HomeMy WebLinkAbout1998-05-11 98-213 ORDERCO"CIL ACTION
Item No. 9a -u3
Date: 5-11-97
RemlSubject Order, Authorizing City Staff to Continue Discussion with Emtam
Maine Healthcare in Regard to Ambulance Service
Raponsible Department: City Manager
C,ommentury: Ants needing of February 9, 1998, the City Council tabled a proposal from the Fare
Department mbegin providing expnndal intentional"transport services and directed staff enter into
negotiations with Rattan Maim Healthcare and Capital AmbWaace in regard to the provision of
ambulance service in the enormously. Since thea a number of meetings have been held and a
conceptual framework has been developed for a possible cooperative vemcge. A copy of a
memorandum outlining this fimnewmkis anached.
The aceomparsymg order auMmbm muffin coreume tins effort by fanner developing this framework
into specific attractions between He parries designed to provide a detailed operating fiamework for
Council consideration The must is to develop a specific agreement or agreements for Count
consideration.
'Phis proposal was presented to the Municipal Operations Committee on May 5, 1998
Department Head
Mauagees Comments:
City Manager
Associated Information: Order, Memorandum
Budget Approval:
tiommanrecmr
Legal Approval:
City S rV
[n¢- need for
aseage
_First Reading Pap—of
--wend
98-213
Amigned to cffot Farnham Nay it, 1998
CITY OF BANGOR
(TITLE) (®xbei, _... Avthoriilng City Sta%to Continue Discussion with Eastern Maine
Healthcare In Regard to Ambulance Service
By w clay cauMp of w CRY OfJa r:
ORDERED.
THAT staff Is directed to continue discussion with Eastern Maine Healthcare and
Capital Ambulance and to develop a specific agreement or agreements
between the parties for a cooperative approach to the provision of ambulance
service to the community. These discussions and agreements are to be guided
by the conceptual framework outlined in the attached May 1, 1998
memorandum from the City Manager. Staff shall periodkally update the
Council on the progress of these discussions and shall provide the Council with
a proposed agreement or agreements on or before August 10, 1998.
IN CITY COUNCIL
May 11, 1998
Ken Hewes, Eastern Maine Healthcare
requested that a copy of a
memo
regarding this order be madepart -
of the record. Motion for passage
Made and Seconded Councilors -
Crowley S Woodcock abstained from
Order �passed
Zf W.ERE
98-213
ORDER
Title, Autborizing City Staff to Continue
Y_Discussion with Eastern Maine Healthcare
in REgard to Ambulance Service
......................
...................................
��eatn
n1�Aa .fir vow .
Councniilmanes n
COUNCIL ACTION
Item No. 9a-zt3
Date: 5-I1-97
Ihm/Subjecro Order, Authorities City Staff to Continue Discussion wkb Laafern
Maine Healthcare in Regard to Ambulance Service
Responsible Department: City Manager
Commem ay: At hs meeting of February % 1998, the City Caused tabled a proposal from the Fire
Department to begin providing expanded marginality tmesport services and directed staff to arta into
negotiatiom with Eastern Maine Hea thcam and Capital Ambulance in regard to the provision of
ambWance service is the community. Score then, a muMa of meetings have been held and a
conceptual framework has been developed for a poss3le cooperative venture. A copy of a
memorandum oudiWsg tido framework is attached.
The aocompmyivg omar a dmenes staff co comma this affort by furtba developing this frarnework
ago specific agrmncna behvem red parties designed to provide a detailed operating fiemework for
Council consideration The intern is to develop a specific agreemem or agreements for Council
consideration.
Thies proposal was presented to the Municipal Operations Commmen on May 5, 1998.
»eperrmwr ueea
Manager's Comments:
City Manager
Associated Information: Order, Memorandum
riummmarecmr
Legal Approval: (�1��J/j�
C Iar rL'
zdoad for
assage
_Mrst Reading Page_of _
—eferral
98-213
Assigned b(bnn Farnham Nay ll, 1998
CITY OF BANGOR
(TITLE.)@rbgr..................AuthorWng City Staff to Continue Discussion Win Eastern Maine
Healthcare in Regard to Ambulance Service
By t" City Owned of tib aty of8ONa0I:
ORDERI&Dt
TUT staff Is directed to continue discussion with Eastern Maine Healthcare and
Capital Ambulance and to develop a specific agreement or agreements
between the parties for a cooperative approach to the provision of ambulance
service to the community. These discussions and agreements are to be guided
by the conceptual framework outlined in the attached May I, 1998
memorandum from the City Manager. Staff shall periodically update the
Council on the progress of mese distusslom and shall provide the Council with
a proposed agreement or agreements on or before August 10, 1998.
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MEMORANDUM
To: Honorable Council Chair and Montana of the City Council
From: Edward A. Barnett, City Manager
Subject: Proposed Ambulance Amngwent
Date: May 1, 1998
On Thursday, April 30, 1998, representatives of the City met with Ftmowrtives OfEastem
Maine Healthcare end Capital Ambulance t continue discussions of a proposed cooperesive
venture between the parties for the provision of emergency and noncnagency ambulance
serve" to our community. In who follows, I will attempt to outline the major points covered in
this discussion, points which may save as abasis for developing a more detailed agreement
between the parties involved. At this prim, ammo es hes been on the general parameters of such
an movement. Should this approach be axeptableto you, additional work will be respond to
develop a mare complete unearned.
OVERVIEW OF PROPOSAL
Based on discussions to date, a cooperative approach has been proposed under which Bangor
Fire would remain the primary emergency response, rescue, and transport organization within the
community. Capital would continue to provide interfacility and critical care tmnsi
Agreements would be developed between the" entities under which bath would provide back up
to the other when necessary, with such agmements including prodo"Is which would be used to
derstra newhen such back upir required. Theagencies would intarowec[thardispamh
systema within a fairly immMiate time frame whrejowdy investigating the potential force -
locating or consolidating dispatch. Other areas ofcooperaborn would be explored and utilized
halmingjointpumlUsing, clams processing, and arming ]Te cooperative ventre would be
administered through &steering committee composed of an equal number ofrepresrnttives of
Paster Mane Healthcare and the City. Medical supervision and oversight would bemovided
by a Council led Fmmilany Medical Services Oversight Committee which would include
represemmtion from both agencies along with physicians and practitioners familiar with
emergency medical services.
Both parties would specifically recognize and agree door individuals and institutions in the
commuaty would retain the right to we their provider of choice regardless of the service
evolved --whether it be emergency or interfacility mention. tion. m addition, both parties would
recognize the existence of mutual aid agreements to which Bangor is aparty and the responses
which are required under these agreements.
Common heatians and D'avt r.
At the present time, the City of Bangor provides a 911 public service answering center at the
Police Depazmarimmith a ringdown line On the Fire Department Emergency Medical Service
calls ere onnsferted to Fire Dispatch, with our dispmchers certified m medical dispatch.
Meridiem Mobile HealtWCopital Ambulance provides an emergency medical dispatch center and
a medical communications center with medical triage and help Imes. At the presend more, no
direct communications link exists between the mmmunicalim s centers operated by Bangor Fire
and Capital.
Underthe proposal, a dedicated phoneline would be established bmveen Nese centers. This
will also require the development ofcooNinffied dispatch protocols to implement the
responsibility allocation discussed below. On an intermediate beads, the parties will work toward
ani wonnectedcompmeraideddisparohsystemmdajoi tdetesystem. At Nesametune,Ne
parties would agree in investigate the feesibility of es ablishing ajoint or co -located dispatch
center as apart of the City's proposed Police/Fire: coarmmtications cannot.
Call Req xe
The Bangor Fire Department would be the primary responding agency to all emergency medical
calls in Burger, whether these calls are initially received via 911 or the Capital call center.
Capitol Ambulance would provide back up response. Protocols will be developed W dtterrane
when back up response is required
Capital will provide primary service for inter -facility Varwfers and critical care transfers with
Baagor Fire providing back up service under similar transfer protocols. Bangor Fire personnel
will be trained in Critical Care Treatment m provide back up support for critical care transfers.
Wldle this represents the overall allocation of drabs;, boor parties specifically recogiu Nat
patents and facilities renin the choice to specify or use either provider for my service which
Neyerecapableofproviding. Thus for example, apatient may specify that di wish Capital
form emergency trunsport or Bangor Five form interfacility transfer. The parties also recognize
that Bangor will continue to respond on me a id to other communities ander ow mutual aid
agreements. Bangor Fire would continue to provide interfacility services to the City Nursing
Facility. The parties would agree W an approach toward marketing Neer services which will
recognize patient choice and avoid aggressive marketing aimed 9 capturing a larger share of
their non -primary business.
plunger Fire will be included in my managed eare agreements negotiated by Eastern Maine
HealNcere which involve emergency or iotufecility transportation.
MANAGEMENT STRUCTURE
An Emergency Medical Services Oversight Committee would be established. This Committee
would oversce and evaluate the enthe emergency medical service response in the region. This
will include review and approval of various proWcols used for purposes such as Nose discussed
above as well as W provide quality asamarrz reviews to dominate that standards of come and
response times are met. In addition, since the nature of Us cooperative venue is likely to
change overtime, this group could be asked to provide advice and recommendations to the
parties on charges In the nature of the arrangement which could improve service quality and/or
timeliness. Based on am discussions, tis Committee would be established by the City Council
and would represent the medical expertise needed to direct and reviesvthe system. Assuch,it
would include members representing physicians Imowledgeable in emergency medicine, EMTs
or paramedics, end representatives of the cooperating agencies including a Council
representative. The size of the Committee should, however, be kept m a manageable level. As
an initial recommendation, it might include the emergency service directors of Eastern Maine
Medical Center and St. Joseph's Hospital, representatives from Capital and the Bangor Five
Department, several trained emergency service providers, and a Commit representative.
In addition, a Steering Committee would else be established to oversee the cooperative
amangement. This group would be responsible for establishing policies, developing protocols,
outlining future developments, reviewing and approving consumes for service to be provided, and
resolving any issues which might surface in regard to existing agreements. This Committee
would be composed of an equal number of representatives from Fastem Maine Hea thcare and
the City.
O r I a n./Armx fm limn e�=�Mn
A number of Orion mess exist for mutual cooperation. These include:
1. Joint Pmchming of Supplies/Equipment.
2. Joint Medical Direction
3. Joint Claims processing and billing.
4. Joint Training.
5. Combined Data Collection and Reporting.
By working together in these meas, it is possible that the parties may realize cost savings or a
higher mW of collections on bills for services.
One other issue will also need to be addressed as this process moves forward: the changing
enviromnent of emergency services. As managed care becomes more prevalent, it appears likely
thin there will he additional screening requirements at the entry pointy into the system — the 911
call center or phone triage locations. As aresuit, wecanarmoipate mattherewill he fewer
emergency calls and transports and a likely increase in Ne range of services offered by
emergency service personnel in the field. For example, routine services Which previously may
have required transport might be provided by ambulance personnel in a patients home with no
need fartransporhation. As each services develop, an allocation of
responsibilities in this areawill he required.
UnderbdatrCUs-Ginds
As we approached these discussions, enumber ofcity goals and interests were articulated as
baric requranro[a for acooperetive amangemrnt. These inclWed:
1. Maintaining the ability of the City m provide a fulh range of emergency medical
and rescue services with response times m or below those currently pmvidN.
2. Inswing the availability of an emergency services wodrf nue necessary m
appropriately respond to all emergency and fire calls.
3. Maintaining a sufficient workload to insure that the skills of emergency response
personnel we mawmined.
4. Providing a cautioned revenue stream from services in order to offset a portion of
the costs associated with maintaining a complete emergency response capability.
The Bangor Fire Depattrom is uniquely suited to meeting the resporee times required for
adequate emergaaay service provision in arm community. At the same time, the costa associated
with supporting the necessary staffing estuipment, and training to meet these response
paremenue is significant. Revenues produced though services provided for a fee are an
important element in maintaining the level of fire and emergency services which the Council and
the commonalty have grown to expect. To the extent possible, we believe fee for service revenues
should be maintained and, if possible, grown in under N limit ma rate impacts and maintain
Bangor's compefifive position in this region.
WOR [a) illdyrat.
Significant work is yet in be done in developing the details ofNeae various arrangements. In
addition, it is clear that the health care area continues to be one characterized by frequent and
sigoificantchaoge. w deoomgionhasnotyNwm Nefullimpactofthmechanges,
particularly in managed core, it is likely Nat change will continue and accelerate. As a result
myjomt aaangement must be structured so as N respond effectively to Nese changes.
Council guidance is needed prior to devoting the time and energy required to mother develop and
implement the approaches outlined above. At this point, we can devote ow energies to
developing a more complete City of Bangor based ambmance service and to competing wind
other entities for a larger market share of this business. Conversely, we can dnect these energies
toward developing an overall emergency medical service which can meet the needs of am
citizens within a cooperative context which still allows individuals and organizations to exercise
their own chat" as to a provider.
Wbile significant discussions most still take place to address the concems of each petty, I would
recommend that we proceed taward the necessary agreements which will implement this
conceptual approach.
Edward A. Barrett
City Manager
This memorandum has been reviewed by Kenneth Hews, Executive V!c Presidmu ofEashan
Maine Healthcare.