OFD Fire-Based

EMS 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 EvaluationMay 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

ecJanFebM

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-11

Jun-11

Jul-11

Aug-11

Sep-11

Oct-11

Nov-11

Dec-11

Jan-12

Feb-12

Mar-12

Apr-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

Orang

e Co

Semin

ole C

o

Mait

land

Longw

ood

Win

ter P

ark

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 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

Orlando Fire Department

Saving Lives and Protecting Property