Riverside County has begun working on a new ambulance services contract. The county’s current contract with American Medical Response expires in June 2015. The board of supervisors has given its Emergency Medical Services Agency strong direction to develop a new contract, put it out to bid and make a selection in time for a smooth transition in 2015 if AMR does not secure the successor contract.
EMS has contracted the Abaris Group, of Martinez, Calif., to develop a draft request for proposals. The $470,000 contract has a July 2015 completion date.
The first steps began last week. Abaris held four public meetings with county emergency medical service stakeholders. About 100 people attended the four sessions, according to Mike Williams, Abaris president.
The fourth meeting was at the Banning City Council Chamber and was the smallest in attendance, although the Hill stood out in numbers attending. Idyllwild Fire District Commissioner Jerry Buchanan and Fire Chief Patrick Reitz were there as well as three Pine Cove residents. County Service Area 38 Advisory Committee President Jerry Holldber, Vice Chair Marge Muir and resident Nancy Borchers attended and met privately with Williams after the open meeting.
The first part of the contract will be a top-to-bottom evaluation of the current emergency medical service system in the county. “The country’s poised for healthcare reform, so the evaluation is very timely,” Williams said during his introduction. Then added, “Obviously some painful things have to be done.”
Williams also stressed that his work was not simply to issue an RFP (request for proposal) for ambulance transportation. “The county executive told me to design a world-class emergency medical services system,” he said.
The trend in healthcare provisions and programs is for payment for value or results, according to Williams. Payments for services, such as ambulance transports, would be diminished. For example, according to data that Williams had, nearly 75 percent of responses to emergency medical calls in Riverside County resulted in transporting the patient to a hospital. That’s more than 110,000 ambulance transports in 2012. The national average is 70 to 75 percent. Of those people transported to a hospital, 46 percent, less than half, were actually admitted.
On the Hill, IFPD transports on average about half its calls. The percentage of transports has grown from 35 percent in 2006 to nearly 53 percent last year. While the number of medical calls from Pine Cove has ranged from 10 to 13 percent, IFPD transports nearly 65 percent of Pine Cove calls.
Regardless of the idea put forward by County CSA manager Bill Brown that the new ambulance contract could sweep Pine Cove into the county’s ambulance service contract if the payment for transports declines, IFPD has a significant portion of its annual revenue in jeopardy.
“There is a lot of speculation at this point in time as to what ‘Obamacare’ means for EMS,” said Idyllwild Fire Chief Patrick Reitz. “There are new opinions and interpretations coming out all of the time, often contradicting something that had previously been released. About the only thing that we can all agree on is that healthcare, including EMS, is going to look very different than what it has historically.”
During the discussion of which components of the current EMS system are working well or broken, local attendees were active participants. One of the system’s problems, mentioned by Buchanan, is referred to as “wall” time. This is the time that ambulance units must wait at a hospital until emergency room staff decides what to do with the patient. While waiting at a hospital, a unit is not available for another emergency call. This delay is exacerbated and more acute on the Hill because there are fewer available units.
During the discussion of a vision for a future system, Holldber said the Hill needs additional ambulance capacity, particularly during holidays and weekends.
“We’re the playground for the county. Our population can go up 10 times,” he said, “What we have now on the mountain top are not enough ambulances.”
During his introduction, Williams said the evaluation was timely given the impending changes to healthcare provisions. And Buchanan clearly agrees, “I see this as a new opportunity. Everything is changing rapidly in Health Care and EMS. The change will give us and everyone in health care delivery systems the chance to evaluate how we do business. Williams and his associate both talked about the shift to value and I believe that as we study the possible methods to improve the value and begin to implement them we will become more, not less, sustainable.”