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HomeMy WebLinkAboutAgenda - 04-02-2002 - 9a S r r 1 ORANGE COUNTY BOARD OF COMMISSIONERS ACTION AGENDA ITEM ABSTRACT .Meeting Date: April 2, 2002 Action Agenda Item No. 9—Q SUBJECT: Non-Emergency Ambulance Transport DEPARTMENT: Emergency Management PUBLIC HEARING: (Y/N) No ATTACHMENT(S): INFORMATION CONTACT: 3/14/02 EM Director Report Nick Waters, ext 3030 Application for Franchise TELEPHONE NUMBERS: Hillsborough 732-8181 Chapel Hill 968-4501 Durham 688-7331 Mebane 336-227-2031 PURPOSE: To consider awarding a franchise to AAA Transport of Durham to provide non- emergency ambulance transportation services in Orange County; and to receive a report on various modifications needed to the existing franchise ordinance. BACKGROUND: In 1994, the Orange County Board of Commissioners made a decision to discontinue providing non-emergency ambulance transportation service as a County function. The decision was made for a variety of reasons, including the need to allocate the County's limited paramedic and emergency medical technician resources to the highest priority need — emergency transportation. Non-emergency transportation was to be provided by private for- profit or non-profit entities franchised to provide "convalescent" or non-emergency transport inside Orange County. Under the terms of the County's April 1993 "Ordinance Regulating Emergency Medical, First Responder, and Rescue Service and Granting of Franchises and Contracts to the Operators in the County of Orange", persons who wish to engage in the service or business of transporting patients between two points within Orange County must apply to the County for a franchise. The Emergency Management Services Department has received and reviewed an application for a franchise to provide non-emergency basic life support transportation from AAA Transport of Durham. Staff has met with the officers of AAA Transport and has investigated the information provided in the franchise application. Currently, Johnston Ambulance is the only private service franchised to provide non-emergency ambulance transportation within Orange County. As allowed by the ambulance franchise ordinance, AAA Transport of Durham has been providing ambulance transportation into and out of Orange County for more than a year. According to the owner of AAA Transport, several institutions in the County that are frequent users of ambulance transportation services have encouraged him to pursue a franchise to allow the in-county transportation of patients. AAA operates six ambulances that will be available to schedule trips within Orange County. Staff x c 2 r believes that the availability of these six additional ambulances should benefit Orange County citizens who need to avail themselves of this private service by providing shorter wait times for ambulances. Staff in the Department of Emergency Management Services has noted an increase in consumer complaints in the past six months about non-emergency ambulance transportation, primarily in regard to increased wait times for service. The ambulance franchise ordinance stipulates in part that a franchise may be granted if"the proposed service will fit within the existing service so as not to adversely affect the level of service or operations of other franchisees to render service". Staff believes that an increasing demand for non-emergency ambulance service is the primary factor driving the increase in complaints about the current franchisee, and that, based on the increasing demands for service, the franchising of a second non-emergency provider will not negatively impact the current franchisee. Franchising another non-emergency provider would also benefit Orange County citizens by providing them a choice in service providers. The Director of Emergency Management has prepared a general outline of the purpose and structure of non-emergency transport service delivery in Orange County. Additional information explains points to consider as staff looks at the long-term non-emergency transportation needs and how the franchise ordinance needs to be revised. Staff believes that the potential benefits to citizens of having a second service provider to choose from justify awarding of a franchise to AAA at this time, recognizing that other work is continuing to develop revisions to the existing ordinance which would include qualitative service standards that would be expected of future franchisees. FINANCIAL IMPACT: Since non-emergency ambulance transportation is arranged directly between individual citizens and the service provider, there is no direct financial impact for Orange County related to decisions to grant franchises. However, staff expects that there will be a positive impact on the allocation of existing County resources. Some County emergency ambulances that must now be used on occasion for non-emergency transports to fill service gaps created by private provider backlogs will be able to be redirected to their intended primary purpose of providing emergency transports. RECOMMENDATION(S): The Manager recommends that the Board: 1) award a franchise to AAA Transport of Durham to help relieve the needs of facilities by having service provided in a timely manner; 2) provide direction to staff regarding any provisions or considerations that the Board would like to have incorporated in a revised ambulance franchise ordinance, including elevated expectations of service delivery criteria; and 3) solicit comments from the Orange County Advisory Board on Aging regarding needed and proposed changes to the County's ambulance franchise ordinance. i 3 NON-EMERGENCY AMBULANCE TRANSPORT REPORT Prepared by Nick Waters, Director of Emergency Management March 14, 2002 Orange County made the decision in early 1994 to stop providing Non-Emergency Ambulance Transportation and to allow private enterprise to perform the service. This decision was based in part on the misuse of the Emergency System and to delay the hiring of new staff positions needed to address the ever increasing call volume of Non-Emergency Transportation. The County Franchise Ordinance was then enacted, and applications for the service were received. Johnston Ambulance Service was awarded a Franchise to operate within Orange County on May 24th, 1994 and has provided the service consistently since. Non-Emergency Transports consist of routine calls to and from doctors' offices, hospitals, or clinics from nursing and rest homes, as well as private residences. Many calls for the service answers are elective calls, when the patient and/or family prefers an ambulance, even though medically it is not needed. Non-Emergency calls are those where response times have no negative effect on the patient outcome. County staff have been receiving an increased number of complaints over the past year, most of them concerning extended wait times to receive service. Staff worked with Johnston Ambulance on several occasions to correct this problem. Non-Emergency Transportation trips fall into one of two types - Scheduled or Short Notice. The trips that are scheduled in advance and are done by appointments take priority over the Short Notice Trips. The Short Notice Trips are put on the schedule at the nearest available time slot for the closest unit, which may be located as far away as in Wake County at the time of the request for service. Managed health care standards developed in recent years have a big impact on ambulance services by releasing patients early from the hospital when they require transportation. Unlike before, the convalescence was done before discharge from the hospital, so travel by family car was generally suitable. The number of people needing this type of service in Orange County, many referred by EMS, is increasing steadily. This situation has caused Johnston Ambulance to be nearly overwhelmed. Another company, AAA Transport of Durham, has applied for a franchise to do business in Orange County. The owner met with staff to present the application and discuss the company's ability to provide service to the citizens of Orange County. Staff feels the company can provide choice to the citizens, especially those with Short Term Notice needs who now experience long wait times. The Service Certification level of Basic Life Support is the same as for Johnston Ambulance Service. The fees for service between AAA and Johnston are comparable, with Base Rates of $225 for both companies. Johnston has a mileage charge of$5.00, while AAA is $5.00 per mile in-city and $7.50 per mile outside. Wait time for Johnston is charged at $45 per hour, with AAA at $60 per hour. Both have charges for oxygen and supplies. Johnston charges $25 for oxygen and supplies can be up to $50. AAA has $35 for oxygen and supplies at $35. AAA offers a flat rate for contracts of$185, for facilities for non-covered services under Medicaid. The Franchise Ordinance governing Non-Emergency Ambulance Transport needs to be updated to more accurately reflect changes in State regulations in recent years and to expand 4 ` t the type of services allowed. The present ordinance has language that is no longer accepted by Medicaid, such as "Convalescent Services", now replaced by "Non-Emergency Service". The ordinance does not address special events, or in disasters allow operations outside the scope of the franchise, or define what a reasonable wait time is for Non-Emergency Transport. The ordinance should also address the charging for services by agencies, such as Rescue Services on wrecks. Emergency Management staff are working on the revisions to the ordinance to bring it up to date so it allows the services needed to be performed in the County. We hope to have the revised ordinance ready for the Commissioners' review by May 2002. ADDITIONAL REPORT INFORMATION: Non-Emergency Transport can be categorized by the origination of the trip. Different trips have demands and complications. The bullets below outline some considerations for the franchise. 1- Trips originating from the Hospital transferring discharged patients out. Not prescheduled, number of trips depend on number of discharges, pressure by hospital to clear beds, very demanding on transport services 2- Trips to hospital from care facilities. Usually follows Doctors consults or nursing shift changes. Several may happen at once, not always willing to schedule, calls 9-1-1 3- Trips from private residences to care facilities or doctors offices, Usually scheduled after the first trip, May result from a Medic's recommendation after assessment, Medics will help with arrangements 4- Trips from residents that are Home Health Agencies, Usually follow visits, are called to 9-1-1, nurses in a rush so Non-Emergency Services are often not called. Rarely an Emergency. 5- Non-Emergency, Non-Medical transport, still must use ambulances, costly , little flexible, transport services not equipped or staffed for this type service Consideration for services to be provided should look at the items listed above and additional needs that can be identified. The revisions to the Franchise Ordinance should have input form DSS, Health, and Department of Aging, in-fact, should also consider which department may be able to offer some of the services Example, The Non-Emergency, Non-Medical could be a service of Department of Aging. Orange County Emergency Management P. O. Box 8181, Hillsborough, NC 27278 5 Office (919) 968-2050 Fax (919) 968-4066 APPLICATION FOR FRANCHISE AMBULANCE * EMS * MEDICAL RESPONDER * RESCUE Date of Application• Name of Applicant: AAA 041- 1A15- Primary Local Business Address: / qc> ,3 6. 01, P3 cyy f cyP� Local Address City/ State/Zip: tO W Q 9,4!1A 270q Telephone number at local base of operations: Name of Owner/ Contact Person: -TE Fr L. - Q A P_T5:/z S Main Office/ Owner/ Contact Person Address: 1q0 $' 6 Milo Okl*)Rjd Nw� Main Office City/ State /Zip: /�ltQ NA ,w� 11/C., r�- 77p,41 Telephone number at main office: 9982 Operating Business /Trade Name: A A A 7e�AS�po� T fjll� Please Mark Category of Franchise Applying For: (A separate application must be completed for each general category of service) Ambulance Emergency Medical Medical Responder Rescue [ Ls non-emergency [ ] BLS transport [ ] First Responder , ( ] Extrication [ ] ALS non-emergency [ ] ALS non-transport [ ] EMT Responder [ J High / Low Angle [ ] ALS transport [ ] Confined Space [ ] Trench, Collapse [ ] Swiftwater [ ] Underwater Application Attachments Required (See Orange County Franchise Ordinance for Additional Details) 1. Certified copy of Articles of Incorporation and / or Charter 2. Applicant's resume of training and experience category of service applying for franchise 3. Financial statement pertaining to [proposed] operations in Orange County 4. Copy of organization by-laws (if applicable) 5. Copy of organization standard operating procedures 6. Current roster of all members and employees, including name, address, and NCDL number. 7. Proposed fee schedule for service in Orange County m . 6 STArM 0J"U � .. NORTH Department of The Secretazy of State , CAROLINA To all whom these presents shall come, Greetings: I, ELAINE F. MARSHALL, Secretary of State of the State of North Carolina, do hereby certify the following and hereto attached to be a true copy of ARTICLES OF INCORPORATION OF AAA TRANSPORT INC: the original of which was filed in this office on the 30th day of May, 2000. IN WITNESS WHEREOF, I have hereunto set my hand and affixed my official seal at the City of Raleigh, this 30th day of May, 2000. �- J. 4k60� Secretary of Sate *. AAA * TRANSPOFRffT M..«.«I ICI CAM Jeff Bartels, Owner/Director 1408-R Old oxford fthway Durham, NC 27704 1-877-77069889 Toll Free (919) 620 0778 Fax (913)620-9889 T0-MR. KENT MCKENZIE,-O.C.E.M.S. RE: AAA TRANSPORT INC FEES tIASE RATE.... ................................ ......_........._........... 225.00 OXYGEN............ . ............ ......------....... . .........................35,00 SUPPLII':S ............................ .. ................... ...35.00 CfCY MaMAGC? ............................. ......................... . 5.00 RIJRAL MILEAGE.. . ........................... ........................... 7.50 WAIT T ML PI3It HOUR..... . ...._..._.................. ...................60.00 CONTRACT RATE IN COUNTY 185.00 JEFF L. BARTFT-S