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Minutes 12/14/1982 MEMORANDUM TO: EMSAC MEMBERS FROM: W. Neil Dorrill, Public Safety Administrator DATE: December 6, 1982 SUBJECT: Regular Monthly Meeting Be advised that the next regular meeting of the Emergency Medical Services Advisory Council will be held on Tuesday, December 14 , 1982 5th Floor Conference Room 4 :00 PM If for any reason you will be unable to attend, please notify my office (774-8468) or Chairman Hill (261-0569) so that your absence will be considered excused. A copy of the Agenda is attached. WND/bm AGENDA EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL Meeting December 14 , 1982 I. Roll Call II. Reading and/or approval of minutes a) Regular meeting of November 9, 1982 III. Advisors Reports IV. Old Business V. New Business VI. Adjourn /bm MEMO TO: Members of EMSAC `, --- FROM N. Neil Dorrill/Public Safety Administrator~ DATE December 30 , 1982 SUBJECT: Minutes of Meeting of December 14, 1982 In accompaniment, please find copy of the Minutes from the Regular Meeting of December 14, 1982. Please review these in order that they can be adopted at the next meeting to be held on January 11, 1982, at 4 :00 PM. Enclosed also is a copy of the EMSAC Membership Roster for your file. WND/bm cc: C. W. Norman, County Manager File 14-D A‘ / � J EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14 , 1982 APPROVAL OF MINUTES OF NOVEMBER 9 , 1982: Minutes of the meeting of November 9 , 1982 were approved as submitted except for the following correction: On Page 1, under "ME MBE WELCOMED" - the names Joan Hamilton and Bill Walker were in error. Mr. Hill expressed his regrets that this mistake was made, but welcomed Mr. Walker as a guest at this meeting and invited him to attend each meeting until such time as there is another vacancy. APPOINTMENTS NAMED : Mr. Hill reported the latest list of appointments to be as follows: District 1 - William B. Shaughnessy District 2 - Marvin Cecile--¢=' District 3 - Jonathan Smelko District 4 - Egon Hill District 5 - David C. Graham Health Officer - Not yet appointed Fire Chief' s Assoc. - Jim Billman County Health Services - Richard Akin Naples Comm. Hospital - "Biff" Comte Naples Police Dept. - Sgt. Richard Davidson Collier Co. Medical Society - Dr. Hanns Erhardt Ex-Officio Members (able to vote) : Sheriff Aubrey Rogers (or his Deputy) Health Officer - Dr. Wm. Cox (or his designee) City of Naples - Chief Norris Ijams Staff Advisors: (not able to vote) : Doug Greenfield, EMS Director John Adams, EMS Coordinator Neil Dorrill, Public Safety Administrator ADVISORS REPORTS: Dr. Adams advised he had nothing to report. Mr. Greenfield read a letter received from Mrs. Joan Hamilton regarding the present rate structure and asked for comments . Hearing none, Mr. Greenfield stated he believed the letter from Mrs. Hamilton - 2 - Naples, Florida December 14 , 1982 LET IT BE REMEMBERED, that the Emergency Medical Services Advisory Council met on this date at 4 :00 P.M. in the 5th Floor Conference Room, Bldg "F" or the Courthouse Complex with the following members as indicated below: CHAIRMAN: Egon Hill MEMBERS : Hanns Erhardt, M.D. Sgt. Richard Davidson Chief Jim Billman David C. Graham (Excused) Marvin Cecil W.H. "Biff" Comte Richard Akin (Represented by Sharon Aragonz William P. Shaughnessy Jonathan Smelko EX-OFFICIO MEMBERS: Chief Norris Ijams (Excused) Dr. John Adams for Dr. Wm. Cox C. G. Whidden for Sheriff Rogers STAFF ADVISORS: Dr. John Adams Douglas Greenfield Dr. Robert Tober (Absent) W. Neil Dorrill ALSO PRESENT: "Skip" Camp, EMS, W. C. Walker, Jr. , Jack Wampler, EMS Billing Dept. , and Billie Moyer. AGENDA I. Roll Call II . Reading and/or Approval of Minutes a) Minutes of November 9 , 1982 III . Advisors Reports IV. Old Business V. New Business VI . Adjourn EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14 , 1982 was prompted by her presence at the special meeting held on November 15, 1982 regarding a complaint by a patient protesting a bill which resulted in a decision of the committee that the charges were justified, fair and appropriate . Mr. Greenfield said he recently had delivered to Mary-Frances Kruse a stack of written responses to the cards sent out with each billing asking for comments on EMS services and hoped to have them back for ex- hibit by the next meeting date . Recalling the responses, he advised that less than 1% were complaints and said he felt that the public is saying they like the service and the quality of care given. Mr . Greenfield further stated that in view of the favorable statements from users he has a problem giving credibility to Mrs. Hamilton ' s challenges of our professionalism, services provided and chances of bill padding. He felt he would have to see a little more activity generated in that direction in order to show some concern and left it up to the committee to pursue the matter further if they chose. Mr. Jack Wampler stated that as a point of interest a base rate type of billing could have serious consequenses from the insurance point of view. Mr. Greenfield replied that this was to have been his next subject but that he didn't want to come in without discussing this with the people who handle data processing or who handle claims and have gone to great lengths to set up our program to meet the needs of the insurance providers, showing codes and breakdown, in order to get the most effective return on our billing . Referring to Mrs. Hamilton 's suggestion of a "fixed tarriff, " Mr. Greenfield - 3 EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14 , 1982 said this committee had addressed that question when it gave its original requisition to the Board for the rate hike and they agreed it was better to charge the individual user for the ser- vices received than to charge a paramedic rate to an individual. Mr. Greenfield added that he believed we could look across state- wide and find that they are actually trying to "nail down" and bill for what the individual actually receives. Sgt. Davidson asked how our rate structure compared with the rest of the State. Mr. Greenfield replied that since this is the beginning of the FY he could not give an honest analysis but that every county has had an increase since last fall. He added that it would take a lot of detailed effort to give an honest answer, but that of the four or five structured large systems he is fam- iliar with, we are within 5 to 10 dollars of each other on base rates as of October. Mr . Hill spoke of the irrational comments he has heard in the past and read as an example the Letter to the Editor from a gentleman from Marco Island stating that0we now pay $700 to take a trip in an ambulance to the hospital`.` Upon reading this, Mr. Hill said he had called the man and asked for a copy of the invoice charging this amount and in so doing, found that the man did not only not have a bill but had never been in an ambulance . When Mr. Hill asked him where he had gotten this information, the man said he had heard it from a doctor in Marco Island whose name he would not divulge . Mr. Hill said he wrote a letter to the man and enclosed a list of Collier Medical Service charges and asked that the list be transmitted to the doctor in question. Mr. Hill - 4 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14 , 1982 said he also invited the man to attend the next meeting, after which he received a letter of apology for having written the letter in ignorance. Mr. Hill expressed concern over the amount of bad publicity the service gets by even those people who should know better. Mr. Greenfield asked if anyone wished to make a comment. Mr. Hillman said he did not feel the letter from Mrs. Hamilton was meant as criticism, but simply was a means of expressing her opinion in regards to the one hearing which she had attended. Mr . Greenfield replied that he did not mean to imply that he was, in fact, taking it as criticism and went on to say that he realized there was a lot of consideration which had to be looked at when the method of billing is being challenged. He stated he had weighed all factors such as private outside services, insur- ance companies, Medicare, etc . , to see what the result would be if we looked at a fixed tarriff and quoted the words of Mrs . Denty, "It would be like taking a giant step backwards . " Mr. Billman then said he was not advocating what Mrs . Hamilton had said, but was simply stating he felt she was expressing an opinion, rather than criticising. Mr. Greenfield agreed . Mr. Hill reported that while he was in Washington D.C. for the Thanksgiving holidays he had looked around the suburbs at how the ambulance service was handled . In some cases, he said, the County had the burden and paid for everything. This , he felt, was not the proper way to go since anyone who had a simple toothache was liable to call for an ambulance . In other counties, Mr. Hill said, they were going the way of a subsidy from the community wherein - 5 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14 , 1982 people paid 5, 10 or 15 dollars a year and are transported free . What is done about those who did not belong to the organization, Mr. Hill did not know. TASK FORCE SELECTED: Mr. Hill said the aforementioned letter and the hearing had convinced him that maybe we need to organize a "task force" to study the problem and had consequently contacted Chief Ijams, Dr. Erhart, Marvin Cecil, and Jonathan Smelko and asked that they form a committee. With Chief Ijams acting as Chairman, they are to study methods used in the State of Florida and come back to us at the February meeting with recommendations . On the basis of their findings which will be forwarded to the Board of County Commissioners, Mr . Hill said, we might either keep the same sys- tem or suggest to EMS that it be changed . Mr. Hill advised that he had talked to Administration and obtained permission for the committee to use the SUNCOM line for out of county calls . When asked if we were going to study the entire system, Mr. Hill said the whole thing would be up to the committee, who are four intelligent people, and he was not going to tell them what to do. "Let them come up with the solution, if there is one," he said. Mr. Greenfield said he did not understand what type of solu- tion we were looking for nor did he understand that there is a problem. Mr. Hill advised that he is mostly interested in the funding potential and that he feels there must be a better way of funding than the one we now have, which is partly County and partly users. He further added that he is not dissatisfied with the EMS - 6 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14 , 1982 organization, since he feels it is the best and would challenge anyone in the State of Florida to prove they have a better one . To Dr. Adam's question as to whether or not we really have a problem, Mr . Hill replied that he thinks we do because so many people are coming to him and saying they are overcharged. Both men agreed that the public is badly in need of an education, since it really doesn't know the facts . Sgt. Davidson said he felt that if only 1% is complaining, maybe we should have a task force to check out the complaints. Mr . Hill advised that he does check them out, after first getting all the facts from Doug Greenfield and from the EMS billing Dept. He further added that the 1% , by complaining very loudly and per- sistently, sometimes carries much more weight than the rest of the 99% . Mr. Shaughnessy asked how many of the 7800 responses were actually transports and Mr. Greenfield reported that 5200 were. Jim Billman felt that the group selected to form a task force represented a cross-section of the council and should be able to come up with a statement which would once and for all silence critics or at least slow them down. Mr. Hill agreed with Mr. Greenfield that we contact Mr. Yenawn, of Syracuse, NY, who is not only the president of Eastern Ambulance Association, but also the management analyst for their accounts receivable. Having a thorough professional insight into the task at hand, it is believed that Mr. Yenawn will be able to provide documentation which will be of great value to us. Mr. Greenfield recalled the years he had worked in private enterprise during which he learned the most inovative means of - 7 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14, 1982 competing in a very competitive industry. Because of his affili- ation, Mr. Greenfield said, he has been able to keep up with what private industry is doing and reports they are campaigning at a local government level. He added that thousands of ambulance services are going under today because they aren' t up on things enough to compete with the economy and ever increasing demands which state and federal regulations are putting on them. It all comes down to looking the public square in the eye and saying, " If you want the service, you must pay the way, " was the approach Mr. Greenfield felt had to be taken. He invited those who may have a more logical approach to come up with alternatives and have the "powers that be" make their decisions. Mr. Hill asked everyone to contact Chief Ijams with their ideas, in hopes of establishing guidelines . SMALL CLAIMS COURT TO BE USED IN COLLECTIONS Mr. Greenfield reported that a former employee who is now managing accounts receivable in Citrus Co. EMS is having very good results using Small Claims Court as a means of collecting past due bills. He advised that after a meeting between Jack Wampler, Bill Reagan, and the County Attorney it was decided to pursue such a program here and a letter from Jack Wampler was read confirming the first approach. According to Mr. Wampler' s letter four (4) outstanding bills will be turned over to Small Claim Court, chosen on a selective basis, and done in accordance with the resolution previously approved by the Board of County Commissioners. Mr. Wampler hopes to come back in 60 days with some good results and reports he was told most times these cases are settled out of court. - 8 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL December 14 , 1982 Doug Greenfield reported that the collection statistics for November are 61% - with an overall 58% for a 12 moth period. He credited Mr. Wampler for making " live contact" with clients before each bill is sent out, which helps to get correct billing infor- mation and said that in cases where persons are picked up in such a condition they were unable to communicate or gave bad addresses, these bills were turned over to a collection agency immediately so they would not stack up on accounts receivable as they used to. TRIAGE UNIT USED IN IMMOKALEE Mr. Greenfield told of the triage system used in Immokalee which has decreased the number of transports tremendously during the past few months . He added that staffing this unit with people who are alert, have good training, and good communications is a problem, however, since most people do not want to work out of Immokalee, but since this unit has been of such value it is getting priority to anything else right now. NEXT MEETING Mr. Hill announced that the next meeting of the EMSAC would be held on January 11th, at 4 :00 PM, in the 5th Floor Conference Room. ADJOURNMENT There being no further business to come before the Council, Mr. Hill adjourned the meeting at 4 : 53 PM. Egon Hill, Chairman Minutes prepared by Billie Moyer - 9 - 11/10/82 GES EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL (3 year terms after initial appointments) Created by Ordinance 80-80 APPOINTED MEMBER PHONE # DISTRICT APPOINTED EXPIRES • 11/9/82 William P. Shaughnessy 394-5223 1 • Pistor 8/31/85 141 Stillwater Court Marco Island, FL 33937 • 8/26/80 David C. Graham 455-3483(h) 5(3) Brown 8/31/83 4973 22nd Place SW 455-1322(w) Naples, FL 33999 8/26/88 Egon Hill 261-0569 4 Wenzel 8/31/84 10/6/81 (re) 430 Putter Point Court Naples, FL 33940 5/44/82 Marvin Cecil 262-3131 (w) 2 Wimer 8/3 4/82 11/9/82 (re) P. 0. Box 2507 8/31/85 Naples, FL 33939 • 11/9/82 Jonathan Smelko 261-2166(w) 3 Kruse 8/31/85 Suite 34 660 North Tamiami Trail Naples, FL 33940 The following members were confirmed by the BCC but names were suggested by other agencie APPOINTED MEMBER PHONE # REPRESENTING EXPIRES • Health Officer 8/26/88 Jim Billman, Chief 774-7111 (w) Fire Chief' s Assoc. 8/33f8+ 10/6/81 East Naples Fire Dept. 657-3019(h) 8/31/84 St. Andrews Blvd. Naples, FL 33942 8/10/82 Richard Akin 657-3663(w) Collier Health 8/31/85 COLLIER HEALTH SERVICES, INC. Services, Inc. 419 North First Street Immokalee, FL 33934 5/11/82 W. H. "Biff" Comte 262-3131 (w) Naples Community 8/31/83 P. 0. Box 2507 Hospital Naples, FL 33939 11/9/82 St. Richard Davidson 262-7272(w) Naples Police 8/31/85 NAPLES POLICE DEPT. Department 355 Goodlette Road N Naples, FL 33940 8/26/80 Hanns Erhardt, M.D. 597-4719 Collier County 8/31/84 144 Channel Drive Medical Society Naples, FL 33940 • Aubrey Rogers 774-8111 Ex-Officio -.Sheriff William Cox,- M.D. 774-8210 Ex-Officio - Health Officer Neil Dorrill 774;8468 Staff Advisory Norris (jams Ex-Officio - City of Naples John Adams, EMS Coordinator Staff Advisor r,....,. cMc n i rortnr Staff Advisor