Advanced Life Support and Sudbury

1. Advanced Life SupportandSudbury Managing the Future September 23, 2009

2. 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

3. 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

4. Sudbury Runs • BLS = 988 (2008) @ $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

5. 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

6. 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

7. 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

8. Governing Body Bullet Point 1 • Executive board (including 3 member Fire Chiefs) • Set rates, reimbursement • Select vendors (with member approval) • Establish regional rules

9. Centralized Dispatch Bullet Point 2 • ALS vehicles GPS equipped • Choose closest response • Valid data collection • Data analysis and continuous improvement • Manage by measuring

10. 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

11. 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

12. 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)

13. 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.

14. 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.

15. 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.

16. 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”