Orlando Fire Department: Impact of Fire-Based EMS Transport

1. Orlando Fire Department OFD Fire-Based EMS Transport

2. Orlando Fire • Department

3. Orlando Fire • Department 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 ?

4. Orlando Fire Department OFD Fire Based EMS Transport EvaluationMay 1, 2011 to April 30, 2012

5. Orlando Fire Department How we got here. • OFD History • Ambulance RFP • Safer Grant • Fire Based EMS Transport Proposal

6. Orlando Fire Department 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

7. Orlando Fire Department Ambulance RFP • Orange County Fire took over Transport (2008) • Orlando contracted with Rural Metro for services (2008) • First full RFP for Ambulance Service

8. Orlando Fire Department 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

9. Orlando Fire Department 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

10. Orlando Fire Department What did we do?

11. Orlando Fire Department What did we do? • Start up preparations • Capital Purchases • Medicare/Medicaid • Billing Company • EMS Reporting System • Ambulance Support Contract

12. Orlando Fire Department 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

13. Orlando Fire Department Capital Purchases • New Rescue Trucks • On Board Computers for Dispatch and Mapping • Power Pro Stretchers • Lifepak 15’s • All needed equipment and supplies

14. Orlando Fire Department 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

15. Orlando Fire Department 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

16. Orlando Fire Department 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

17. Orlando Fire Department 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

18. Orlando Fire Department Operational Statistics

19. Orlando Fire Department Operational Statistics • Transports • Daily average transports • Ratio OFD /RMA Transports • Compliance summary • Service Level Mix • Transport Related injuries and complaints

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21. Orlando Fire Department .

22. Orlando Fire Department 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%

23. OFD Service Level Mix Orlando Fire Department

24. Orlando Fire Department .

25. Orlando Fire Department Financial Statistics

26. Orlando Fire Department Financial Statistics • Billing Summary • Medicaid/Medicare Adjustments • Payer Mix Comparisons • Revenue Collected

27. Orlando Fire Department 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

28. Orlando Fire Department 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

29. Orlando Fire Department Agency Pay Class Comparison

30. Orlando Fire Department 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

31. Orlando Fire Department 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

32. Orlando Fire Department Where do we go from here?

33. Orlando Fire Department 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

34. Orlando Fire Department Saving Lives and Protecting Property