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Minutes 08/10/1983 Naples, Florida, August 10, 1983 LET IT BE REMEMBERED, that the Emergency Medical Services Ad- visory Council met on this date at 4:00 P.M. at the newly dedicated Administration/Operations Complex of Collier County Department of Emergency Medical Services, 3123 Terrace Avenue, with the following members present: CHAIRMAN: Egon Hill MEMBERS: Dr. H. R. Ehrhardt Sgt. Richard Davidson (Absent) Chief Jim Billman David C. Graham (Absent) • Marvin Cecil W. H. "Biff" Comte Sharon Aragona for Richard Akin (Absent) Jonathan C. Smelko William Shaughnessy EX-OFFICIO MEMBERS: Chief Norris Ijams Dr. James Meli Dr. William Cox E. G. Whidden for Sheriff Rogers (Excused) STAFF ADVISORS: Anne Foster Doug Greenfield W. Neil Dorrill Dr. Robert Tober (Absent) ALSO PRESENT: Dr. Heinrich Schmid Jack Wampler, EMS Billing; and Billie Moyer AGENDA I. Roll Call II. Reading and/or Approval of Minutes for the Meeting of July 13, 1983 III. Old Business IV. Report on Collections V. New Business VI. Adjournment EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL August 10, 1983 The minutes of the meeting of July 13, 1983 were corrected as follows: Advisor's Reports, paragraph two, that the CPA would report to the chairman, Egon Hill, who would then put the report through proper channels to the Board of County Commissioners. Mr. Dorrill suggested that under Advisor's Reports, REPORT ON TASK FORCE: That the third sentence begin as follows: Mr. Dorrill said, "I think the staff . . ." HANDLING OF MEDICAL COMPLAINTS: Add this sentence: This committee should bring its findings back before EMSAC. OLD BUSINESS Mr. Dorrill advised of events concerning air ambulance service within Collier County. He stated, "Last month we received, reviewed and forwarded to the Board of County Commissioners with a recommendation for their approval, a Certificate of Public Convenience and Necessity for a BLS air ambulance service with Royal Airways that is a fixed based operator in Naples, Florida; we obtained further references and I spoke with the airport director. This was forwarded to the board and the board unanimously approved their certificate; however, this firm is also, currently providing ALS services in a joint-venture relationship with Flight Nursing, Inc. , out of Broward County. "Recently Royal advertised the fact in the Naples Daily News that they were offering this service and they also advertised this in their ad which appears in the Yellow Pages. I called the president of Royal and indicated to him that they had neither a Collier County Certificate nor an H.R.S. Certificate nor had their aircraft complied with F.A.A. Air Charter Regulations concerning their activity. We indicated that they need to cease and desist. H.R.S. did some very similar things to them, in particular, they wrote Royal a letter indicating their ad- vertising and publicity in the local newspaper has been noted when in fact, none of the units or services certify them as such." Mr. Dorrill added, "I have subsequently spoken with Flight Nursing who has filed a certificate with my office for an ALS Air Ambulance under the terms that they would use aircraft owned, flown and operated by Royal Air of Naples, with the exception being that they would be staffed and equipped by their own employees from the east coast. In light of a rather awkward operating arrangement, in my own opinion, combined with some of the problems that we encountered with them, I would ask that Ann also elaborate with some problems that H.R.S. has had with them in the past. I certainly think this council needs to discuss whether or not we want to forward their petition to the board or whether we want to get additional information from them or whether we would request that the board deny their petition." -2- Ann Foster reported that Royal Airways has the physical airplanes but that Flight Nursing is an altogether different company and they intend to use Royal Airways planes. She contacted Tallahassee regarding Flight Nursing's intention of coming into Collier County and she re- quested something from them in writing on what they knew about Flight Nursing. She received a letter from Tallahassee dated July 22nd which she read. (See letter attached, marked "Exhibit A." Mr. Dorrill expressed concern with liability regarding the trans- port of individuals from the hospital to the air ambulance and delivery of them to Royal Airways, if something should happen to that person due to the fact that Royal does not hold a certificate. He feels the ambul- ance company would be liable for turning individuals over to someone who is unlicensed. Mr. Cecil added that more investigation should be made of those persons who are staffing these airplanes. Jack Wampler reported that his experience with Flight Nursing, Inc. , has been that serious collection problems have developed. Ann Foster advised that there is one licensed, legal, properly run air ambulance service that is only BLS service at this time that is based here and operates out of Naples and uses Collier County EMS employees. It is called Ambassador Airways. She related that Ambassador is plan- ning to install equipment for ALS; however, a definite date for this installation is not known at this time. Doug Greenfield thought it might interest the council to know that he has received correspondence from H.R.S. relative to licensing of air ambulances and they are in the process of finalizing their drafts of new licensing requirements. The H.R.S. is requesting input from council's such as ours regarding the practicality of these rules and regulations. He feels that Tallahassee must complete their work in order to give us a direction in deciding what equipment an airplane will be required to contain. Marvin Cecil made a motion that the council not support Flight Nursing, Inc. 's. application at this time until we have further in- formation to back their legitimacy as an ALS service which shall include the ultimate outcome of the current investigation by the State. The motion was seconded by Dr. Ehrhardt. Upon oral vote, the motion carried unanimously. REPORT ON COLLECTIONS Chairman Hill called upon Jack Wampler for his report. Jack reported a total for last month's billing of $45,653; collections of $37,614 or a percentage of 76% collected; total cummulative since April 1981 is up to 62. 7%. He also reported that MediCare now has approved a greater profile allowing a greater amount than we have received in the past. Our base rate allowance has now moved up from $55.00 to $75.00. -3- r NEW BUSINESS Mr. Hill asked Doug Greenfield to explain the raising of charges by nine percent (9%) as requested in the proposed budget recommendations. Mr Greenfield referred to the original accounts receivable manage- ment audit completed in 1981, early part of 1982. He reported that the two people who did the audit, Mr. Yenawine from New York and Ms. Mason from the East coast, in discussing the accounts and billing operation and money management program altother, it was noted that we needed to be more aware of a constant trend to have a small increments of increases over a period of time rather than do what he had seen the county do in the past -- which was wait every two or three years and then have a big increase. It was Mr. Yenawine's suggestion to increase every six months of small increments of two or two and one-half percent (2% or 22%) to meet their needs and their financial growth. Mr. Greenfield reported that the EMS has to have a reserve capital outlay fund which has never been asked for in the past which accumulates to approximately $55,000.00, that the budget has to absorb next year. This amount is being charged against EMS this year. He explained that in years to come when it becomes necessary to purchase new vehicles or equipment, these funds will be available to draw from. Mr. Hill inquired as to the cost of an ambulance. He was advised that $40,000 will buy an ambulance with radios only -- not an equipped ambulance. It costs about $55,000 to fully equip an ambulance. It was projected that a new ambulance is required about every five years. Chairman Hill asked for comments and discussion on the prospect of raising the ambulance fees by nine percent (9%) . Dr. Ehrhardt referred to his letter of July 13th in which he opposes any increases in the present rate structure. (See Exhibit B, attached) Dr. Schmid related the transport of a patient from the Beach Club Hotel to Naples Community Hospital. He felt the service could be more carefully adjusted to the services required; that in this case it did not warrant the services of six individuals in the transport of this patient. Doug Greenfield responded that when the Sheriff's office receives a call there are two types of services that respond, one, the fire ser- vices who do not transport, and second, the EMS service which does transport. The third, usually law enforcement if they are in the area. He added, "This is something that' s been talked about a lot over the last couple of years. We can only start to change that by having better information on the receiving end by a triage dispatch system in this county in reference to numbers of responders to calls." Mr. Greenfield went on to explain the various positions of stations of ambulances throughout the county and how they are utilized to their -4- fullest at the present time. Dr. Schmid said, "It makes sense; I under- stand it a lot better than I did before." Dr. Ehrhardt made a motion that EMSAC is not in favor or raising fees at the moment. Chairman Hill asked for a second to the motion. There being none, the motion died. Some discussion ensued with re- ference to the council becoming more knowledgeable before this decision could be reached. Dr. Meli made a motion that EMSAC's recommendation to the County Commission regarding fee schedules be tabled until the next council meeting on September 14, 1983. The motion was seconded and passed unanimously. The meeting was adjourned at 5:00 p.m. J.C. Smelko Secretary Enclosures (2) -5- II. R. EHRHARDT. M. D. 144 CHANNEL.DRIVE VANDERBILT BEACH "EXHIBIT B" NAPLES. FLORIDA 33940 Piioxs (813) 397-4719 July 13 , 1983 __...... _. . ._ __. Mr. Egon Hill Chairman Emergency :Medical Services Advisary Council - Naples, Florida 33942 Dear Mr. Chairman, Referring to the "Current and Proposed Rate Structure" in the 1983/84 budget I find the "Precautionary I.V./ Monitor Surcharge" listed as 335 .00 which would save the patient only 250.00 instead of 360.00 as the report of the Task Force suggested. . _ The surcharge should only be S25.00, namely the charge for BLS. Of course "I .V. Charge-Start" in amount of S5 .00 and the cost of the I .V. fluid is added. On the other side I feel that the "First Aid Charge (No Transport) " in amount of S 35 .00 is too low and en- courages abuse . The regular charge of BLS should be added whenever an examination was performed or first aid (banda •es etc . ) rendered. Finally I oppose any increase in the present rate struc- . tune which will not be understood by the public and will only create bad feelings toward NS. The difference in net income from Ei'13 revenues for 83/84 with a 9;J rate in- crease amounts only to "350 , 387" which constitute about 3. 5 of a budget of approximately 1. 5 Plillion. I am sure that these 350 ,387 can be recovered somewhere by the County without any property tax increase . i;r. Chairman, please bring the proposed Rate Increase up to a vote by E:iSAC . Re oectful1 ,-7 (/? =:.R. nrhardt , .i. D. 7 , . % MEMORANDUM DATE: August 22 , 1983 TO: EMSAC Members FROM: W. Neil Dorrill , Public Safety Administrator SUBJECT: Minutes of EMSAC Meeting . In accompaniment please find copy of Minutes of the regular meeting held on August 10 , 1983 . Please review these in order that they can be adopted at the next meeting to be held on Wednesday , September 14 , 1983 at 4 : 00 P .M. at the new EMS Headquarters , 3123 Terrace Ave . WND/bm cc : C . William Norman, County Manager Grace Spaulding, Administrative Aide File 14-D