Orlando Fire Department

Report
OFD Fire-Based
EMS Transport
OFD Transport Timeline
BEGIN 1
YEAR
OFD TRANSITION 90 DAY BILLING
OFD
TO FULL ALS & COLLECTION LAG TRANSAUTO ACCIDENTS
TIME
PORT
EVALUATION
Feb
2011
Mar
2011
Apr
2011
May
2011
Jun
2011
Jul
2011
Aug
2011
12 MONTH EVALUATION PERIOD
Sep Oct Nov Dec Jan Feb Mar Apr May Jun Jul
2011 2011 2011 2011 2012 2012 2012 2012 2012 2012 2012
EVALUATION
RFP FOR
OF
BLS
DATA
TRANSAND
PORT
RFP
PROVIDE
PREPAR
R BEGINS
ATION
Aug
2012
Sep
2012
90 CONTRACT
EXTENSION*
(Available for any
possible RFP
challenges)
RFP PROCESS
Oct
2012
Nov
2012
Dec
2012
Jan
2013
Feb
2013
Mar
2013
Apr
2013
Transport Evaluation Criteria
Operational Evaluation: Did the addition of Fire-Based EMS
Transport impact the high quality of service already being
provided to the citizens and visitors in the City of Orlando?
Financial Evaluation: Did the addition of Fire-Based EMS
Transport generate sufficient revenue ?
How we got here.
• OFD History
• Ambulance RFP
• Safer Grant
• Fire Based EMS Transport Proposal
•
•
•
•
•
OFD History
Leaders in EMS in Central Florida
Mid 70’s introduced Advanced Life Support
(ALS)
Introduced ALS Engines in the 80’s
All Stations ALS and then all Units in the 90’s
OFD has always provided the “Back Up”
transport system
Ambulance RFP
• Orange County Fire took over Transport
(2008)
• Orlando contracted with Rural Metro for
services (2008)
• First full RFP for Ambulance Service
Safer Grant
• OFD submitted for 46 personnel
• Equal to the number of persons in the required budget
reduction
• IAFF and City worked together for the Grant
• 2 year Grant Awarded for the 46 personnel
•
•
•
•
•
•
Fire Based Transport Proposal
Since OFD doing most of the work on scene, we
proposed doing transport
No expansion of personnel
OFD proposed ALS and Auto Accidents Transport
BLS calls to a Private Provider
Approximate 2/3 to 1/3 split of Transports
OFD added Rescues 6, 9, &15 from redistribution
of manpower
What did we do?
•
•
•
•
•
•
What did we do?
Start up preparations
Capital Purchases
Medicare/Medicaid
Billing Company
EMS Reporting System
Ambulance Support Contract
Start Up Preparations
• Established Working Committees on
– Operations Changes Fire/EMS/Transport
– Supply/Logistics Trucks and Stations
– Training both in EMS Transport and Hospitals
– Quality Assurance, Report Writing and Treatment
– EMS Policies
– General Policies
– HIPAA
•
•
•
•
•
Capital Purchases
New Rescue Trucks
On Board Computers for Dispatch and
Mapping
Power Pro Stretchers
Lifepak 15’s
All needed equipment and supplies
•
•
•
•
•
Medicare/Medicaid
Average time to receive is 9-12 months +
Medicare submitted in December and received
Medicare # in March
First payment received in May
Medicaid submitted after Medicare award
First payment received in June
Billing Company
• OFD needed an experienced Billing Company
• OFD Piggybacked on an Orange County
contract for services
• Advanced Data Processing Inc (ADPI) leaders
in EMS industry on billing and recovery
EMS Reporting System
• OFD Report system was inadequate for EMS
Transport reporting
• Changed to a mobile reporting system on
ruggedized laptops
• Crews able to complete reports at the hospitals
& obtain signatures from hospitals and patients
for billing
Ambulance Support Contract
• City Contracted with Rural Metro for BLS/ALS
backup support
• Contract Includes:
–
–
–
–
–
Supplied Dedicated Units to the City
Units dispatched by OFD
Has the same Computers in units as City
Able to talk on our radio system
Full time Dispatcher in OFD Communications Center
Operational Statistics
Operational Statistics
•
•
•
•
•
•
Transports
Daily average transports
Ratio OFD /RMA Transports
Compliance summary
Service Level Mix
Transport Related injuries and complaints
.
1800
1600
1400
1200
1000
800
Monthly Transports OFD
Monthly Transports RMA
OFD 19174 / 1597 Month
RMA 7728 / 644 Month
600
400
Daily Average OFD 52
200
Daily Average RMA 21
0
OFD 70.96% of Transports
RMA 28.56% of Transports
.
Transports by Units (May 2011 to April 2012)
3000
2500
2000
1500
1000
500
0
Compliance
• System Goal to provide a transport unit on the
scene in 10 minutes or less 90% of the time
Study Period May 2011 to April 2012
• OFD Average is 95.92%
• RMA Average is 93.80%
• System Average is 94.86%
OFD Service Level Mix
100%
90%
87% 87%
80%
87% 87% 88% 88%
86%
85%
84%
84%
84%
84%
70%
60%
50%
BLS
40%
ALS1
ALS2
30%
20%
10%
0%
15% 14% 14% 14% 13%
12% 11% 11% 10% 11%
12% 12%
1%
1%
2%
2%
2%
2%
2%
2%
2%
2%
2%
1%
2000
.
1800
19174
OFD
Transports
1600
1400
1200
Transports
Injuries (3)
Complaints (3)
1000
800
600
400
200
0
May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr
Financial Statistics
Financial Statistics
• Billing Summary
• Medicaid/Medicare Adjustments
• Payer Mix Comparisons
• Revenue Collected
Billing Summary
May 2011 to April 2012
• Total Billable: $18,263,927 Gross
• Adjustments to Billable: $4,351,904
(Medicaid/Medicare)
• Net Adjusted Billable: $13,912,023
• Total Deposits in Bank: $ 4,800,394
•
•
•
•
•
•
•
Medicare/Medicaid Adjustments
Medicare and Medicaid are capped by Law
BLS ALS1 ALS2
City Rates are $700 / $900 and $1000
Medicare pays $268 / $319 and $462
Difference
$432 / $581 and $538
Medicaid pays $136 / $190 and $190
Difference
$564 / $710 and $810
Differences are reported as adjustments
Agency Pay Class Comparison
100%
30%
33%
60%
19%
18%
40%
27%
80%
20%
0%
24%
33%
16%
24%
23%
24%
20%
Self Pay
24%
29%
18%
24%
Insurance
48%
Medicare
(-$581)
43%
9%
41%
7%
51%
7%
8%
Medicaid
(-$710)
Total Billable
• For the study period, OFD has submitted
$18,263,927 in gross billable Transports
• This results in a gross average of $1,521,993 in
billable transports per month
• After Adjustments the average is: $1,159,335 in
billable per month
Total Revenue Collected
• For the study period $4,800,394 has been
deposited in the EMS Transport Account
• The results in an average of $400,032 a month
deposited (cash in the bank)
• Sent to Collections: $1,131,269
Where do we go from here?
•
•
•
•
•
Where do we go from here
Continue the same model of service
Allow billing account to fully mature
Begin the RFP process for Ambulance Support
Monitor call volumes for future needs
Continue the high excellence of service
Saving Lives and Protecting Property

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