Title
Health Services Department recommending the Board review the structure of delivery of ambulance transport services in County Service Area No. 7 and determine if changes should be made including but not limited to whether an exclusive operating area for ambulance transport services should be established. (Est. time: 30 min.)
Body
Fiscal Impact/Change to Net County Cost: There is no Net County Cost associated with establishing an exclusive operating area in County Service Area #7.
Background: On December 14, 1999, following extensive review of the ambulance transport system structure within the County, the Board directed staff in Public Health to take appropriate steps to establish an exclusive operating area for 911 ambulance transport services in County Service Area (CSA) #3 and to leave CSA #7 as a non-exclusive area. Over the past decade, there have been discussions with the Board regarding the benefits and the disadvantages of the current approach.
The County is tasked with the obligation to establish an organized and efficient Emergency Medical Services (EMS) response system that assures reasonable countywide response time reliability, clinical competence and financial performance. It is also imperative for the County to assure that the operational, clinical and economic advantages of the current system are not lost to fragmentation of the market.
The history of ambulance transport services is provided in the Board report accompanying this item. Currently, the County is the provider of ambulance services under a public utility model. However, because CSA #7 is a non-exclusive operating area for all services, inclusive of Advanced Life Support (ALS) service, critical-care transports, and inter-facility transports, a third party provider may apply to contract with the County to furnish any or all of those services within the CSA #7 boundaries. The purpose of this agenda item is to discuss whether the Board desires to alter or change that current structure. The attached Board report outlines considerations the Board should take into account when making this review.
Upon that review, the following decision(s) require the Board's attention:
Should CSA #7 remain as a non-exclusive operating area for ambulance transport services?
If yes, no further decisions are needed at this time. The County currently subcontracts transport and dispatch with the EI Dorado County Emergency Services Authority Joint Powers Authority ("JPA") and that contract will continue through June 30, 2018.
If no, changes to the system may be considered as follows:
a. the County may establish an exclusive operating area (EOA) in CSA #7, and "grandfather" the County as the exclusive provider under the provisions of Health and Safety Code section 1797.224. The County would need to consider what services would be exclusive, i.e. ALS emergency transports, critical care transports, inter-facility transports, etc; or
b. the County may establish an EOA in CSA #7 and use a competitive process,
such as the one conducted this past spring for CSA #3, to determine a
successful bidder to furnish ambulance transport services. As part of this
process the County would need to have further discussions with the JPA
regarding their current contract.
The establishment of an exclusive operating area in CSA #7 will require revision of the County's EMS Plan.
Action to be taken should the Board decide to designate CSA #7 as an EOA:
1. Staff to revise EMS Plan.
2. Staff to file revised EMS Plan with State EMS Authority.
3. Staff to carry out any other administrative activities needed to bring about the change (e.g., conduct competitive process; negotiate agreement with ambulance transport services contractor, etc.).
Contact: Kathy Lang