Chelmsford Fire Department-Based Ambulance in Partnership with a Private Ambulance Provider

September 13, 2007 Paul Cohen, Town Manager

GOAL #1
High-Quality Pre-Hospital Emergency Medical Care. - The Chelmsford Fire Department s Firefighter/EMTs and/or a licensed private ambulance providerEMTs have delivered and s will deliver high-quality pre-hospital emergency medical care.

GOAL #2
Public Safety: Have All Five Fire Stations Open Throughout the Year.
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A closed fire station increases the response time for fire and medical emergencies. Revenue from ambulance operations would provide the necessary $106,000 to increase the minimum # of Firefighter/EMTs on duty at any time to 12.
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Proposal Summary
Chelmsford Fire Department operates one primary emergency response ambulance from the Center Fire Station. A private ambulance contractor, responds to all emergency medical calls by bringing an ambulance into town to provide secondary emergency response ambulances.
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Why Consider This?

Unable to Keep the TownFive Fire s Stations Open Throughout the Year Due to Budgetary Constraints. Five-Year Financial Forecast Projects Mounting Budgetary Deficits Contract with Trinity Expires on 12/31/07 All Aspects of Town Operations Being Reviewed For Effectiveness.
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Fire Department Overtime Expenditures

FY03: $607,864 FY04: $493,068 FY05: $445,422 FY06: $441,032 (24 hr shift began in May) FY07: $372, 951 FY08: $230,000 (budget)
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Financial Forecast
Anticipated FY09 Budget Deficit Currently Stands at $1,015,600 Anticipated Budget Deficit Currently Projected to Grow to $11.5 Million in Five Years

Trinity EMS Contract

Expires on December 31, 2007 TownLast RFP for Ambulance Service s Was Issued in November 1996. Contract Has Been Extended Annually
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Recent Efforts to Control Costs and Raise Revenue

Health Insurance Co-Payments Increased from $5 to $15 for office visits and from $25 to $50 for emergency room visits. Adoption of MGL Chapter 32B, Section 18 to Require Medicare Extension Plan for Town Retirees Establish Fire-DPW Facility Committee to Determine Future Facility Needs Establish Solid Waste & Recycling Task Force to Possibly Increase Recycling Rate Obtain Additional Chapter 70 Education Aid in State Budget Eliminated 2 FT DPW Positions in the Highway Department Reduced Fire & Police Overtime One-Year Lease of the Old Town Hall to the Innovative Academy Charter School TIF Agreement to Bring Circles, Inc to Occupy 45,000 sq/ft of Office Space & Provide 300 Jobs Bid Towing Services General Government and School Department Accounting Moved to a Single Chart of Accounts $10 Administrative Fee on Recreation Program Registrations. Regional Purchasing for Office Supplies and Recycling Events Park School Buses at the Chelmsford Forum to Obtain Rent Payment & Motor Vehicle Excise Taxes Stipend Review Committee Obtain Planning Assistance Grants from NMCOG Sale of Surplus Town Parcels and Tax Possessions Explore Consolidation of School and General Govt. Information Technology Departments 9

Chelmsford Fire Department-Based Ambulance Service

Essentially replicates the current delivery method for emergency ambulance service. The primary response ambulance continues to be located in the town center. An additional ambulance is stationed in town each time an emergency medical call is dispatched. Firefighter/EMTs Continue to Respond to Every Emergency Medical Call from the TownFire s Stations.
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Financial Summary
Gross Billable Charges: $1,089,545 - adjustments & bad debt (35%): ($381,340) Net Collections: $708,205 Personnel Expenses: Operations Expenses: Net Revenue: ($392,112) ($113,304) $202,789
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Projected Net Revenue

The projected net revenue by operating one primary emergency response ambulance would be $200,000. Half of this net revenue would be needed to provide a minimum of 12 Firefighter/EMTs on duty at all times.

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Ambulance Call Volume

Calendar 2006: 2,648 Medical Calls Average of 7.25/day 2,145 Medical Transports (81% of calls) Average of 6/day Total # Calls Increasing by 100 in recent years

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Current Emergency Medical Response

Fire Department Responds to All Calls 54 of 56 of Firefighters are EMTs Trinity EMS Staffs an Ambulance 24/7 in Chelmsford Center at No Cost to the Town. Trinity Transports Patients to the Hospital & Bills Patients for Ambulance Transportation Services. Secondary Response Ambulances Are Available from TrinityMain Headquarters at Drum Hill. s Greater Lowell Emergency Medical Service Provides Paramedic Service
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Fire-Based Ambulance
Fire Department Staffs an Ambulance at the Center Fire Station. Secondary Response Ambulances are Provided at No Cost to the Town by a Private Ambulance Provider. Hire Five Additional Firefighter/EMTs. New Fire Captain Oversees Operations.
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Fire Dept. Staffing Levels

Current Staffing Level: 13 Assigned per Shift with Minimum of 11 or 9. Closing of Either East, South, or West Fire Station. Proposed Staffing Level: 14 Assigned per Shift, with Minimum of 12. All Five Fire Stations Open.
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Simultaneous Ambulance Transports

Calendar 2006: Average of 23/Month Are Two Transports Within 90 Minutes Average of 3/Month Are Three Transports Within 90 Minutes. Fire Department Responds to All Medical Calls A Private Ambulance Contractor Responds When the TownAmbulance is Not Available. s
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Mutual Aid
Establish Mutual Aid Agreements with Westford, Tewksbury, Billerica, & Carlisle. Establish Mutual Aid Agreements with Additional Private Ambulance Providers. Chelmsford Would Respond to Mutual Aid Requests From Other Communities.
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Additional Staffing
Can This Be Done with Only Five Additional Firefighter/EMTs? Yes, because the additional staffing levels provide the necessary personnel increase the minimum # of Firefighter/EMTs per shift to 12 in order to staff the ambulance. Comparable towns such as Tewksbury & North Andover operate two ambulances with 12 Firefighter/EMT Minimum Staffing Levels.
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Other Mass. Cities & Towns

69%, which is 242 out of 351, Massachusetts Cities & Towns Provide a Town-Based Ambulance Service. Adjoining Communities of Tewksbury, Billerica (Separate Dept.), Westford, & Carlisle Provide Fire-Based Ambulance.
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Is this An Irreversible Decision?

No. No one knows for certain what would be the Chelmsford Fire Departmentactual s experience in operating an ambulance. If after, a three-year period, the operation were not financially viable, the Town could return to its current state and absorb the additional Firefighter/EMTs by attrition due to anticipated retirements.
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Question
Why DoesnThe Town Award an Ambulance t Contract to the Highest Bidder? Town Counsel has advised that the anti-kickback provisions of the US Social Security Act prohibit the solicitation or receipt of, or the offering or payment of, compensation (or remuneration as the statute calls it) in exchange for referrals for services for which payment may be made, in whole or in part, under a Federal health care program such as Medicare or Medicaid.
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Question
Why doesnthe Town consolidate the t number of fire stations? A recent analysis performed by the MMA Consulting Group concludes that the Town needs to maintain its five fire stations to provide an effective response time for fire and medical emergencies.
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Question
What about the cost for pension and retired health insurance for the five new Firefighter/EMTs? The contribution levels of newly hired employees into the pension system covers almost all of their future pension costs. As for retired health insurance costs, these costs would not be incurred for about 30 years. Ituncertain what this s nationhealth care system will be at that time. s
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Question
What About the Additional Liability? The Town already responds to all medical emergency calls and has liability insurance coverage. There is no additional premium if the Town were to provide ambulance transportation service.
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Question
Would there be additional Workers Compensation insurance costs? Police and Firefighters are not covered under Workers Compensation insurance, but are covered by MGL Chapter 41, Section 111F which provides for no loss of pay if injured on duty. The Town has an insurance policy for injured on duty medical costs. The Town already responds to medical emergency calls.
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Question
How will ambulance billing take place? The Town would contract with a vendor that is experienced in municipal ambulance billing services. The fee is estimated to be 4% of funds collected and is included in this analysis.
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Question
Could a Fire-Based Ambulance Service be Operational By January 1? Yes, the Town could purchase a new ambulance off the State bid list and receive the vehicle within a few weeks. Existing Firefighters are already trained as EMTs.
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Question
Will a private ambulance contractor provide coverage for Town events such as Chelmsford High School football games and the 4th of July parade at no cost to the Town? Yes, as is required under the current agreement.
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Closing Thought
Finally, we believe that the most important element of emergency rescue is a well-trained and professional First Response team. The Town should never lose sight of the fact that it is the immediate response of our EMT-trained firefighters, police officers and ambulance personnel in those first few minutes of an emergency medical situation which can literally determine life or death. During the highly publicized and politicized course of our study, this has remained the central focus of our committee. Ambulance Study Committee Final Report June 26, 1995

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