Special Notice / Hearing: None__
Vote Required: Majority
To: Honorable Board of Supervisors
From: Louise Rogers, Chief, San Mateo County Health
Nancy Lapolla, MPH, Director, Emergency Medical Services
Subject: Agreement with American Medical Response West for Emergency Ambulance Services with Advanced Life Support Ambulance Transport for all Areas in the County as Identified in the Exclusive Operating Area
RECOMMENDATION:
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Adopt a resolution authorizing an agreement with American Medical Response West (AMR) for emergency ambulance services with Advanced Life Support (ALS) ambulance transport for exclusive operating areas (EOA) of the County, for the term of July 1, 2019 through June 30, 2024, with the option for an additional five-year term until June 30, 2029, based on contract performance.
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BACKGROUND:
The San Mateo County EMS Agency (EMS Agency) provides administrative and regulatory oversight for the local EMS system. The EMS Agency’s primary function is to plan, implement, and evaluate the local EMS system and its various components. This includes the licensing and contract management of ambulance providers and coordination and monitoring of air and ground ambulances.
The current agreement for ALS ambulance transport within the EOA is set to expire on June 30, 2019. The State of California Emergency Medical Services Authority requires EOAs that meet certain criteria to go out for a Request for Proposal (RFP) process for ALS ambulance transport services at periodic intervals, usually every 10 years. To prepare for the RFP process, the EMS Agency conducted two reviews: an extensive system assessment that included a county-wide stakeholder survey, and a UC Berkeley MPH Graduate Studies Program study assessment of the current EMS system. The reviews concluded that the County EMS system was performing well and successfully meeting the needs of individuals that access EMS through the 9-1-1 system for trauma, stroke, ST segment elevated myocardial infarction (STEMI), and cardiac arrest.
On July 18, 2018, an RFP was released for emergency ambulance services with ALS ambulance transport within the EOA. AMR, the County’s current ambulance vendor, submitted a winning proposal and received a recommendation from a group of seven expert panelists.
DISCUSSION:
Under this new agreement, AMR will provide emergency ambulance services to the County for the term July 1, 2019 through June 30, 2024, with the option for a second five-year term based on clinical and operational performance and the recommendation of the County’s Emergency Medical Care Committee (EMCC) and EMS Agency Director. There is no cost to the County for these services because AMR recovers its costs through payment from users of ambulance services.
Highlights of the new agreement include: 1) a reduction in ambulance transportation rates from the previous contract; 2) an increase in eligibility for its Compassionate Care Program from 125% to 250% of the Federal Poverty Level; 3) a fleet of 25 new ambulances over the next three years; 4) a new bariatric ambulance to safely transport patients weighing up to 1,400 lbs; 5) a DriveCam driver safety and monitoring system on all ambulances; 6) 75 new LIFEPAK 15 monitor/defibrillators in the first five years of the agreement.
Additionally, AMR has committed to increased clinical performance and oversight by adding the following staff positions to its Quality Improvement program: a Community Education Service Advocate, two additional Clinical Field Specialists, and a Clinical and Operational Data Analyst. AMR also will fund the full cost of operating a highly valued quality improvement software package called FirstWatch. FirstWatch includes the Online Compliance Utility program for response time, oversight, and the FirstPass program for measuring quality medical care provided to our residents and visitors. The EMS Agency will make FirstWatch available to all fire departments within the County at no cost. Finally, AMR will make employee enhancements including: increased compensation; a paid emergency medical technician to paramedic scholarship program; sleep rooms for employees to use between shifts; no-cost fitness center memberships; and low-cost healthy food vending machines.
The new agreement continues funding for the San Mateo Prehospital Emergency Medical Services Group (JPA). The JPA was formed in 1997 by fire departments within the County to provide ALS fire first response to 9-1-1 medical emergencies saving the contract ambulance provider valuable resources. This relationship with the JPA has been recognized statewide as a model program for emergency medical services and response. There is a separate agreement between the County and the JPA that outlines the requirements and payment schedule for first responder services. This agreement will be brought to the Board for your approval within the next few months.
Additionally, AMR supports the EMS system by payment of fees for services and oversight that facilitate ambulance transport. These fees include dispatch service fees to the Public Safety Communications Dispatch Center (PSC), Computer Aided Dispatch maintenance fees, EMS Agency Oversight & Monitoring fees, and Radio System Maintenance fees as listed in the chart below. PSC will bring a separate agreement with AMR to your Board that outlines the operational relationship and payment schedule for emergency medical dispatch services.
|
|
Annual Fees |
Monthly Fees |
|
Dispatch Fees |
$1,038,734 |
$86,561.17 |
|
CAD Maintenance Fees |
$60,000 -100,000 |
$5,000 - 8,333 |
|
Radio System Maintenance Fees |
$131,144 |
$10,928.67 |
|
EMS Agency Oversight & Monitoring Fees |
$941,130 |
$78,427.50 |
|
Pager Fees |
$24,000 |
$2,000 |
|
JPA First Responder Fees |
$4,815,508 |
$401,292.33 |
This agreement allows an annual ambulance transportation rate increase based upon the Consumer Price Index for all urban consumers in the San Francisco-Oakland-San Jose area (“Bay Area CPI”) and the average percent of the Contractor’s collection rate in the four most recent quarterly financial reports. This agreement includes an ambulance base rate of $2,431 which is a reduction of 5.5 percent from the current rate of $2,574.
Since the initial presentation to your Board on April 9, 2019, the agreement has been available for public review. The EMS Agency has heard from various stakeholders and is recommending you move forward with this agreement for approval.
The County’s Contract Compliance Committee has approved a waiver request for a five-year term for this agreement. The agreement has been reviewed and approved by Risk Management as to form. The agreement and resolution have been reviewed and approved by County Counsel as to form.
Approval of this agreement contributes to the Shared Vision 2025 outcome of a Healthy Community by providing coordinated and time-appropriate medical response services and care to residents and visitors of the county. Under the agreement, AMR will be required to meet or exceed the response time standard for each zone on 90% of 911 emergency medical calls. It is anticipated that AMR will meet or exceed the ambulance response time standard for 90% of 911 emergency medical calls.
PERFORMANCE MEASURE:
|
Measure |
FY 2018-19 Estimated |
FY 2019-20 Projected |
|
Percent compliance with ambulance response time standards for 911 emergency medical calls |
93%* |
90% |
*Please note that AMR is contractually obligated to achieve a 90% compliance rate, however they are expected to exceed that rate by 3 percentage points in FY 2018-19
FISCAL IMPACT:
The term of the agreement is July 1, 2019 through June 30, 2024, with the opportunity for an extension of an additional five years to June 30, 2029, based on performance and the recommendation of the EMCC and EMS Agency Director. There is no Net County Cost associated with this agreement as AMR recovers fees from users of ambulance services and their insurance providers.