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OFD Fire-Based EMS Transport Orlando Fire Department
OFD Fire-BasedEMS Transport
Orlando Fire Department
OFD Transport Timeline
OFD TRANSITION TO FULL ALS &
AUTO ACCIDENTS
90 DAY BILLING COLLECTION LAG
TIME
BEGIN 1 YEAR OFD
TRANS-PORT EVAL-
UATION
12 MONTH EVALUATION PERIOD
EVAL-UATION
OF DATA AND RFP
PREPAR-
ATION
RFP FOR BLS
TRANS-PORT
PROVIDER BEGINS
RFP PROCESS
90 CONTRACT EXTENSION*
(Available for any possible RFP challenges)
Feb2011
Mar2011
Apr2011
May2011
Jun2011
Jul2011
Aug 2011
Sep 2011
Oct2011
Nov2011
Dec2011
Jan2012
Feb2012
Mar2012
Apr2012
May2012
Jun2012
Jul2012
Aug2012
Sep2012
Oct2012
Nov2012
Dec2012
Jan2013
Feb2013
Mar2013
Apr2013
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 ?
Orlando Fire Department
Orlando Fire Department
OFD Fire Based EMS Transport Evaluation
May 1, 2011 to
April 30, 2012
Orlando Fire Department
How we got here.• OFD History
• Ambulance RFP
• Safer Grant
• Fire Based EMS Transport Proposal
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
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
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
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
Orlando Fire Department
What did we do?
Orlando Fire Department
What did we do?• Start up preparations• Capital Purchases• Medicare/Medicaid• Billing Company• EMS Reporting System• Ambulance Support Contract
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
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
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
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
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
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
Orlando Fire Department
Operational Statistics
Orlando Fire Department
Operational Statistics• Transports • Daily average transports• Ratio OFD /RMA Transports• Compliance summary• Service Level Mix• Transport Related injuries and complaints
Orlando Fire Department
.
May
JuneJulyA
ugSeptO
ctN
ovD
ecJan FebM
archA
prilA
verage
0
200
400
600
800
1000
1200
1400
1600
1800
Monthly Transports OFDMonthly Transports RMA
OFD 19174 / 1597 Month
RMA 7728 / 644 Month
Daily Average OFD 52
Daily Average RMA 21
OFD 70.96% of Transports
RMA 28.56% of Transports
Orlando Fire Department
.
R1- 2553R2- 2699R3- 1137R6- 1527R7- 2393R8- 1052R9- 1837R10- 1809R11- 1949R12- 1378R15- 283R101- 96R102- 11R171- 21R801- 31
0
500
1000
1500
2000
2500
3000Transports by Units (May 2011 to April 2012)
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%
OFD Service Level Mix
May-11Jun-11
Jul-11Aug-11Sep-11Oct-11Nov-11Dec-11Jan-12Feb-12Mar-12Apr-12
0%10%20%30%40%50%60%70%80%90%
100%
12%12%15%14%14%14%13%12%11%11%10%11%
87%87%84%84%84%84%85%86%87%87%88%88%
1% 1% 2% 2% 2% 2% 2% 2% 2% 2% 2% 1%
BLSALS1ALS2
Orlando Fire Department
Orlando Fire Department
.
May Jun Jul Aug Sep Oct Nov Dec Jan Feb Mar Apr0
200
400
600
800
1000
1200
1400
1600
1800
2000
TransportsInjuries (3)Complaints (3)
19174OFD Transports
Orlando Fire Department
Financial Statistics
Orlando Fire Department
Financial Statistics
• Billing Summary
• Medicaid/Medicare Adjustments
• Payer Mix Comparisons
• Revenue Collected
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
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
Agency Pay Class Comparison
Orlando Fire Department
Orland
o
Orange
Co
Semino
le Co
Maitlan
d
Longw
ood
Wint
er Park
0%10%20%30%40%50%60%70%80%90%
100%
24% 16% 9% 7% 7% 8%
27%33% 43% 41% 51% 48%
19% 18% 24% 29% 18% 24%
30% 33% 24% 23% 24% 20% Self Pay
Insurance
Medicare (-$581)
Medicaid (-$710)
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
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
Orlando Fire Department
Where do we go from here?
Orlando Fire DepartmentWhere 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
Orlando Fire Department
Saving Lives and Protecting Property
