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Minutes 02/10/1983 Naples, Florida February 10 , 1983 LET IT BE REMEMBERED, that e Emergency Medical Services Advisory Council met on this date at 4 : 00 P .M. in the 5th Floor Conference Room, Building "F" of the Courthouse Complex with the following members as indicated below: CHAIRMAN: Egon Hill MEMBERS : Dr. Hanns Erhardt Sgt. Richard Davidson Chief Jim Billman David Graham (Absent) Marvin Cecil (Excused) W. H. "Biff" Comte (Excused) Richard Aiken (represented by Sharon Aragona) Wm. Shaughnessy Jonathan Smelko EX-OFFICIO MEMBERS : Chief Norris Ijams Dr . John Adams for (Excused) Dr. Wm. Cox E . G. Whidden for Sheriff Rogers STAFF ADVISORS : Dr. John Adams (Excused) Douglas Greenfield Dr. Robert Tober (Absent) W. Neil Dorrill ALSO PRESENT: Jack Wampler, EMS Billing, Dr. Elizabeth Handley, and Billie Moyer. AGENDA I . Roll Call II . Reading and/or approval of minutes a) Regular meeting of January 10 , 1983 III . Advisors Reports IV. Old Business V. New Business VI . Adjourn EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL February 10 , 1983 MINUTES APPROVED Per Dr . Ehrhardt ' s request, the Minutes of the Regular Meeting of January 11 , 1983 were adjusted to read as follows : Page 6 , Paragraph 6 - "Dr. Ehrhardt suggested that the committee should not decide as to the frequency of the meetings today, but should be given time to think it over. Furthermore, the Council should request especially the attendance of the ex-officio members because their absence has a degrading effect upon members who attend voluntarily. " ADVISORS REPORTS AUDITOR GENERAL REPORT ON EMS Mr. Greenfield reported on the letter received from the President of the Florida Association of Emergency Medical Systems (FACETS) reference to legislature 's adoption of 10D-66 this year and recommendations from various agencies as to what should be done concerning licensing and certification procedures . A request had been made of the State Auditor General to research the EMS role under HRS with a recommendation as to whether or not they were, in fact, the most appropriate agency to carry out the EMS licensing function. Mr . Greenfield mentioned there has been dis- satisfaction over the past 10 years with their ability in the field to do the testing, etc. One recommendation the legislative body had the Auditor General look at was the Department of Pro- fessional Regulation. In addition, Mr. Greenfield said , the Fire Chief 's Association evidently had some lobbying to include the State Insurance Commissioner ' s Office in the investigation; - 2 - February 10 , 1983 resulting in three (3) potential agencies which might end up with certification and licensing responsibility. This function could either remain with HRS , be handled by the Department of Professional Regulation, or in the Insurance Commissioner ' s office, in his capacity as the State Fire Marshall . Mr. Greenfield felt that each of these agencies had its own merit and said that after attending several group discussions throughout the state and weighing the merits of each, he believed the firefighters ' strongest concern on the issue is that they would like to see EMS come out of the small , unrecognized module type of atmosphere it has in Tallahassee and get into a position where it can be raised to a bureau status . That in itself had created a lot of discussion within the EMS Provider ' s Association in the state , Mr . Greenfield added, and pointed out that the greatest weakness noticed by those who have been working with HRS over the last decade is their position in government structure . Even though some pretty good laws have been passed by the legis- lature recognizing EMS , Mr . Greenfield said, the laws did not give them the funding needed to carry out their responsibilities . Mr . Greenfield mentioned that various alternatives had been looked at and that the State Fire Commissioner felt there will not be any licensure fees (certification or recertification fees for EMT ' s or paramedics) and that a lot of things such as fire inspections, will fall under the present criteria. The Provider 's Association for the State of Florida EMS is made up of all facets of EMS providers; private, governmental , third-party services , and fire departments , Mr . Greenfield said . - 3 - i EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL February 10 , 1983 Mr. Greenfield said he had attended a meeting in Jacksonville on the 21st of January and that a representative of DPR had been present with the completed Auditor General 's report. A copy of this report was handed out to members by Mr. Greenfield, and each member was asked to look over and think about the Auditor General 's opinion that licensure and certification go to DPR because they have the manpower, the expertise and facilities to really take over this activity, and leave the administration of EMS to HRS . The HRS response is included in this secondary summary and the group indicated that they supported the Auditor General ' s findings at this time and they don ' t mind going in that direction. However, they want to make certain the legislature understands that this is the limit to what they will let go concerning certification . HRS definitely wants to maintain control of the administration of EMS from a state perspective . Mr. Greenfield pointed out that the first page of the intro- duction is an actual proposal of the Executive Board of EMS Pro- viders and that it does not recognize the Auditor General ' s recom- mendation but rather the feelings of the majority of EMS providers in the State of Florida, which is made up mostly of firefighters . He added that a poll had indicated a 3-1 decision that licensing and certification should remain under HRS and that they have made recommendations for changes which they would like to present to the legislature . Mr . Greenfield said there didn 't seem to be anything going on in Tallahassee right now but that Elaine Gordon is still battling to see that this is given to DPR. - 4 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL February 10 , 1983 Mr. Greenfield said he would be meeting with our State Association on February 24th & 25th, along with the new HRS Director and a special physician brought in from Tallahassee who will be lobbying it and stated he would like to be able to go to them with some idea of the feelings of the members of EMSAC. Mr. Greenfield read the proposal of the Executive Board, commenting on the proposal of the development of an equitable fee structure for all EMS providers to provide adequate funding for the other proposals made. He said that this is another item which private concerns have been battling since last June be- cause under current 401 provisions which were approved in June, fire departments , municipalities and government-run systems had no fees . For the first time, Mr . Greenfield said, we did not have to pay for a license renewal , but a private agency had to pay upwards of $600 . Remarking that he had his own feelings in this matter, he said he would like to have the feelings of others and asked if anyone wanted to have a special meeting after they had a chance to digest this . It was agreed that rather than have a special meeting, the members were to call the Public Safety office with their opinions, which would be passed on to Mr. Greenfield . PROTOCOL IN HANDLING CONSUMER COMPLAINTS : It was agreed that the subject of protocol in handling cus- tomer complaints regarding service or fees should be discussed at a time when Dr. Tober, the Medical Director, could be present and Mr . Dorrill was asked to make an urgent plea for him to attend the next meeting . Doug Greenfield stated that HRS has provided us - 5 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL February 10 , 1983 clarification and written documentation of Chapter 401 and 10D-66 , adding that we cannot deal effectively with the issues of protocol unless we ourselves are familiar with the laws . He stated that the next meeting he would provide every member with a copy of the current Chapter 401, 10D-66 . REPORT ON COLLECTIONS : Mr . Wampler reported that the January collections were 63 .3% - almost a percent higher than the month before, and that the overall collections since the start of 1981 is now approaching 60% (58 . 9%) and rising steadily. He added that the January bill- ings were the highest since the beginning of this fiscal year, ($77 , 901) and that it looks as though we will exceed this amount in February. He also said that the collections were coming in very well. Mr . Hill remarked that he was extremely pleased with the job the EMS billing department is doing. Mr . Shaughnessy asked how long a bill was kept on the books before writing if off and Mr. Wampler informed him that a public debt cannot legally be written off . He explained that bills are on a 90 day cycle, that is , the 1st bill is sent out immediately, the second after 30 days , a phone call is made at 45 days, a 60-day notice is sent, followed by a 75-day notice and a 90-day notice, after which it is either placed with a collection agency, put on a time-payment system, or held. Mr . Shaughnessy asked what percent of the bills go into a holding pattern after 90 days and Mr Wampler told him this was difficult to say, since sometimes it takes some estates a long time to pay off . He added that the uncollectable area probably amounts to about 25% . - 6 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL February 10 , 1983 NEW BUSINESS TASK FORCE COMMITTEE REPORT: Mr . Hill asked for a report from Norris Ijams , Chairman, on the findings of the Task Force Committee nominated to study the rate structures and operations of our EMS system and those of other counties in the area and mentioned that we had been fortunate in getting the services of Dr. Elizabeth Handley, R.N. , who has not only a PHD in Administration, but is a Lt . Colonel in the Air Force, Retired. Mr . Ijams reported that the group had not only been meeting once a week, but that some members had been riding with the EMS Supervisor in order to become familiar with the service we are concerned with. Mr . ,Ijams felt that by getting to know the "nuts and bolts" of the whole operation, disecting it, and then putting it back together again, we would better be able to know if this is really what we want. Chief Ijams explained that this is a monumental task and that "we have only scraped the tip of the iceberg" and asked the con- sideration of the entire committee in being patient while waiting for the results . He also assured the members that the Task Force Committee realizes they are not an investigating group, but merely a study group, and as such is well aware of their limitations . He stated that they will not get out of the bounds of restriction, which they are following according to County guidelines and the laws they are governed by and will stay within their area of author- ity and responsibility. Mr. Hill noted that he had attended some of the meetings as - 7 - EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL February 10 , 1983 an observer and was well pleased with what he had seen. He also said he had ridden with the EMS Supervisor once and found it very interesting and informative . Mr . Hill recommended that anyone who was able should also do this, since it will help them get a different perspective of what the EMS is doing. Doug Greenfield asked that anyone wishing to do so should call his office to make arrangements . MEETING DAY CHANGED - AGAIN: Mr . Dorrill mentioned that the recent change from Tuesday to Thursday for EMSAC meetings had posed a problem to some members and it was agreed that the second WEDNESDAY of the month would be more suitable . NEXT MEETING: The next meeting of the EMSAC will be held on Wednesday, March 9 , 1983 , at 4 : 00 P .M. in the Fifth Floor Conference Room. ADJOURNMENT There being no further business to come before the Council , the meeting was adjourned at 5 : 40 P .M. Egon Hill , Chairman Minutes Prepared by: Billie Moyer - 8 -