planned initially - and could handle transports pushed to CCEMS and patients with oxygen that are using unsafe vehicles. • Expected growth In population and Assisted Living and Skilled Nursing Facilities under construction will increase future demand for these services. • Competition makes free enterprise better, and entry should not be restricted when people are falling through the cracks. After considering all aspects of the review, the PSA recommended approval of the Just Like Family COPCN Request. The vote was 3 to 1, with the dissenting view expressing concern about the demand for services and financial aspects of the COPCN operation (enclosure 3). In addition to recommending approval of this COPCN Amendment, the PSA is providing the written questions posed to Just Like Family and their responses (enclosures 1 and 2) along with the dissenting member's Minority Opinion (enclosure 3), so you can review the issues in more detail, prior to making a decision. If you have any questions regarding the PSA review, please feel free to contact me. Respectfully, c2-4-24.t-.6. ell: 1 Janet Vasey Chair, Public Safety Authority Enclosure 1 PSA Questions and Responses Enclosure 2 PSA Questions and Responses Enclosure 3 PSA Minority Opinion Cc: Collier County Manager 2 { Packet Page -1254- 10/27/2015 16.E.6. Questions on the Just Like Family COPCN Class 2 Advanced Life Support (ALS) Transfer Application Requirements for Approval Collier County Ordinance 04-12, granting a Certificate of Publc Convenience and Necessity (COPCN),states:"The Board of County Commissioners shall not grant a certificate unless t shall find, after public hearing and based on competent evidence that each of the following standards has been satisfied" The following questions relate to satisfying each of the 4 required standards. The standards are identified in quotations. Questions are for Just Like Family unless addressed to CCEMS. 1. 'That there is a pubic necessity for the service." a. `The extent to which the proposed service is needed to improve the overall EMS capabilities of the County." You have stated that there is a need to provide additional post-hospital medical transfer service for ALS and BLS patients. Your hatters from hospital CEO's and Directors (Appendix F)support this assessment. They state: 'There is a heavy demand for transports' and the potential that,ir additional transport services are added,the dynamics of the admission and discharge processes Amid improve significantly for all stakeholders, and help local healthcare providers improve throughout. This last issue relates to the large patient backups in the Emergency Departments last season. Hospitals were unable to admit new patients until current patients were discharged, Question for CCEMS Chief Kopka, you participated in discussions with the hospitals to alleviate this problem since it seriously impacted the wait-times for unloading EMS patients Did these discussions address whether hospital delays could be reduced if patients leaving the hospital had faster Class 2 transport? What is your opinion? For the most part ambulance offloads are due to lack of available beds or lack of medical staff. h the situation that the hospital was waiting for a post hospital transport service to transfer a patient and that service was busy- having another service available may free up a bed quicker- and possibly decrease ambulance offload times. Question for CCEMS CCEMS currently provides post-hospital transfers when a private Class 2 contractor i s not available. How many post-hospital medical transfers did EMS provide during the last year (August 2014 to July 2015)? Please identify whether they were routine or emergency. Attached spreadsheets.Note- EMS only does emergency transports. 1 Packet Page -1255- 10/27/2015 16.E.6. b. "The effect of the proposed service on existing services with respect to quality of service and cost of service." Several letters (Appendix F)addressed the advantages of having a 'choice' and 'affordable additional options'as well as 'multiple transportation options.' Question: You have provided a Schedule of Rates. How do your prices compare to prices charged by others currently providing this service (private and EMS)? • / have attached rates from Just Like Family Concierge Medical Transport, Collier County and Ambitrans for your review. Please note pricing for our service is the same as Ambitrans and far less than EMS. JLF Concierge Ambitrans Collier Medical Transport EMS Code Service Description Rate A0428 BLS Rate (Non-emergency) $395.00 $ 395.00 700.00 A0429 BLS Rate (Emergency) $ 425.00 $425.00 700.00 A0426 ALS (Non-emergency) $395.00 $395.00 700.00 A0427 1 ALS (Emergency ALS Level 1) $500.00 $500.00 700.00 A0433 ALS (ALS Emergency Level 2) $ 725.00 $ 725.00 1 $ 750.00 A0434 Specialty Care Transport $ 900.00 $900.00 Rate 800.00 A0425 Mileage (Per loaded mile) $ 10.00 $ 10.00 $ 12.25 A0999 j Oxygen $ 45.00 S 45.00 c. "The effect of the proposed service on the overall cost of EMS service in the county." Questions for CCEMS: You have been providing this post-hospital transport when necessary to meet the demand. One hospital CEO suggested "The effects of having a second option may also contribute to more appropriate use of 911 services and improve EMS's ability to manage true emergencies" . As stated in the reply above in the situation that the hospital was waiting for a post 2 Packet Page -1256- 10/27/2015 16.E.6. hospital transport service to transfer a patient,and that service was busy- having another service available may free up a bed quicker- and possible decrease ambulance offload times. How would this new transport affect EMS operations? Would this allow CCEMS to keep units available for emergency calls and affect response times? d 'The effect of the proposed service on existing hospitals and other health care facilities. Question: As mentioned earlier, several hospital CEOs were supportive of your proposed service. Have any of the local healthcare facilities, such as assisted living and nursing care facilities, addressed the need for your transport services? • Most definitely. in fact, we currently have at least a dozen contracts to bill Collier County facilities for NEMT that keep us rather busy. They have all requested services for patients who need additional BLS services that our company has declined due to our pending COPCN. In addition, there was a recent roundtable discussion held on August 23rd at Avow hospice where mechanics of patient discharge, transports, and EMS off-load times were discussed with many administrators from the ALF and nursing home community. It is our belief that a common thread in the talks was the need to streamline the transport process. e. "The effect of the proposed service on personnel of existing services and the availability of sufficient qualified personnel in the bcal area to adequately staff all existing services." Question: You have requested to provide `post-hospital medical transfer services for routine and emergency ALS and BLS patients.' What type of post-hospital emergency transports do you anticipate? - If you are specifically speaking of post hospital emergency transports they would most likely be hospital to hospital. E.g. NCH-NN ER to NCH-OT ICU. Question: How many ambulances are you planning to provide? How many paramedics do you plan to hire? Are you hiring EMTs also? Do you have these qualified personnel on staff? • In our startup phase we will have one ambulance in service. We anticipate growing that number as demand increases. - Ye4 we plan on using Paramedics and EMT S and currently have some on staff and some resumes on file for hire once we receive our COPCN. We plan on using a flexible scheduling pattern of eight or twelve hour shifts to accommodate the work schedules of the Paramedics and EMT's so the exact number of staff is difficult to provide at this time. We can assure you we will meet or exceed all 3 Packet Page -1257- 10/27/2015 16.E.6. state required staffing guidelines. 2. 'That the applicant has sufficient knowledge and experience to properly operate the proposed service:' Question: You are contracting with Dr. Tober to be your Medical Director. Will he be providing additional training, quality assurance reviews, etc. for your paramedics? • Steve Epright, Medical Transport Director's background of training at EMS and Quality Assurance will oversee the training of our Paramedics and EMT's. Dr Tober will approve and oversee the training plan. All calls will be reviewed through our quality assurance program. Ordinance 04-12 requires that your paramedics "must work with a Collier County EMS ambulance for a sufficient length of time pursuant to subsection (8)for the County's Medical Director to properly judge the paramedic's capability." Will your paramedics train on CCEMS ambulances annually? • No. We are not contracting with Collier County for medical direction. We are contracting with Dr. Taber privately as Medical Director much like the situation already in place with Ambitrans and Dr. O'Leary. Question: What level of drugs will you carry on your vehicles? The full range of drugs carried by CCEMS or something less? How will your paramedics gain experience with these medications? • CCEMS is a 911 response service. It is our belief that to carry all medications used by CCEMS is overkill for a class 2 provider. We will conform to all state standards for medications used on ALS vehicles. 3. "That, if applicable, there is an adequate revenue base for the proposed service." Queition: Have you investigated the reimbursement for your transport service provided by medical insurance companies and Medicare/Medicaid? Some insurers pay CCEMS significantly less than billed amounts and there are a large number of uncollectible accounts each year. • Yes. We have interviewed numerous billing firms to handle our BLS and ALS billing needs. We have decided that outsourcing our billing to an experienced company with an excellent reputation and understanding of the industry and Medicare was the best way to start our company. The company we are working with hand selects their clients as well and provides education to the community's providers in addition to our company on how to correctly bill Medicare for our services. We feel this service will help not only our company bill correctly but also benefit the residents of Collier County. 4 Packet Page -1258- 10/27/2015 16.E.6. 4. "That the proposed service will have sufficient personnel and equipment to adequately cover the proposed service area." Question: You plan to operate 24/7, serving Collier County. Please address where your personnel and equipment will provide service in Collier County. Will you cover the entire county, out to Everglades City and Marco Island, or will you concentrate on a smaller area? • We plan on providing service to all residents of Collier County and have no plans to concentrate on a specific area. Our service will be determined by the patients and medical community needs. We have no intention of leaving any area of Collier County out of our service. Thank you for your responses. Janet Vasey 8/24/15 5 Packet Page-1259- 10/27/2015 16.E.6. Mr. McNally, Here are the answers to the best of our ability at this time. The following documents have been attached: a) Collier County EMS Common Protocol b) Job descriptions for EMT's and Paramedics c) Concierge Medical Transport Performance Appraisal d) State of Florida BLS and ALS ground unit equipment list. e) Zoll Equipment Checklist Application 1. Written medical protocols, written Training Program, Quality Assurance and forms for daily equipment checks. • As a startup business in the BLS and ALS transport industry there are tasks which must be taken in order. One of those tasks is placing a Medical Director under contract after acquiring a COPCN. When discussing written protocol, specific training policy and specific equipment it must be remembered that all of these decisions originate with the Medical Director. • We can speak in only in generalities at this time,but we plan to use the Collier County Common Medical Protocol with changes or additions that complement the inter-facility transport industry. We have attached a copy of the Collier County 2015 EMS Common Medical Protocol for your review. • Just Like Family Concierge Medical Transport takes issues of quality very seriously and will do everything required by Florida state statute and Collier County protocol to assure a quality EMS system is put in place. 2. Job description for BLS and ALS transport personnel • Attached 3. Job performance review sheets for BLS and ALS personnel • Attached 4. Written training program • Training Plan overview attached 5. Written training documents for recertification program • We plan to keep records of training documents on file, this is covered thoroughly in Florida state statute as one of our requirements. • It is not our responsibility to recertify EMT's and Paramedics. 643-1.008 Emergency Medical Technician and 64J-1.009 Paramedic is the mechanism for recertifying EMT and Paramedics in the state of Florida. • We will require all EMT's and Paramedics to keep their certification up to date as required by the state of Florida. 1 Packet Page -1260- 10/27/2015 16.E.6. 6. Shift requirements • Since expanding our company to the BLS/ALS arena we have employed and collected many applications from local EMT's and Paramedic's wishing to participate in our program. We anticipate using 8,12,and 24 hour shifts specifically hoping to compliment local off duty EMS and firefighter's schedule so they can work part-time for our company. 7. Written agreements with clients to prove Financial security • We do not have written agreements with hospitals or facilities to provide BLS or ALS transportation at this time because we are still in the process of applying for our COPCN. We have contracts, relationships and do business with almost all of the hospitals and Assisted and Independent Living Facilities in Collier County between Just Like Family Home Care and Concierge Transport Services(NEMT). This has given us a great opportunity to educate the community about what our plans are and talk about future agreements or contracts. There is definitely a need and the response has been extremely positive due to our existing reputation in the community and being a locally based company. 8. Complete readable equipment list the Ambulance will be stocked with and contracts for equipment that requires PM and calibration. Excerpt from Collier EMS Ordinance Vehicles and Equipment. Each Operator's vehicles shall be equipped with the proper medical and emergency equipment as jointly agreed to by the medical director of each licensed provider and the lows of the State of Florida. • I have attached excerpts from 643-1.002 Basic Life Support Service License— Ground, and 643-1.003 Advanced Life Support Service License—Ground,which detail equipment carried required to be carried on BLS and ALS ground vehicles. It is our policy to meet or exceed these standards. Again equipment lists are finalized after protocol review with a contracted Medical Director • On the issue of calibration we are in the process of developing a contract with Riley's Emergency Medical Equipment Repair.http://rileymedrepair.com/. This will be finalized after the Medical Director has approved the purchase of specific models of equipment. • I have listed the FL BEMS list of equipment where calibration or testing is required by statute. III. MEDICAL EQUIPMENT FOR TESTING (Chapter 643-1, F.A.C., and KKK-A- 1822) • 1. Installed suction. (Transport only) • 4. Blood pressure cuffs: infant,pediatric, and adult. • 14. Portable oxygen tanks,"D"or"E"cylinders, with one regulator and gauge. 2 Packet Page-1261- 10/27/2015 16.E.6. • Each tank must have a minimum pressure of 1000 psi, and liter flow at 15 liters per • minute. • 17. Hand operated bag-valve mask resuscitators,adult and pediatric accumulator, • including adult, child and infant transparent masks capable of use with • supplemental oxygen. • 18. Portable suction, electric or gas powered, with wide bore tubing and tips which • meet the minimum standards as published by the GSA in KKK-A 1822E • specifications. • 26. Installed oxygen with regulator gauge and wrench,minimum"M"size cylinder • (minimum 500 PSI) with oxygen flowmeter to include a 151pm setting, • (not required for non-transport vehicles.)(Other installed oxygen delivery systems, • such as liquid oxygen, as allowed by medical director.) 9. Form for daily equipment checks • We are planning to install the Zoll "Rescue-net Dispatch"program within the next two months. As a part of this program"Zoll Vehicle Checklist"will be added to all of our vehicles hand held devices. There will be no paper checklist. • You can review the app at Zoll Checklist 10. Written testing exams for verification of BLS and ALS proficiency • It is my opinion that written testing for BLS/ALS proficiency is not effective.After almost 40 years in the field my view on written testing is that it only measures the ability of a person to pass a test. I would rather use a training and quality assurance program that measures proficiency in every day practice and provide constant feedback to our EMT's and Paramedics to fine tune daily performance. 3 Packet Page -1262- 10/27/2015 16.E.6. Public Safety Authority Minority Vote Regarding just Like Family Ronald L. Myers,Vice Chairman September 17, 2015 To whom it my concern: The PSA met on September 9,2015. It discussed an application for a Certificate of Public Convenience and Necessity(COPCN) for Class 2 Advanced Life Support in Collier County submitted by Just Like Family.I casted the only NAY vote for the following reasons: Collier County elected to operate as a"Limited Franchise"model for its Emergency Medical Services(EMS) system over two decades ago.It is County-owned and operated as an all ALS,single treatment and transport provider.This system design maximizes revenue opportunities and has proven to be the most financially efficient system design for EMS at the national level.A similar decision was also made regarding the licensing process for non-emergency private providers.Both ALS and BLS providers are expected to be high performance providers.They are measured using fractal response times and with 90% reliability for all calls or requests for service. CCEMS'cost per transport is more than$908(excluding its debt service).While CCEMS is an effective system, it still requires additional tax dollars,beyond their collected user fees, to sustain its operational cost It is critical that both government and private providers understand the financial aspects of the marketplace.The private ambulance sector is a low-margin business that has to focus on being effective and cost efficient. Private providers would achieve a more reasonable profit line if they,too,had access to tax dollars to subsidize the non-paying customers. Private providers must survive strictly from user fees (billings)and cash collected to fund their operations.Sudden and unforeseen operational failures have been known to occur in undisciplined markets with too many providers.This actually occurred in Collier County in 2011 when its then-licensed provider unexpectedly relinquished its license and departed the county. The current private provider,AmbiTrans,was granted its license in October 2011.They have invested and grown with the County's needs.They are reporting better than 95%on- time performance for inter-facility transports. CCEMS is required to make less than one transport per day for inter-facility transfers.CCEMS is generally requested for faster response times for more urgent patients or when AmbiTrans is unable to arrive within thirty minutes of the caller's request. Page # 1 Packet Page -1263- 10/27/2015 16.E.6. Public Safety Authority Minority Vote Regarding Just Like Family Ronald L. Myers,Vice Chairman CCEMS receives monthly reports from AmbiTrans for completed transports.When asked by the PSA,no formal complaints were received about AmbiTrans in the past year. As you may be aware,I have over 40 years experience in the private ambulance sector and have co-owned two large ambulance services.In addition,I serve on the National Advisory Council for the National Academy of Ambulance Coders(NAAC). It is essential to fully comprehend Medicare, Medicaid and third party insurance coverage requirements for ambulance reimbursement for long-term success. Insurance companies routinely challenge initial invoices for proper mode of transport.The patient must meet the"medical necessity"criteria rules for non-emergency transports. If that does not occur,payments are denied.If a patient could be transported by"other means,"those payments will also be rejected. Medicare has recently been auditing private ambulance companies and the hospitals that order the transfer of patients.If the sending and receiving facilities are owned by same healthcare group,Medicare has been challenging those claims for payment Attached is a scanned article(May 2,2015)regarding Jacksonville,Florida hospitals and a federal prosecutor's lawsuit. Also attached are the fee schedules for reimbursement from Medicare and Medicaid. The American Ambulance Association,through multiple surveys and working with Centers for Medicare and Medicaid Services (CMS),reports that Medicare's reimbursement rates does not cover the cost for providing ambulance service. In addition,most private providers are experiencing 90 to 125 days to collect their invoices. Competition is often seen as beneficial and generally makes any provider perform better. However,I view the EMS 9-1-1 sector and the non-emergency provider market more as a "Public Utility." If there are too many infrastructures to support,someone has to pay that cost,and it often leads to"anemic"providers. The COPCN does not require a financial model to reflect how a new applicant forecasts their planned cash flow for the first year of operation.JLF did submit a Profit&Loss statement from their parent company from January 1 through May 1,2015.This reflected a 10.8% net income,($312,577).The parent company is a nurse registry organization,and it appears that this will be how the new operation will be supported.Considering that CCEMS' fully loaded cost to operate a 24-hour unit is close to$1,000,000 per year,I have serious concerns how this applicant will perform financially. Page# 2 Packet Page-1264- 10/27/2015 16.E.6. Public Safety Authority Minority Vote Regarding Just Like Family Ronald L. Myers,Vice Chairman jLF has no experience as a private ambulance provider,nor do they have a Medicare and Medicaid provider numbers to date for Part B reimbursement.Their rate schedules mirror those of AmbiTrans.They claim they are the"going market rates?They also plan on obtaining hospital agreements with discounts off of their published rates. lithe Board of County Commissioners considers approving this application, I highly suggest considering requiring a performance bond and/or a letter of credit naming the County as the recipient.This would make licensed providers properly notice the County within a reasonable timeframe if they decide to exit the market. This requirement would also give the County some financial support and time to find a replacement provider. Obviously,language and price values would have to be discussed before implementing a performance bond.If a provider goes out of business or fails without notice,CCEMS could be negatively impacted and deflect them from their primary obligations as the only 9-1-1 treatment and transport provider. Personally,1 do not see a proven need,because AmbiTrans provides a high level of service without any supporting tax dollars. Respectfully submitted, Ronald L.Mye Vice-Chairman Public Safety Authority Attached: Article related to Jacksonville Hospital Medicare fee schedules Medicaid fee schedules Page# 3 Packet Page -1265- 10/27/2015 16.E.6. lawsuit against hospitals sending patients home in ambulances could have nationwide impact I Jacksonvilte.com 911311510'24AM .,,,, ,, 'r�r'orld-Gass i.. --- - NOW t !S CJ :� i it t f;til. tbiattowardtiww ebgtl+�I ,. Cancer Experts, ...., a-. , _ ..ataar•+ats boar r..nom 85° 86° f , .;tt:.:,, ,... r u:s,::.. t HOME NEWS SPORTS MONET LIFE REASON OPINION OBITS PHOTOS VIDEOS CLASSIFIEDS CARS JOSS HOMES DEAN HOME/NEWS MART S t D E g Lawsuit against hospitals sending { a ' patients home in ambulances could it have nationwide impact Learn Mare, to led Sat Mag2.20,F1 ii IL r `^ - BV Derek Gilliam Sat.may?2Vt5?c..le 30 Ism pda_ � ., ; BACK PHOTO't OF 2 A federal prosecutor in ` Jacksonville has developed a legal ma strategy that could have This Week's Circulars `. a, hospitals across the country on ., the hook for billions of dollars in 4 .., ..A-7, :. unnecessary ambulance services. a. U.S.Attorney A. Lee Bentley III said a group of f i Jacksonville hospitals has agreed to reimburse No,ren Faw einatun Naval-FOP ORCULAtt• the federal government for ambulance piiiimu d companies'inappropriate billing despite the hospitals not receiving direct financial gain. The legal strategy allows the government to sue ,' ' ' t: • because the hospitals were the cause of the a l fraudulent billing by calling the ambulance ,;.:. services to take patients from the hospital to rta� nom ancta J,n their residence and provided the necessary * J�pr forms to bill federal health care programs, arum uowr wuce.upsKyii'«sono,,,�,r-os/30•'3-Acz,ro troAt according to the U S Attorneys Office. States Attnmer A.tee Berairy.at aol,otx,ceIi u' ,moment V,Aa,or M.tiCnartlStr,wSr a rW,taer n, The total amount of the settlement is about 57.5 tetla,a,onens0A Ac A:r oa Thv Ot:rmatec,,,u,dc,o`U.S. D'stnct Jud41e t'^Wtny.1 cu ,tzar at tie Fe«xai million, Cow o,.,se or 6b^may.Sept e b,A.eon n utn•r! Jac sdwale.FL tF!.oa.dA The hospitals agreed to reimburse the government S6.25 million tar non-emergency ambulance rides. An ambulance service agreed to pay 51.25 million. However,Baptist Medical Center officials believe the organization did nothing wrong and -fundamentally disagree"with the allegations. The government's position essentially forces hospitals to become knowledgeable about complicated federal regulations applicable to ambulance companies,"said director of public http.IfJacksorrviiie.cominews!health-and-fitness/2015-05-02lstorYfi awsuit-against-hos pit als-sending-patients-home-ambulances Page 1 of 6 Packet Page -1266 10/27/2015 16.E.6. Lawsuit against hospitals sending patients home in ambulances could have nationwide impact I}acksonvilie.com 9/13115 10:24 AM relations Cindy Hamilton.It puts the focus on reimbursement, not patient care' RECOMMENDATIONS FOR YOU The appropriate mode of transport should be determined by the attending physician.based walkers urged to May on a professional assessment of the patient's clinical needs:she said. off St.Simons island [teach as big Bator Baptist settled the lawsuit to avoid the inconvenience and expense of lengthy litigation, swims In surf Hamilton said. The settlement does include language that the hospitals and ambulance companies do not admit fraudulently billing federal health care programs. � Fantasy Week la Start or sit Etlla t P Tyrod At least one of the operators of an ambulance service in the lawsuit is calling the ..' ^ TaTlorf government's actions a"federal money grab"that's bankrupting companies nationwide. 3.' , .'* We will continue to maintain to our dying breath that we are innocent,'said Michael Assaf, president of Liberty Ambulance.'It's happening all over the nation.This is a federal money ,' ' 'walking'no longer a guarantee for Duval grab in our opinion.' students who don't He said he's refuted every claim the federal government has presented to him.He said the rev'— - graduate federal prosecutor who is working these cases even told him that ambulance billing for a;`''"1 s"`�e federal health care programs is one of the most difficult systems to navigate. :: Nom,Terry Recently,the U.S.attorney's offices in South Carolina and New Jersey shut down about a ` Parker is being ;xw,._._,. transformed dozen ambulance companies in those states with large settlement agreements. Liberty Ambulance is the only company involved in the lawsuit that hasn't settled with the . U.S.Attorney's Office. The hospitals included in the lawsuit are:Baptist Medical Center Downtown.Baptist Medical ; ° r+� Center South,Baptist Medical Center Beaches,Baptist Medical Center Nassau.Memorial Hospital Jacksonville,Orange Park Medical Center.Specialty Hospital Memorial Health, , ealth, - i_, Lake City Medical Center and OF Health Jacksonville. ono- ,; te St.Vincent's Medical Center and the Mayo Clinic did not have the same problems with [,;..-r ` .4 „-n ambulance transport as the other Northeast Florida hospitals,according to the U S. Attorneys Office. surntmari -- The two largest,private ambulance companies in Jacksonville — Century Ambulance and Liberty Ambulance — also were sued.Century settled and agreed to pay Si.25 million over five years. 5 .. John Glover,chief executive officer at Century Ambulance.said his company fully _i: . cooperated with the government during the investigation. He said Century is looking at this n„Y as a constructive process and company officials meet weekly with hospital officials to discuss how to make sure they are in compliance with federal health care program billing practices. 'Health care fraud is a serious matter and it is not tolerated by Century,period,”he said."We do business the right way.' Jason Mehta,an assistant U.S.attorney,began the federal investigation into Medicare fraud , by Jacksonville ambulance companies in 2011 after a whistle-blower lawsuit was filed by $20 for ticket to I ai Cage aux Folks at. Shawn Pelletier.an EMT since 1996 who worked for Century from 2004 to 2006 and Liberty from 2007 to 2009. °�0t�` VALE: 'f''="'`'Oc°' . 29% $20 Pelletier said he witnessed documents being falsified for the purpose of billing Medicare or Medicaid during his employment at both companies,according to the lawsuit. JUST IN Mettle said as he began pulling information from the ambulance companies,he noticed the majority of the non-emergency ambulance rides originated from the hospitals.Most of those Man suffers gunshot wound to shoulder rides ended at a nursing home He said the other most common transport from a hospital in in Westside Saturday night http:l ldacksonville.com i news/health-and-fitness/2015-05-02/story;lawsuit-against-hospitak-sending-patients-home-ambulances Page 2 of 6 Packet Page -1267- 10/27/2015 16.E.6. Lawsuit against hospitals sending patients home in ambulances could have nationwide impact I jacksonvilie.com 9)13f1510.2+1At+! an ambulance ended at the patients'residences. a35am The next most common destination was to another hospital.Mehta said St.Augustine leach boy,11, hospitalized after getting hit by vehicle He said there are also reasons far a hospital to use an ambulance service to transport a Saturday night patient home.but when he cross-referenced those rides with available medical records,the 1073fer. U.S.Attorneys Office deemed the vast majority were not needed. Mark Woods:Here's to you,die-hard Mehta said although the hospitals didn't gain financially from billing Medicare,they did gain Jaguars fan t035pm indirectly by removing patients who had already been treated,allowing for rooms to be tilled • quicker with new patients. Mission Continues gives time,supplies to active duty,civilian veterans Baptist countered that it is often taster to transport a patient by family,friend or taxi. 9 31pm The other hospitals also contend they did nothing wrong. '1 knew I could beat It':1i-year-old OakLeaf cancer survivor back to school, It is important to note that UF Health Jacksonville did not receive any payments for basebrall transportation or ambulance services and did not charge federal payers for any services, roe, • which were central to the lawsuit,the hospital said."UF Health Jacksonville only makes Walking'no longer a guarantee for requests for transportation services.As a condition of the settlement. UF Health Jacksonville Duval students who don't graduate has not admitted to any wrongdoing or violation of applicable laws but has agreed to provide Duval additional guidance and education to employees involved in requesting ambulance services." HCA Healthcare owns tour of the hospitals sued by the federal government—Memorial (}{tII1ik Pao PRESS RELEASES Hospital,Orange Park Medical Center,Specialty Hospital Memorial Health and Lake City t Berkshire Hathaway HomeServices Medical Center. Florida Network Realty Welcomes Paul Wilson "Our goal is to do what is best for our patients—including post-discharge transport,whether vita A:L:TEMi i 1143e1 A ReLFAEF by ambulance or not,"spokeswoman Ilyssa Drumm said."There are complex Medicare rules €NG that govern the appropriateness of when ambulance companies may bill for such transport if INTRODUCING the patient is deemed well enough to travel in a cab or van.This settlement addresses that C 17 LEI,RF,TI)'v i':i r issue for certain former patients,and we are pleased the matter is resolved.' Mehta said since the U.S.Attorney's Office lawsuit became public,the expenses of flag' ambulance transport has decreased by one-third in the Jacksonville area and many of the hospitals have began voucher programs tar taxi services. i Mehta said ambulance companies filing fraudulent claims is a nationwide issue. He said while federal health care program expenses are increasing,the rate at which ambulance t to,.. ;:;,',t transport expenses are increasing is about twice the rate of other expenses. ,.i,.. , .. In tact,this type of ambulance transport—a minimum of$150 per ride —cost the U.S government$250 million during a six-month span in 2014,according to Mehta, Bentley,the U.S.attorney for the Middle District of Florida.said the total hospital liability .:Li,:2II.FOR could be in the billions as the statute of limitations for this type of crime goes back six years. DETAILS Mehta described trying to fix the problem in arcade-style terms using Whack-a-Mole as an example. \/\`L at "You hit one and three more popped up,"he said about past investigations.'This has unplugged the machine" r'"N. Derek Gif @am (904)359-4619 -..;.. ; : http:,/iacksomrilk.camf news/health-and-fitness/2015-05-021 story/lawsui t-against-hospitals-sending-patients-tome-ambulances Page 3 of 6 Packet Page -1268- 10/27/2015 16.E.6. SummersDan 'rom: Robert Tober[rbtobermd @yahoo.com] dent: Thursday, October 08, 2015 12:04 PM To: OchsLeo; SummersDan; KlatzkowJeff Subject: Just Like Family BLS/ALS Non-Emergency Transport Mr.Ochs,Mr. Klatzkow and Mr. Summers: Please consider this email as the County's notification of my intentions to have an affiliation and business association with Just Like Family Concierge Medical Transport of Naples.This notice is in accordance with Article 10 of my Medical Director contract with the Board. Just Like Family Medical Transport is seeking a Class 2 ALS non-emergency transport Certificate of Public Convenience and Necessity. It is my belief that an additional non-emergency transport service will further assist hospitals and other facilities with additional transportation options and services.My engagement with Just Like Family is desirable so it can contribute to further reductions in the County EMS calls for non-emergency transportation services. This additional Class 2 ALS non-emergency provider should assist Collier EMS in making more pre-hospital emergency resources available for emergency calls for service. I am confident that my association will not deter from any of my duties as the County Medical Director and I will work to ensure proper medical direction in accordance with State rules and the Board of County Commissioners. I have been in continuous contact with Watler Kopka,EMS Chief and verified that he is indeed supportive of my doing this on behalf of CCEMS. Respectfully, Robert Tober,MD,FACEP Medical Director Collier County 1 Packet Page -1269- 10/27/2015 16.E.6. From: IlDniChristinc To: 8orliChn5tne Subject: FW:Just Like Family BLS/ALS Non-Emergency Transport Date: Wednesday,October 14,2015 10:55:57 AM From: Ochs Leo <Leo0chsikolli_ergov.net> Date: October 14. 2015 at 9:35:51 AM EDT To: "rbtobermaiiJyahoo.com" <rbtobermdriiyahoo.com> Cc: KlatzkowJeff cleffKlatzkow(&colliergov.net>. PriceLen enPricefikolliergov.net>, SummersDan <DanielStimmersii;volliergov.net> Subject: FW: Just Like Family BLS/ALS Non-Emergency Transport Dr. Tober: Thank you liar your email of October 8'11 providing notification in accordance with our Board's contract of your intentions to have an association with the Just Like Family Concierge Medical Transport. We appreciate your concern to make sure that the ALS non-emergency transport services are maximized in order to allow County [MS to locus on its core pre-hospital erner2ency services. Please consider this email the County's notification of its opinion relative to your October 8th email correspondence and Article 10 of your Medical Director contract. After consultations with the County Attorney. I belie c that no conflict of interest exist per the terms of the aercement. If these representations materially chan2c in the future. you are required to notif the County of same and may need a seek another opinion a.ith respect to conflicts of interest. Thank t -)r your continued service to our community. Sincerely. .lea Ochs Leo E. Ochs, Jr. Collier County Manager leoochsPcolliergov.nt 239.252.8383 From: Robert Tober [mailto:rbtobermdayahoo.com] Sent:Thursday, October 08, 2015 12:04 PM To: OchsLeo; SummersDan; KlatzkowJeff Subject: Just Like Family BLS/ALS Non-Emergency Transport Mr. Ochs, Mr. Klatzkow and Mr. Summers: Packet Page-1270- 10/27/2015 16.E.6. Please consider this email as the County's notification of my intentions to have an affiliation and business association with Just Like Family Concierge Medical Transport of Naples. This notice is in accordance with Article 10 of my Medical Director contract with the Board. Just Like Family Medical Transport is seeking a Class 2 ALS non-emergency transport Certificate of Public Convenience and Necessity. It is my belief that an additional non-emergency transport service will further assist hospitals and other facilities with additional transportation options and services. My engagement with Just Like Family is desirable so it can contribute to further reductions in the County EMS calls for non- emergency transportation services. This additional Class 2 ALS non- emergency provider should assist Collier EMS in making more pre- hospital emergency resources available for emergency calls for service. I am confident that my association will not deter from any of my duties as the County Medical Director and I will work to ensure proper medical direction in accordance with State rules and the Board of County Commissioners. I have been in continuous contact with Watler Kopka, EMS Chief and verified that he is indeed supportive of my doing this on behalf of CCEMS. Respectfully, Robert Tober, MD, FACEP Medical Director Collier County Packet Page -1271-