Mountain-Valley Emergency Medical Services Agency Board of Directors Meeting Minutes June 10, 2009

Transcription

1 Mountain-Valley Emergency Medical Services Agency Board of Directors Meeting Minutes Location: Time: Board Members Present: Board Members Absent: Guests: Staff: Amador County Board of Supervisors Chambers Jackson, California 10:00 a.m. Louis Boitano Amador County; Gary Tofanelli Calaveras County; Jim Allen Mariposa County; Terry Woodrow Alpine County Jim DeMartini Stanislaus County Allan McNany - American Legion Ambulance Steve Andriese Executive Director; Jim Worobe Deputy Director; Marilyn Smith Response and Transport Coordinator; Tina Casias - Executive Secretary A. Call to Order The meeting was called to order at 10:02 a.m. by Chairperson Louis Boitano. B. Welcome and Introductions The Chair welcomed those present. Individual introductions were made. C. Correspondence Steve Andriese referred to correspondence received from the West Side Community Healthcare District Board of Directors. The letter was read to Board members after which Mr. Andriese explained that the letter was protesting the increases in the ground ambulance fee schedule adopted by the Board at the meeting in February After a short discussion, Board members requested Mr. Andriese send a letter responding to their concerns. D. Additions/Deletions, Corrections to Agenda Steve Andriese requested that Action Item # J-Approval of Kaiser Base Hospital Agreement be pulled from the consent calendar. He stated that Kaiser had submitted the contract the previous day with changes that will require some time to check over. Since their current agreement will not expire until August 2009, MVEMSA has time before the next Board meeting to discuss these changes with them. This item will be re-agendized at a later date. M/S/C (Woodrow/Tofanelli) To approve agenda as corrected E. Public Forum There were no comments from the public.

2 Page 2 F. Approval of Consent Calendar M/S/C (Woodrow /Allan) To approve consent calendar as presented G. Status of State EMS Funding Mr. Andriese related to Board members the areas of concern that occurred during the past month. The pot of General Fund monies slated for the State EMS Authority contained two special areas of funding. The first was money slated to fund Poison Control Centers throughout the State in which $2.4 million had been spent. About three weeks earlier, this funding was said to have been completely cut from the budget; however, this had not been verified thus far. The reason for the concern was that Mountain-Valley s State funding originated from the same pot of money. The second area of concern involved an Executive Order signed by the Governor on June 8, The order read It is ordered that except for projects funded by the American Recovery Investment Act; or projects funded by bonds, grants, or projects specifically mandated by court orders; or public/private partnerships that require no direct State expenditures; or any funds encumbered on or after March 1, 2009 for contracts entered in to for which goods or services have not been provided; or for contracts proposed to be entered in to during the 2008/2009 fiscal year by State agencies, regardless of funding source, are hereby disencumbered, and the funds will revert to their original funding source if no legal liability will be incurred by the State. Approval to continue encumbering the funds must be obtained from the State Secretary and the Director of the Department of Finance. Mr. Andriese emphasized to Board members that the Executive Order sounds as though it may affect the current year contract the State has with Mountain-Valley. However, there was an exemption further on in the Executive Order that read: It is further ordered that the services and functions of State government directly related to the preservation and protection of human life and safety, including but not limited to, emergency and disaster response activities, and the provision of 24-hr. medical care, shall be deemed critical, and exempt from this order. Mr. Andriese advised members that Mountain-Valley has not yet been declared exempt. The concern was the wording within the Executive Order as follows, the services and functions of State government which may not include local government EMS agencies. Clarification has been requested from the State EMS Authority. However, the EMS Authority is moving ahead with processing Mountain-Valley s invoices for the current fiscal year, and is also moving ahead with Mountain Valley s contract for the next fiscal year because the assumption is that the exemption is applicable.

3 Page 3 H. Preliminary Budget for FY09/10 Mr. Andriese began by stating that with the fee schedule changes that were adopted by the Board in December 2008, Mountain-Valley would not be looking at the size of the deficit that existed in past years. The deficit, in past years, topped the $200,000 range, and almost brought Mountain-Valley to the point of extinction as an Agency. Some of the changes from the current year s budget are: 1) The Agency has received tentative approval for a special project grant award of $12,833 to link the Agency s trauma data system with the State CEMSIS data base. 2) A full-time Quality Improvement/Facilities Coordinator position has been filled and added to the proposed budget per direction of the Board at the February 2009 meeting. 3) Funds have been added to the Non-local Travel and Staff Training line items on a one-time basis to cover the cost of sending the new QI Coordinator to Six Sigma Quality Management training. 4) An amount of $21,600 has been added to the Consultant Contract to provide the Agency with contract assistance in evaluation, selecting, and identifying funding sources to replace the Agency s non-federal/state compliant data collection system. 5) A one-time increase to Office Equipment Purchase for the replacement purchase of the Agency s obsolete copy machine. 6) Staff pay adjustments have been included based upon the terms of the 5 year salary contract established by the Board in FY05/06. 7) Adjustments have been made to both revenue and expense line items based upon preliminary analysis of historical expenditures, contract changes, and estimated project needs for FY09/10. 8) Local fund revenue adjustments have been made to the County contributions, and fee schedules to reflect the fee changes approved by the Board at the December 2008 meeting. Mr. Andriese went on to say that due to the loss of major special project grants, the reduction in the General Fund Allotment, and in spite of local fee increases, the preliminary budget still contains an anticipated $29,152 deficit. A majority of the expenses responsible for this years deficit are one time costs to replace aging equipment that the agency has not been able to replace in past years, and for training of the newly hired QI Coordinator. Baring any additional major cuts in the State General Fund Grant, there appears to be adequate reserve funds to cover the reduced deficit for this fiscal year. Board member Jim Allen referred to the Office Equipment purchase, and asked if the new copy machine purchase price was $15,000? Mr. Andriese explained that Agency staff has received estimates that were between $12,000 and $15,000. He stressed that some of the Agency s copying projects require large scale copying. The current copier was purchased 12 years ago at a cost of approximately $12,000. It was now requiring repairs on a regular basis.

4 Page 4 Chairman Louis Boitano asked if the leasing option had been considered. Mr. Andriese reported that this option had been considered, but found it to be more expensive over the long term. Board member Jim Allen commented that most of the service and supply line items show substantial increases, and in these current economic times the appropriate action should be to cut costs. He asked for comments from other members. Chairman Louis Boitano stated that he has served on the Board of Directors for the Mountain-Valley EMS Agency for several years, and during that time the Agency has squeaked by on purchases in order to keep budget costs down. Over the last 10 or 12 years, a lot of expenses were not paid for with reserve funds because of State Special Project grants that helped pay for some expenses. These now seem to have dried up. Now if the reserve funds are dipped into, there is nothing to replace them. Over the years, Board members and Agency staff have worked diligently to keep budget costs down, but sooner or later, he stressed, it does catch up. M/S/C (Woodrow /Tofanelli) To approve prelimary budget I. Renewal of Trauma Center Contracts Steve Andriese began by giving some background information. He stated that back in 2004, the Board of Directors approved the Trauma designation of Doctors Medical Center, and Memorial Medical Center as the first Trauma Centers within this EMS region. The contract with each facility expired this year, and is due for renewal for another 5 years. There is a requirement change in the agreement beginning this year. This requirement is that each Trauma Center must maintain Trauma Center designation by the American College of Surgeons. So far, Doctor s Medical Center has received approval. Memorial Medical Center has had some issues. However, there is a site visit scheduled by the American College of Surgeons on July 11, 2009 at which time Memorial Medical Center will be reassessed. It is expected that they will receive approval. The Board was asked to approve both Trauma Center contracts for another five years. Mr. Andriese was asked by Supervisor Boitano how Memorial Medical Centers pending approval would effect their Trauma Contract should they not receive ACS approval. Mr. Andriese replied stating that there is language contained in the contract that would deal with a negative outcome. M/S/C (Allen/Woodrow) To approve the renewal of the Trauma Center contracts

5 Page 5 K. Approval of ALS First Responder Agreement for Oakdale City Fire MVEMS Agency staff member Marilyn Smith informed Board members that the aforementioned agreement was different from other ALS first responder agreements typically processed by the Agency. This agreement would allow the Oakdale City Fire Department to provide ALS first responder services under certain conditions. California State regulations require that ALS first responder services must be provided on a 24 hour, 7 day week basis. Oakdale City Fire does not have the capability to do that, but they do have paramedic resources that they would like to utilize. This agreement allows for the continuation of what has been done previously; which was to allow them to serve as an ALS first responder only when requested by the Oakdale City SWAT Team; the Oakdale City Fire Water Rescue Team; the Oakdale City Fire Technical and Confined Space Rescue Team; and the Stanislaus County Hazardous Materials Response Team. Ms. Smith continued stating that the new caveat in the agreement was the addition of language that requires all Paramedic personnel employed by Oakdale City Fire and assigned to respond to incidents shall complete a minimum of 25 ALS calls per calendar year. Oakdale City Fire has a prearranged agreement with Oak Valley District Ambulance to have their paramedic personnel ride along in order to attain the 25 required ALS calls. These calls will be monitored throughout the QI system just as regular paramedic calls are. The EMS Authority was consulted in determining the language to be used in the agreement that would make the 25 call requirement feasible. Mr. Andriese provided further explanation by pointing out this agreement s difference from other ALS First Responder agreements throughout the Region. These particular paramedics would not be serving the public, but would be serving the Police Department, the Fire Hazmat Team, etc. M/S/C (Woodrow /Allan) To approve the ALS First Responder Agreement for Oakdale City Fire L. Report on the Status of the EMS Data System EPSIS Mr. Andriese began by referring to the Agency s data collection system as a casualty of the eight year budget crises. He proceeded to give some background information to Board members in order that they understand that this data collection system must be a priority. The priority will be to find funding sources in order to rectify the situation. Mr. Andriese reported that until about eight years ago, the Agency used a data system called DataPro. This program was developed in house, and, at the time, met the Agency s needs. The program collected patient care data from providers on every patient seen within the regional EMS system. Staff members were able to query the program for needed data. However, the program was old, and the Agency was dependant on a single vendor for any desired upgrades. This was problematic.

6 Page 6 Another complicating factor was that there were no State standards for EMS data collection in existence at the time. Every local EMS Agency in the State of California and across the nation developed its own requirements for data collection. Each local EMS agency s data collection requirements differed from other local EMS agencies, making it difficult to do any type of comparative analysis. EMS Agency administrators and medical directors knew this problem could not be fixed at the local level. It required the state or national level to develop standards that needed to be complied with at the local agency level. A national data set called NEMSIS (National EMS Information System) was developed at the National level. This system contained an accumulation of all the data elements collected from numerous EMS agencies across the nation. Federal funding had been received that would fund the establishment of a national data bank to collect this data, and measure the performance of EMS services. Another component at the National level, was that a system had been designed that would certify data collection system vendors, only if they met the requirements of the gold standard (highest) or silver standard. If one of these standards were met, any vendor selling EMS software equipment was guaranteed to have the ability to collect all the required data elements. Unfortunately, DataPro, the program the Agency had adopted, was no longer compatible with some of the data collection systems being used. So, eventually, DataPro was abandoned in favor of the EPCIS program. This EMS data collection system was developed in Marin County. The software was free, and it was offered to providers who did not have their own software programs to use. The Agency used it as their own data collection system. The ambulance service providers, who were using their own software, were asked to import their data to the EPCIS system. Unfortunately, it has never worked well, and there has never been an incentive to contribute additional funds toward program upgrades. The program had always been considered a temporary one. Over the last five years, the Agency has stumbled by using the EPCIS program. Agency staff constantly struggle to capture the necessary data reports needed in order to properly evaluate how the system is progressing, and additionally to evaluate the quality of medical care being provided. The struggle has been ongoing, and it is effecting the Agency s ability to function properly. A point had finally been reached where the State developed its own data collection system that would collect data from all the local EMS agencies, and transfer that data to NEMSIS. A timeline of about 2 years has been established by the State that requires that local EMS agencies comply by establishing their use of a gold or silver compliant system that is compatible with local systems and local providers. This system must also be able to be linked to the State s data collection system, CEMSIS. As reported earlier, the Special Project Funding for the trauma data is for a separate Trauma Data Collection System that is compatible with the trauma data elements, and the

7 Page 7 Agency will be linking to that system and sending data. At the moment, the Agency does not have the capability to meet the new NEMSIS data element requirements, due to the inability to collect all the required data elements necessary. Therefore, a change in the data collection system the Agency uses is necessary. The Agency has been working closely with the ambulance service providers in order to keep them abreast of any changes or decisions at the federal level. Some service providers have their own data collection systems, and the Agency does not want to dictate to them the use of a particular system. However, there is a concern that the systems already in use may not be compatible with the data system that will be chosen by the Agency. Staff member, Jim Worobe, has requested responses to an RFI (Request for Information) from vendors for cost estimates of data collection systems. Mr. Andriese has estimated an initial cost of approximately $150,000 for the purchase of the software and installation costs to get the system up and running. On top of the initial up-front cost, he estimated a yearly cost of approximately $50,000 - $60,000 for software upgrades, which would include software for all the providers that choose to use the system. In addition, there are some costs that will be incurred in the future. The Agency is searching for any available grant funding that could be used to help defray costs. The current economic crisis is not the appropriate time to incur such a large expense. However, should the opportunity arise in which a funding source can be identified, the Agency must be able to move quickly to take advantage of the opportunity. Mr. Andriese was not asking for any action at this time. He only wanted to inform Board members of the latest information available at this time. M. Nomination and Election of the Chair and Vice-Chair for FY09/10 M/S/C (Woodrow/Allen) To nominate and elect Louis Boitano as chair Vote - Unanimous M/S/C (Allen/Tofanelli) To nominate and elect Terry Woodrow as vice-chair Vote - Unanimous N. Next Scheduled Meeting Due to Board member conflicts, the next meeting, originally scheduled for August 12, 2009, was changed to August 19, The meeting place will be in Bear Valley, Ca. The October 14, 2009 meeting was also changed to October 21, The meeting will take place at Copper Fire in Calaveras County. 0. Adjournment The meeting was adjourned by Chairperson Louis Boitano at 11:15 a.m.