Advanced Life Support and Sudbury

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Advanced Life SupportandSudbury

• Managing the Future
• September 23, 2009

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Basic Life Support (BLS)

• Sudbury established ambulance service 1976
• Emergency Medical Technicians Basic (EMT-Bs)
• Statewide Protocols
• Bandaging, stabilizing, transporting
• Cardiac defibrillation
• Epinephrine Epi Pen
• Glucose, albuterol

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Advanced Life Support (ALS)

• Emerson started ALS service in 1982
• One of 23 hospital-based services
• Emergency Medical Technicians Paramedic
  (EMT-Ps)
• Statewide Protocols
• Intubation, 12 lead cardiac monitor, Intravenous
  (IV) fluid replacement, 44 medications, advanced
  assessments
• Loss Leader

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Sudbury Runs

• BLS 988 (2008) _at_ 576.07 per run
• ALS 385 (2008) adds 108.03
• Cost of service ranges from 250 - 265
• 39 of calls are ALS
• 56 of ALS calls are billable
• 46 of billable calls are Medicare (101 calls)
• Total Sudbury Revenue for FY09 354,367.52

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Emerson Hospital

• FY07 loss on operations 8.7 million (Boston
  Globe 3/21/08)
• ALS loss at least 100,000 per year
• No more loss leader
• Continue ALS operations until September 2010

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Central Middlesex Emergency Medical Services
Collaborative (CMEMSC)

• Established September 2008
• 13 Emerson service communities (with Emerson as
  member)
• Purpose Design replacement regional ALS
  delivery system

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Central Middlesex Emergency Rescue Authority
(CMERA)

• Bullet Point 1 - Governing body of regional ALS
  service
• Bullet Point 2 - Centralized dispatch for
  all-in communities
• Bullet Point 3 - Vendor-provided regional ALS
  service
• Bullet Point 4 - Centralized billing
• Bullet Point 5 - Development of local fire-based
  ALS service buttressed by regional backup

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Governing Body
Bullet Point 1

• Executive board (including 3 member Fire Chiefs)
• Set rates, reimbursement
• Select vendors (with member approval)
• Establish regional rules

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Centralized Dispatch
Bullet Point 2

• ALS vehicles GPS equipped
• Choose closest response
• Valid data collection
• Data analysis and continuous improvement
• Manage by measuring

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Vendor-Provided ALS Service
Bullet Point 3

• Initial system ALS provider
• Scaffolding - provide backup to local,
  fire-based ALS services
• Training
• QA/QI Quality Assurance/Quality Improvement

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Centralized Billing
Bullet Point 4

• Common rate
• Medicare 200
• Essential to fund system
• Bill for Assessments
• ALS service 30 of runs
• Assessments additional 30 of runs
• Expertise in billing under new paradigm

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Development of Local, Fire- Based ALS
Services
Bullet Point 5

• Each community that desires will establish local,
  fire-based ALS system (Wayland model)
• Local ALS vehicles will be available for regional
  dispatch
• Regional reimbursement will go to local ALS
  provider (400)
• Closest vehicle dispatched
• Regional ALS provider will plug holes with
  dynamically deployed ALS truck(s)

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Service Participant Agreement(All-In)

• Abide by the rules established by the CMERA
  governing board. This board will be made up of
  three Fire Chiefs periodically elected by CMERA
  members from CMERA participating towns.
• Pay 450 (or other fee as may be voted on by
  CMERA) to the CMERA system per ALS service or
  assessment incident. (400 for the ALS vendor
  50 for CMERA.)
• Conduct all billing through the CMERA selected
  billing vendor.

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Service Participant Agreement(All-In)

• Utilize the CMERA established billing rate or
  other rate that may be voted on by CMERA in the
  future. This is presently Medicare 200.
• For those towns with no local fire-based ALS
  service -
• Direct all requests for ALS service through the
  CMERA ALS dispatch center.

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Service Participant Agreement(All-In)

• For those towns with local fire-based ALS
  services,
• Make their ALS units available for regional
  dispatch.
• For regional dispatch, accept 400 as the
  regional reimbursement for services.
• For local dispatch in the member's community,
• Charge CMERA rate (presently Medicare 200)
  which will be kept by the local community.
• Alert central dispatch of local response and
  provide essential data for effective central
  record keeping.
• Install a GPS tracking device on ALS
  participating ambulance for use by CMERA in
  tracking and dispatching ALS calls.
• Installation, maintenance, and tracking costs to
  be paid by the regional ALS vendor.
• Each community will have remote access to GPS
  tracking system.

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Selectmen Actions

• Endorse immediate increase billing rate to
  Medicare 200 (previously voted)
• Provides funding for SFD ALS service development
• Increase revenue
• Offsets decrease in January 2010 Medicare rates
• Vote to be All-in