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Minutes 02/25/1998 EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL (EMSAC) INFORMAL MINUTES February 25, 1998 2:00 P.M. Health Building 3"d Floor 3301 East Tamiami Trail Council Members Present: Bob Laird Excused: Paul Gunther-Mohr Roger Evans George Leamon Rhona Saunders Gail Dolan Unexcused: Chief Jim Tobin Commander Reed Mike Davis Fay Biles Others: Leo Ochs Chief Flagg Commander Page Barbara Brown The regular monthly meeting of the Collier County EMSAC committee was called to order at 2:05 P.M. on Wednesday February 25, 1998 by Bob Laird, Chairman. Fay Biles made a motion to accept the minutes of the January 28, 1998 meeting. Motion 2nd by Sheldon Reed. Motion passed. OLD BUSINESS: Commander Page reported Chief Flagg was waiting on John Yonkosky to fax a copy of a document that he had received from Medicare. John Yonkosky's estimation of what Medicare would pay this year came up short. Commander Page believed it was actually less than was paid last year. Commander Page stated right now they are still negotiating with Medicare. DOR is trying to find out why there has been a reduction and they will pursue. Roger Evans inquired on the additional charge. His understanding was to create the higher charge so that as a pattern of higher charge over a period of time, doesn't mean your paid that, but charged that, and then that becomes your rate base. When your rate change period comes about, Medicaid looks back at the rate charge history, and that is what assist in increasing the rate. 1 Commander Page stated based on the $302 rate John Yonkosky was expecting to go from $250 to $280. That didn't happen although it is still being negotiated with Medicare.. Rhona Saunders inquired if this would impact from now forward on what is collected from Medicare or what they have paid us already. Commander Page replied yes, but again it is still being negotiated. Commander Reed inquired as to the impact? Commander Page stated currently we are charging $302. Commander Page thought we were getting a little less than we were this last year, $252. So, nothing has really changed. Rhona Saunders stated the budget was based on the estimated increased. Leo Ochs stated the budget for next year has not been formulated as yet. It is not necessary based on what Medicare does. Mike Symkowski, Budget Director, will be going before the Board in early March with his annual Executive Summary that asks the Board to set some basic budget policy guidelines. The section on EMS, will give some historical data of the overall budget and the breakdown and the major funding sources for the operation being obviously ad valorem and user fees. They will decide what kind of position do they want to take. Leo Ochs thought historically it had been half and half. Chief Flagg stated it ranges between 60% and 40%. Leo Ochs stated the Board would need to decide as a policy level decision first and foremost, how much ad valorem support they want to provide to the operations. That will dictate the rates that need to be charged in order to make up the difference. Chief Flagg wanted to clarify; Medicare is changing. This has been said all along. The theory was, that if you have an eighteen month window and you stay above the Medicare allowable rate for eighteen months, then Medicare would give an increase to your Medicare rate. Mr. Yonkosky did that eighteen months ago. The fee was increased above what Medicare allowed to $302. Medicare's allowable rate for the vast majority of transports, not all of them, was and still is $250. What that means, Medicare pays $200 and the patient is responsible for the 20% or $50. Eighteen months ago based upon the information provided by Medicare, they said, if you increase the rate above what we allow for an eighteen month period, then we will increase what we allow. That did not happen. Now, my understanding is, Mr. Yonkosky is pursuing a review with Medicare as to way they did not increase the rate as a result of increasing the rate above what Medicare allowed eighteen months ago. Now this ultimately will become the Boards decision. Many systems have realized you cannot base your level of service or quality of service based upon what Medicare and medical insurance's are is going to reimburse. Some of the systems have set a rate at $200, some are not charging at all. More and more systems are saying they can't play the Medicare game anymore, they are setting a reasonable fee; the public pays taxes for emergency services and the balance will be ad valorem. That decision for Collier County lies with the Board of County Commissioners. Once they set the fee, the balance will be ad valorem. The EMS division right now is what is called an 2 enterprise fund. This means a portion of it is tax supported, a portion of it is user fees, and they have to balance each other out to be a budget. Other systems have gone to a system where the EMS system is a totally ad valorem fund, and a completely separate fund collects the revenues from fees. Lee County is one of those systems. Leo Ochs stated he felt the Board would be asked, as a policy level, if EMS has been on the average a 50/50 split, do you want to maintain that percentage split for the coming Fiscal Year? If the Board chooses to, then Chief Flagg develops the operating budget and 50% of that will be ad valorem supported. Then we figure what the rate structure needs to be based on the projected call volume to raise enough revenue to fund the remaining half of the operating budget. Chief Flagg stated the danger of approaching the budget from that prospective is it sends your fees potentially through the roof or you lose your level of service Commander Reed stated if EMS needs to go to a full ad valorem mode and what ever gets generated back into revenue is the way to go, it is better to do that sooner than later. Diane Flagg would like to have the Commissioners understand, that EMS will state what their professional recommendations are in terms of service levels and what the projected cost for those service levels will be. Based upon the third party payers, Medicare and Medicaid, DOR will show what they can expect in terms of a reimbursement. If they want to try to increase fee reimbursement through higher bills we can tell from vast experience that is not a good way to go. There may be an opportunity to increase the bills slightly through a capped mileage, that was one of the previous discussion. Charging mileage and capping it at seven miles, and that may help some. But going to the $350 or $380 bills, then a new issue is created with the community. Chief Flagg also stated she has given numerous presentations, advising people their EMS millage is 0.19856 rounded off to 0.2 mills, which equates to $20/year on a taxable value of $100,000. If your homes taxable value is $200,000 that equates to $40 a year No complaints are heard from the community on the tax amount's or the service levels. What she heard hundreds of complaints about, before the Board made the revisions to the fee structure, was the amount of the bill. Commander Reed stated Chief Flagg had recommended two units last year, and only received one, so that leaves the department down one unit. Leo Ochs stated on the copy of the Budget Policy there is a reference to two units being proposed. Chief Flagg stated what dictates pre-hospital emergency services is largely response time. As a result of that, in dictating the units we need, are the response times. We have to put 3 units in place due to response times. When the medics are not on a call, they are doing other things such as community EMS programs, hypertensive screening, & glucose screening. EMS units are running over 100 calls a day right now. The helicopter is running over 100 missions a month which is one of the busiest ships in the State of Florida. Placement of EMS units, and putting units in service is dictated by response times. Chief Flagg stated the projected runs for FY 98 - 15,200 billed transports. Fay Biles asked how many runs were billed last year total? Mike Davis mention he noticed the emergency lane had been put into place at the Gordon River Bridge. Is it a success? Chief Flagg answered yes, it will be a greater success when they implement the utilization of changing the signal. The purpose of the emergency lane was to get the unit to the intersection. Step two of the process is to purchase the signal"devices. There is someone that will be manning the radio at the City Corn Center so the medic unit, once the devices is on the signal, the medic unit will call the Corn Center and they will change the light to green to allow the unit to proceed across the bridge. There is no room for an emergency lane on the bridge, so the purpose of the emergency lane is just to get them to the intersection, step two is to control the lights to get them across the bridge. Mike Davis inquired about a satellite facility. Chief Flagg did not recommend that. Gail Dolan stated it would not help. NEW BUSINESS: Commander Page reported on an incident last week. The North Naples Fire Department was allowing citizens to ride their units. EMS had an issue where a young man was video taping accident scenes and going into the patients' homes. That was a patient confidentially issue and the Fire Chief was called. Chief Flagg stated that is actually not legal. She had the duty Commander call, as soon as it happened, contact the fire department and tell them medical scenes are EMS responsibility. Commander Page reported on a call at the Beachwalk tennis courts. A man was feeling weak, the unit was dispatched and they responded from North Collier and they were there within three minutes, and transported the patient to the hospital. When the EMS Lieutenant was getting his times, we had a resident call complaining about the length of time it took for the fire department and EMS to get there. When Jeff Page researched the times there was a ten minute delay from the time the Sheriffs Office received the call and ten minutes before it was dispatched it to EMS. It was researched and apparently the dispatch center dropped the call. Rhona Saunders inquired how EMS picked the patient up if the call was dropped. Jeff Page said the party called a second time. 4 fc tf g 1. ✓v� Sheldon Reed stated the Sheriff desperately needs a new cad system with some back ups. The City's system, which they will be replacing in the next couple of months, their old system has built in timers, if you have a call that's waiting for more than a couple of minutes, the machine starts beeping. Bob Laird reported on the Letter to the Editor he had sent in answer to Karen Mathewson letter. After reading the letter he felt it was necessary to respond. He reported he had discussed his letter with Leo Ochs, and Chairman Berry. Chairman Berry wanted him to poll the council members to make sure they were in agreement to his response. Chief Flagg, reported the City Manager on Marco had sent a letter asking for a proposal to provide both EMS and fire service to the City of Marco. She has referred the letter to the County Administrator. Chief Flagg, also reported on March 10, she will be doing a presentation to the Public Safety Committee on EMS. The AED Ordinance will be out of the County Attorneys Office by the end of February. This will successfully create the program where anyone in the community who wants an Automatic External Defibrillator will be able to call the organization, set up a class, and then be able to purchase an AED. In addition EMS also has a commitment from manufacturers for ninety (90) AED's, which generally run between $2500 and $5000 a piece. The study has been completed on where the AED's should be placed, based upon statistics. EMS will be giving AED's to target areas to implement and also provide the training for them. After the Ordinance is approved, it will be advertised, then it has to go to the Board for approval. This program will serve as a model for the rest of the nation. An AED is a medical device that requires a physicians prescription. Physicians are unwilling to write a script because of the liability. It will be a complete program so John Q. Public who wants an AED can get the training, and purchase an AED. They will also receive annual follow up. The manufacturers were so interested in this program that they are willing to commit that number of AED's, they will be using Collier County as an example to sell the AED's throughout the nation. t,+� Roger Evans inquired as to where the liability lies with the program? ?7')"''t 5 ' Chief Flagg stated the AED's 100% of the time, which is really unusual in medicine, will not, has not, inappropriately shock someone. EMS has been working with the manufacturer's the last few years to get them to design an AED for use by John Q. Public. The AED's is a complete self contained & self charging unit. All it has is a red light and a green light. If there is something wrong with it the red light shows. If they see a red light they call EMS. It has a five year battery. It was designed specifically for the lay public. We are real confident with the product that is there, and the law changed to include the AED's as a part of the Good Samaritan Law. The last link in this program, is putting the Ordinance together to tie the training to the AED purchase, so anyone can go out and buy it. 5 1 Bob Laird reported on the Commission Meeting, February 17, 1998. The Paramedic's were honored with the Phoenix Awards. He complimented Chief Flagg, for the good work she does, as well as the medics. Fay Biles did not understand Chairman Berry's comment that they have to separate fire and EMS. Chief Flagg stated it doesn't necessarily matter how the system's are governed. Chief Flagg does not remember hearing the City Council, or the Board of County Commissioners, or Marco City Council ever saying to the fire departments, you will not respond to medical calls, or saying to EMS, you will not respond to fire calls. Because the reality is that both systems respond to the same calls to provide the service. The issue of how they are governed is a discussion for the elected officials. But the reality is in daily operations you only benefit by partnering with things like the single vehicle response program, common fire training programs, common medical training program because you are all working the same emergency scenes. In the field if it is a medical scene, the fire department gets there on the EMS medic unit via the single vehicle response program, or they get there on a fire engine and the outcome for the community is better if that firefighter has some basic medical understanding. The same is true of EMS Paramedics at a house fire. It is better for the community if each department works together. What is best is for everyone to have some basic knowledge of each other's profession, and to be able to interface, and support each other. The reality is the Paramedics are at a fire scene, and are better serving the public providing fire ground support than just sitting in their truck. Chief Flagg reported the special risk legislation is progressing. The Senator that opposed it and was a result of the reason why the legislation failed last time has actually signed on as a co-sponsor of the bill this year. Chief Flagg also reported on the House Bill in reference to the Certificate of Need process. Currently the State of Florida, has said to the Board's of County Commissioners, that it is their responsibility to assure that you have a unified approach to emergency medical services in your community. Then they make the decision as to how the unified approach occurs. The purpose of the (CON) legislation was to eliminate duplication of services and an uncoordinated response to medical emergencies. Years ago, before CON legislation, you had multiple agencies responding to a single incident, one grabbing an arm, one grabbing a leg, and who ever pulled the hardest got the patient. That was the purpose of the legislation. Mike Davis made a motion to adjourn, second by Rhona Saunders. Motion passed unanimously. ectfully submitted, c4—)t-bcx->L- (;-alc"7.4...>n Barbara, Brown 6 r EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL (EMSAC) AGENDA February 25, 1998 2:00 P.M. HEALTH BUILDING 3`D FLOOR 3301 EAST TAMIAMI TRAIL CALL TO ORDER APPROVAL OF MINUTES OLD BUSINESS NEW BUSINESS PLEASE NOTE: All future meeting dates will be held last Wednesday of each month at 2:00 P.M. unless you are notified of a necessary date or time change.