HomeMy WebLinkAbout04152 - AMR AMBULANCE MOU MO 6498 American Medical Response
MOU for Joint Monitoring of Emer.
Ambulance Services (incl EMS Agency)
X 11aX1116`1iC'_ =s AGREEMENT#4152
`2� M06498, 10-6-99
MEMORANDUM OF UNDERSTANDING (MOU) FOR JOINT MONITORING OF
EMERGENCY AMBULANCE SERVICES
This MOU is entered into pursuant to Schedule E-I in the Agreement for "ALS Exclusive
Operating Areas -American Medical Response Master Contract' (hereafter referred to as "the
Contract'). The City of Palm Springs hereby known as "City", and the County of Riverside,
acting through its Emergency Medical Services (EMS) Agency, do enter into this Agreement
with reference to the following facts:
A. The participants agree to consult on issues regarding provider performance, changes or
cancellation of the contract with the provider and distribution of performance penalty
monies received under the performance based contract and other decisions related to
administration of the contract.
B. By entering into this MOU,the participants do not waive or otherwise relinquish any
legal rights or obligations as they may have under law.
Now therefore the participants agree as follows:
1. The EMS Agency will provide staff for day-to-day management and administration of the
Contract with regular reporting of performance to the EMS Administrative Group
described in 42 below.
2. Each participating agency will designate an individual to serve on an EMS
Administrative Group that will mutually review performance reports, monitor contract
compliance and determine use and allocation of performance penalty monies received
from the provider as well as other duties mutually agreed to, on behalf of the city. The
individual will be the City Manager or designee from each city, the Riverside County Fire
Chief or designee in the unincorporated areas, and the EMS Agency Director or designee.
3. The term of this agreement shall begin September 15, 1998 and run through June 30,
2003, or throughout the term of the Contract if extended, with the emergency ambulance
provider.
4. There shall be no assessments to the City for the costs of administering the Contract or
this MOU.
5. Performance standards will be as specified in the Contract between Riverside County and
the emergency ambulance provider, or as otherwise modified from time to time.
6. City may request modified services as provided by the Contract, subject to negotiated
costs or savings and EMS Agency approval.
MOU
Page 2 of 2
7. City will invoice the County of Riverside EMS Agency annually for payment of
penalties.
8. Ambulance rates will be set in accordance with County and HSA policy with input from
the involved cities.
9. All notices, statements, demands, requests, consents, approvals, authorizations,
agreements, appointments or designations hereunder shall be given in writing and
addressed to each party to this MOU.
10. The participants agree to cooperate in carrying out the purposes and intent of this MOU
and to execute, acknowledge and deliver all additional agreements, instruments or other
writings reasonably necessary to carry out this MOU. However, no party hereto shall be
compelled to surrender its discretionary powers of approval as contemplated in this MOU
by virtue of this covenant.
City of/Palm Springs
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EI&2GENC;Y MEDICAL SERVICAGENCYPn�.,r9w)3m-5o29
CO T1'OF RIVERSIDE HEALTH SERVICES AGEN Y, DEPARTMENT OF PUBLIC HEALTH
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DATE: December 7, 1999
TO: Office of the City Clerk
City of Palm Springs
FROM: Ann Yoshinaga, Senior EMS Specialist
SUBJECT: MOU for Joint Monitoring of Emergency Ambulance Services
Enclosed are the copies of the signed MOUs for joint monitoring of emergency ambulance
services. I have also enclosed a copy of the update of AMR's performance that was submitted
to the Board of Supervisors in October. Please forward this to your City Manager. If you have
any questions, please call me at 9091358-5029.
Enclosures
JUbIVII I I AL d U 1 HL bUJAKU UI- SUF'LKVIJUKS oF• t,4
CO#TY OF RIVERSIDE, STATE OF C f FORNIA
-I SUBMITTAL DATE: September -
FROM: Health Services Agency/EMS 28, 1999
SUBJECT: Update on County Agreement with AMR and AMR's response time performance
RECOMMENDED MOTION: That the Board of Supervisors accept this report from the EMS Agency
regarding AMR's response times in Riverside County in comparison to the standards in the
County/AMR Agreement.
BACKGROUND: At its meeting on March 9, 1999, the Board of Supervisors received a report from
EMS on ambulance response times in the cities of Murrieta and Temecula. That report specified that
AMR had failed to meet its contracted response time requirements in the Southwest Zone (which
included the cities of Murrieta and Temecula). At that time, AMR committed to make changes in their
ambulance deployment system to ensure that the Southwest Zone and all other zones would meet
contract requirements. In addition, the Board of Supervisors requested that the EMS Agency return in
September 1999 to give the Board an update based on AMR's performance from March 1999 through
July 1999.
On September 15, 1998 the Board of Supervisors approved the County/AMR Master Emergency
Ambulance Agreement. This Agreement encompassed seven of the county's 12 exclusive ambulance
operating areas and 18 of the 24 cities. A key part of this Agreement is AMR's requirement to meet
certain ambulance response time criteria. The response time requirements were phased in over the
first nine months of the Agreement. For the period September 15-December 31, 1998, AMR was to
meet the requirement 85% of the time.
(continued on page 2)
K nneth B. Cohen, D' ector
Health Services Agency
FINANCIAL DATA:
CURRENT YEAR COST: $ ANNUAL COST: $
NET COUNTY COST: $ IN CURRENT BUDGET: $
BUDGET ADJUSTMENT: YES% NO% FORFY:
SOURCE OF FUNDS:
C.E.O. RECOMMENDATIONS: Receive and file.
County Executive Officer Signature: } r
— s
a a
° ° MINUTES OF THE BOARD OF SUPERVISORS
v
On motion of Supervisor Buster, seconded by Supervisor Venable and duly carried by
❑ unanimous vote, IT WAS ORDERED that the above matter is approved as recommended.
0
Ayes: Buster, Venable, Wilson and Mullen
Noes: None Gerald A. Maloney
E o Absent: Tavaglione ` Cie d
Date: October 5, 199 By yt
E xc: Health Servic Agency Deputy Clerk
a
v
o a �
FORM„ Prev.Agn.ref. Dist. AGENDA NO.
(Rev e-) 3/9/99 3.20 all X
Health Services Agency/EMS
September 28, 1999
Update on County's Agreement with AMR and AMR's response time performance
Page 2 of 4
For the period January 1-M2rch 31, 1999 the requirement was 88% of the time, for the April 1-June 30,
1999 the requirement was 89% and finally beginning July 1, 1999 through the life of the Agreement,
the requirement is that AMR meet the standard 90% of the time. These standards are consistent with
national recommendations from medical organizations and work to ensure that the greatest number of
patients can be served.
The County/AMR Agreement response time standards are designed by percentage by zone.
Reporting response times by zone allows for a wider area of compliance and is in keeping with current
state of the art in ambulance performance measurement. Likewise, ambulance response times are
reported as a percent of compliance rather than by averages. Averages may "hide" late calls in an
area with short response times. AMR is required to meet a certain compliance percentage (now 90%)
of the time standards (generally, 10 minutes for cities/urban areas and 14 or 20 minutes for more rural
areas). AMR is not required to meet a certain response time percentage in any particular city. To
ensure that all areas of a zone receive optimal response times, the County/AMR Agreement allows for
penalties to be assessed to AMR for every late call if it does not meet one of the permitted exemptions.
The EMS Agency began assessing these penalties April 1, 1999. For April-June 1999, the penalties
reflected are 50% of the total penalties assessed as per the County/AMR Agreement. The penalties
from July 1999 forward are at 100%. The penalties assessed to date are specified as follows:
April $24,540
May $29,540
June $21,800
July $42,160
August $40,100
(July and August penalty calculations are still preliminary)
In each of AMR's seven zones, the EMS Agency has formed an EMS Administrative Group to review
AMR's performance standards. Each of these groups has ongoing quarterly meetings. Each group will
determine how the penalty money will be spent in each zone. Our goal is to have the money used to
enhance first responder training and equipment in each city or jurisdiction.
AMR-reports their response times and compliance to the EMS Agency monthly by zone. After careful
review, spot checks, audits and review of materials submitted by the cities and County Fire, the EMS
Agency develops a report, which shows AMR's compliance results. Review of July and August data is
not yet complete so information for those months is preliminary only. Summary of this data shows:
Northwest (Riverside, Corona and Norco) -AMR in full compliance for every month.
Central Zone (Moreno Valley and Perris) - AMR did not meet compliance in December 1998,
January 1999, April 1999 or May 1999. However, they did meet requirements in June, July and
August 1999.
Southwest (Temecula, Murrieta, Canyon Lake and Lake Elsinore) - Did not meet compliance
November 1998-February 1999 or in April-May 1999. However, AMR met compliance in June-
August 1999 and has shown big improvements over the past few months.
Health Services Agency/EMf
September 28, 1999
Update on County's Agreement with AMR and AMR's response time performance
Page 3 of 4
San Jacinto Valley (Hemet and San Jacinto) - AMR in full compliance for every month.
Pass (Calimesa, Banning and Beaumont) - AMR in full compliance except for February 1999
and July 1999. The Pass area's low call volume can lead to a wide variance in monthly
compliance whereby AMR, by being late to just four additional calls in a month, caq drop their
compliance by 1% or more. Overall in this zone, AMR has been in compliance for 9 of the 11
months.
Desert (Palm Springs, Desert Hot Springs, La Quinta and Coachella) -AMR in full compliance
for every month.
Mountain Plateau -AMR in full compliance for every month.
Overall - Except for January 1999, AMR has been in full compliance.
The attached graphs for each zone show AMR's compliance versus the required percentage.
In our March report to the Board, we stated that AMR would soon begin making changes to their
ambulance deployment system. AMR made those changes in March 1999 and made additional
adjustments in early July 1999. These adjustments included changing from all 24 hour shifts to a mix
of 10, 12 and 24 hour shifts designed to meet the call volume needs of the County and changing the
standby locations of many of the ambulances. We feel these changes have markedly improved AMR's
response time compliance countywide.
In addition, the EMS Agency has set clear standards for when AMR's response time clock begins and
when it ends. (See attached memo to AMR dated June 21, 1999.) Further, AMR now has direct
computer-to-computer links with both the City of Riverside and City of Corona dispatch centers. These
links have decreased the time it takes to get an ambulance en route to a call. AMR and County Fire
are continuing to work on technological methods to decrease the time it takes to "hand off' a call from
County Fire to AMR.
Also, as part of the County/AMR Agreement, the cities of Norco, Corona and Riverside now have
paramedic first responders on their fire engines. The cities now receive payment from AMR for
paramedic first responders and thereby the citizens of these three cities now receive enhanced
paramedic service faster than that provided by AMR.
AMR has made dramatic improvements to their response time compliance percentages. AMR has
made the necessary changes to their ambulance deployment system and hired additional personnel to
meet the County's requirements.
Clearly, AMR is committed to meeting the standards specified in the County/AMR Agreement. They
have made substantial improvements in meeting response time requirements since March 1999 by
adding additional ambulances, hiring more personnel and improving the quality of their dispatch
procedures. The EMS Agency will continue to monitor AMR's performance and report to the Board
annually on AMR's compliance with the County Agreement.
Health Services Agency/EMI •
September 28, 1999
Update on County's Agreement with AMR and AMR's response time performance
Page 4 of 4
On September 13, 1999 the EMS Agency was notified by AMR that their parent company, Laidlaw, was
going to sell the whole of AMR at an asking price of$1.2 billion. The EMS Agency received
assurances from top AMR management that nothing will change in day-to-day operations. In addition,
local AMR management has been informed that their capital budgets are funded and that AMR in
Riverside County will be receiving 14 new ambulances during the next 12 months. The County/AMR
Agreement has many provisions in it that will hold AMR or any subsequent buyer of the company to the
agreed upon standards. Furthermore, if AMR is ever found to be in breach of the contract, the County
has the right and authority to use all of AMR's ambulances and equipment to run calls pending
resolution of the situation. The EMS Agency will continue to monitor the situation closely and inform
the Board of Supervisors of any major announcements or changes regarding AMR's operations.
MO:re
AMR Overall Compliance Through 8199
k
100.0%
98.0% -------- -
94.0%
90.0% - - ----- - -
�9�ft-
88.0% _ -
c 86.0% - —_- -_-__.--
N
U
d 84.0% -—
82.0% - -- -------------- --
--- ---- - --
80.0% ---- -
78 0% -- -4-Adjusted Compliance % -' --Required %
76.0% - - --- -
74.0% ---- --- - -- -- -- ------ ------ - --- - --- - - -
72.0% - - - - -. .. - - --- - --- -- - - --- -- - -- -
70.0
Nov Dec Jan Feb Mar Apr May June July Aug
Month
AMR Compliance Northwest Zone
F
96.0% -
92.0% .
C1141
_R
F-
E
o 88.0% - —
Y
C
N
U
a 86.0% - -- --
•-9�Compliance %
84.0% - —15—Required
82.0% -------- -- ----
80.0% -
Nov Dec Jan Feb Mar Apr May June July Aug
Month
AMR Compliance Central Zone
94.0%
92.0%
90.0% -
88.0% -
86.0%
Y
C
84.0%
W
EL
82.0% -
tCompliance
80.0%
—0—Required
78.0% -
76.0%
74.0% - '
Nov Dec Jan Feb Mar Apr May June July August
Month
AMR Squtwest Through 8199 (July and August Preliminary Data)
100.0% -
95.0% - -
90.0% -
r
Y
C
0 85.0% -- ----------- - -- ------ ------- --
EL
EL
-O-Compliance
80.0% --B-Required
•
75.0% - - -- - - ------ — - - - ----- - -- ----- --- - —
70.0% -
Nov Dec Jan Feb Mar Apr May June July Aug
Month
AMR Compliance, Hemet/SJ Zone
98.0%
96.0% -
94.0%
92.0%
90.0% -
c
88.0% -
m
a
86.0% -
°
84.0/° - ---4�—Compliance %
Required
82.0% -
80.0%
78.0% '
Nov Dec Jan Feb Mar Apr May June July Aug
Month
Pass Zone Nov 98-June 99
94.0%
92.0% --
i
90.0% ----------- ------ — --- - -- -- —
�I
y
U
.° 88.0% — -- -- — ---
a
E
0
U
w
86.0% ---- - - - --- --
a
84.0% 1 Compliance %
-HRequired i
80.0%
Nov Dec Jan Feb Mar Apr May June July Aug
Month
AMR Compliance, Desert Zone
96.0%
94.0% -
92.0% -
90.0%
c c...a
m
.a
E
U 88.0%
a+
C
U
V
IL 86.0% -
84 0% - —4--Compli2nce %
—R—Required •
82.0% -
80.0%
Nov Dec Jan Feb Mar Apr May June July Aug
Month
EMERGENCY MEDICAL SERVICE A ENCYPhone:(909)35&5029
COUNTY OF RIVERSIDE HEALTH SERVICES AGENCY, DEPARTMENT OF PUBLIC HEALTH
' �r peps '� .r. i r r rr •r•
June 21, 1999
Peter Hubbard, Managing Director
American Medical Response
1044 East La Cadena Drive
Riverside, CA 92501
Dear Mr. Hubbard:
1 received your Ambulance "On Scene" Policy with an effective date of February 25, 1999.
Please revise your policy to incorporate the following requirements:
Uni is are considered to be on scene when they arrive at the location to which they are
dispatched. Units responding to large complexes such as multi-level apartments,malls,
etc. will be placed on scene when they arrive at the side of the building to be entered or
where directed by a reporting party, fire, or law enforcement if already on scene.
Units responding to areas such as mobile home parks or gated communities will be
placed on scene at the home or dispatched address (not at the entrance to the complex).
Any delays reaching the location such as locked gates.or speed bumps can be reasons for
an exemption submission.
When a potentially dangerous scene situation is identified, the units will be marked on
scene when they reach the staging location.
We expect AMR to develop a list of known areas where response times are difficult to measure,
such as the Palm Springs Tram or Lake Penis, and submit this list to the EMS Agency for
approval.
In the area of communications, transporting units will maintain radio communications with both
their company communications center as well as the First Responder agency. Radio
communications with the First Responder agency shall be for the purpose of pertinent patient and
scene updates. Once the staff of a transporting unit are assigned a call, the), shall advise the First
Responder agency's communications center of their response by giving their unit designation and
the scene to which they are responding.
Page 2 of 2
On Scene Notifications and Communications
Please make these changes in your system by July 1, 1999. if you have any questions or
comments; please call me at 909/358-5029.
Sincerely,
n
Michael Osur, EMS Agency Director
cc: Gary Feldman, MD,Public Health Officer
Kenneth Cohen, HSA Director
Randy Skomsvold, Vice President AMR