{"id":58,"date":"2009-10-08T08:21:04","date_gmt":"2009-10-08T08:21:04","guid":{"rendered":"https:\/\/sudbury.ma.us\/fire\/2009\/10\/08\/advanced-life-support-als-and-billing-rates\/"},"modified":"2018-03-16T11:24:10","modified_gmt":"2018-03-16T15:24:10","slug":"advanced-life-support-als-and-billing-rates","status":"public-archive","type":"post","link":"https:\/\/sudbury.ma.us\/fire\/2009\/10\/08\/advanced-life-support-als-and-billing-rates\/","title":{"rendered":"Advanced Life Support (ALS) and Billing Rates"},"content":{"rendered":"

The continued availability of ALS to Sudbury and surrounding communities is a serious concern now that Emerson Hospital, our primary ALS provider, has announced that it will no longer provide ALS service past the end of September, 2010. <\/p>\n

 <\/p>\n

The 13 communities that are presently serviced by Emerson have been working to establish a replacement, regional ALS service, and in doing so have discovered the great expense associated with a dedicated service, which expense has historically been masked by Emerson’s long standing practice of accepting ALS operating losses for a variety of reasons. <\/p>\n

 <\/p>\n

That expense must now be satisfied, and increasing ambulance billing rates in anticipation of Sudbury’s participation in a regional effort and long term move towards providing ALS within the Fire Department is essential.<\/p>\n

 <\/p>\n

To view the presentation given by Fire Chief Ken MacLean to the Board of Selectmen at their September 23rd meeting see below.<\/u><\/p>\n

 <\/p>\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n\n
1<\/td>\n“Managing the Future”<\/p>\n
    \n
  • Managing the Future<\/li>\n
  • September 23, 2009<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
2<\/td>\nBasic Life Support (BLS)<\/p>\n
    \n
  • Sudbury established ambulance service 1976<\/li>\n
  • Emergency Medical Technicians \u2014 Basic   (EMT-Bs)<\/li>\n
  • Statewide Protocols\n
      \n
    • Bandaging, stabilizing, transporting<\/li>\n
    • Cardiac defibrillation<\/li>\n
    • Epinephrine \u2014 Epi Pen<\/li>\n
    • Glucose, albuterol<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
3<\/td>\nAdvanced Life Support (ALS)<\/p>\n
    \n
  • Emerson started ALS service in 1982<\/li>\n
  • One of 23 hospital-based services<\/li>\n
  • Emergency Medical Technicians \u2014 Paramedic (EMT-Ps)<\/li>\n
  • Statewide Protocols\n
      \n
    • Intubation, 12 lead cardiac monitor, Intravenous (IV) fluid replacement, 44 medications, advanced assessments<\/li>\n<\/ul>\n<\/li>\n
    • Loss Leader<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
4<\/td>\nSudbury Runs<\/p>\n
    \n
  • BLS = 988 (2008) @ $576.07 per run<\/li>\n
  • ALS = 385 (2008) \u2014 adds $108.03\n
      \n
    • Cost of service ranges from $250 – $265<\/li>\n
    • 39% of calls are ALS\n
        \n
      • 56% of ALS calls are billable\n
          \n
        • 46% of billable calls are Medicare (101 calls)<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n
        • Total Sudbury Revenue for FY09 = $354,367.52<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
5<\/td>\nEmerson Hospital<\/p>\n
    \n
  • FY07 loss on operations $8.7 million (Boston Globe 3\/21\/08)<\/li>\n
  • ALS loss at least $100,000 per year<\/li>\n
  • No more loss leader<\/li>\n
  • Continue ALS operations until September 2010<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
6<\/td>\nCentral Middlesex Emergency Medical Services Collaborative (CMEMSC)<\/p>\n
    \n
  • Established September 2008<\/li>\n
  • 13 Emerson service communities (with Emerson as member)<\/li>\n
  • Purpose \u2014 Design replacement regional ALS delivery system<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
7<\/td>\nCentral Middlesex Emergency Rescue Authority (CMERA)<\/p>\n
    \n
  • Bullet Point 1 – Governing body of regional ALS service<\/li>\n
  • Bullet Point 2 – Centralized dispatch for \u201call-in\u201d communities<\/li>\n
  • Bullet Point 3 – Vendor-provided regional ALS service<\/li>\n
  • Bullet Point 4 – Centralized billing<\/li>\n
  • Bullet Point 5 – Development of local fire-based ALS service buttressed by regional backup<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
8<\/td>\nGoverning Body<\/p>\n
    \n
  • Executive board (including 3 member Fire Chiefs)<\/li>\n
  • Set rates, reimbursement<\/li>\n
  • Select vendors (with member approval)<\/li>\n
  • Establish regional rules<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
9<\/td>\nCentralized Dispatch<\/p>\n
    \n
  • ALS vehicles GPS equipped<\/li>\n
  • Choose closest response<\/li>\n
  • Valid data collection<\/li>\n
  • Data analysis and continuous improvement\n
      \n
    • Manage by measuring<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
10<\/td>\n         Vendor-Provided ALS Service<\/p>\n
    \n
  • Initial system ALS provider<\/li>\n
  • \u201cScaffolding\u201d – provide backup to local, fire-based ALS services<\/li>\n
  • Training<\/li>\n
  • QA\/QI \u2014 Quality Assurance\/Quality Improvement<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
11<\/td>\nCentralized Billing<\/p>\n
    \n
  • Common rate\n
      \n
    • Medicare + 200%<\/li>\n
    • Essential to fund system<\/li>\n<\/ul>\n<\/li>\n
    • Bill for Assessments\n
        \n
      • ALS service 30% of runs<\/li>\n
      • Assessments additional 30% of runs<\/li>\n<\/ul>\n<\/li>\n
      • Expertise in billing under new paradigm<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
12<\/td>\nDevelopment of Local, Fire- Based ALS Services<\/p>\n
    \n
  • Each community that desires will establish local, fire-based ALS system (Wayland model)<\/li>\n
  • Local ALS vehicles will be available for regional dispatch\n
      \n
    • Regional reimbursement will go to local ALS provider ($400)<\/li>\n
    • Closest vehicle dispatched<\/li>\n<\/ul>\n<\/li>\n
    • Regional ALS provider will \u201cplug holes\u201d with dynamically deployed ALS truck(s)<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
13<\/td>\nService Participant Agreement
\n(\u201cAll-In\u201d)<\/p>\n
    \n
  • Abide by the rules established by the CMERA governing board. This board will be made up of three Fire Chiefs periodically elected by CMERA members from CMERA participating towns.<\/li>\n
  • Pay $450 (or other fee as may be voted on by CMERA) to the CMERA system per ALS service or assessment incident.   ($400 for the ALS vendor; $50 for CMERA.)<\/li>\n
  • Conduct all billing through the CMERA selected billing vendor.<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
14<\/td>\nService Participant Agreement
\n(\u201cAll-In\u201d)<\/p>\n
    \n
  • Utilize the CMERA established billing rate or other rate that may be voted on by CMERA in the future. This is presently Medicare + 200%.<\/li>\n
  • For those towns with no local fire-based ALS service –\n
      \n
    • Direct all requests for ALS service through the CMERA ALS dispatch center.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
15<\/td>\nService Participant Agreement
\n(\u201cAll-In\u201d)<\/p>\n
    \n
  • For those towns with local fire-based ALS services,\n
      \n
    • Make their ALS units available for regional dispatch.<\/li>\n
    • For regional dispatch, accept $400 as the regional reimbursement for services.<\/li>\n
    • For local dispatch in the member’s community,\n
        \n
      • Charge CMERA rate (presently Medicare + 200%) which will be kept by the local community.<\/li>\n
      • Alert central dispatch of local response and provide essential data for effective central record keeping.<\/li>\n<\/ul>\n<\/li>\n
      • Install a GPS tracking device on ALS participating ambulance for use by CMERA in tracking and dispatching ALS calls.\n
          \n
        • Installation, maintenance, and tracking costs to be paid by the regional ALS vendor.<\/li>\n
        • Each community will have remote access to GPS tracking system.<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/li>\n<\/ul>\n<\/td>\n<\/tr>\n
16<\/td>\nSelectmen Actions<\/p>\n