TO: Mayor Bien-Willner and Town Council Members
FROM: Brian Dalke, Interim Town Manager
Dawn Marie Buckland, Deputy Town Manager
Deborah Robberson, Assistant Town Attorney
DATE: March 14, 2019
DEPARTMENT: Town Manager
Staff Contact Dawn Marie Buckland, (480) 348-3555
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AGENDA TITLE:
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Discussion and Direction Regarding Emergency Ambulance Services Contract
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Background:
Emergency medical transports were once provided by Rural/Metro Corporation as part of its License Agreement with the Town for fire protection services. Since 2007, when the Town entered into an Intergovernmental Agreement with the Phoenix Fire Department for fire protection services, emergency ambulance service has been provided by Professional Medical Transport, Inc. (PMT). The current contract with PMT expires on September 30, 2019.
Regulation by State. Ambulance providers are regulated by the Arizona Department of Health Services (DHS). They must obtain a Certificate of Necessity (CON) from DHS, which authorizes the provision of ambulance services in a specific geographic area. Currently, there are three CON holders whose authorized service area includes the Town of Paradise Valley: 1) PMT; 2) Maricopa Ambulance, LLC; and 3) ABC Ambulance.
Two types of ground emergency ambulance service are authorized by DHS:
1) Basic Life Support (BLS) service, where the ambulance has limited equipment and pharmaceuticals and is staffed by emergency medical technicians (EMT’s); and
2) Advanced Life Support (ALS) service, where the ambulance is equipped with more sophisticated medical equipment, carries additional pharmaceuticals, and is staffed with at least one paramedic.
DHS also regulates ambulance rates-the fees charged to a user. These rates differ depending on whether the transport was BLS or ALS service (and also on the geographic location within the state). DHS has established a Phoenix Rate Group, and the same transport rates apply to all ambulance providers in the group. PMT and Maricopa Ambulance are part of the Phoenix Rate Group; ABC Ambulance is not. Currently, PMT’s approved rates are: $848.73 for a BLS transport; and $952.81 for an ALS transport.
DHS must approve all emergency ambulance contracts. Therefore, after the Town’s contract with PMT terminates, DHS approval will be required of any emergency ambulance service contract the Town enters. The approval process can take up to several months.
Town Ambulance Usage. Based on data provided by PMT, the Town averages two ambulance calls per day, with half of the calls resulting in a transport to a hospital. This level of demand is minimal when compared to many other Valley municipalities. The call history provided by PMT for the past four years is:
Year No. of Calls for Service No. of Transports
2015 612 382
2016 692 405
2017 561 332
2018 731 379
PMT Ambulance Service. Historically, the Town requires ALS service from its ambulance providers. The License Agreement with Rural/Metro Corporation, effective January 1, 2000, required it to operate one transport unit (ambulance) staffed by a paramedic and an EMT and to operate it out of a fire station within the Town. Likewise, the existing contract with PMT, requires ALS ambulance service, which is staffed by one paramedic and one EMT. PMT dedicates one ambulance to Town service 24/7; the ambulance is staged in a facility it leases from the Town located behind the municipal court building.
As is customary in other jurisdictions, the Town provides no financial subsidy or payments to PMT. The ambulance provider derives its operating revenue from user fees paid when the patient is transported. As noted above, these user fees/rates are set by DHS.
On occasion, a firefighter paramedic accompanies a patient to the hospital in the ambulance. This occurs as required for patient care in situations where the patient’s condition is serious and requires additional ALS provider(s). In those cases, pursuant to its contract with the Town, PMT pays an ALS service fee for these “ride-ins” equal to the difference between the ALS and BLS rate. This is the standard “ride-in” fee approved by DHS. The ALS service fee is currently $104.08. The Town and its fire service provider (Phoenix Fire Department) split the fee in accordance with the IGA between the parties for fire service.
The number of paramedic ride-ins for the past several years follows:
FY No. of Ride-Ins
14/15 125
15/16 184
16/17 192
17/18 189
18/19 (thru Dec.) 79
Response Times. The state sets response-time parameters for its CON holders, and pursuant to its contract with the Town, PMT is required to meet the following state-mandated response times:
10 minutes on 90% of all ambulance calls
15 minutes on 95% of all ambulance calls
20 minutes on 97% of all ambulance call
Some municipalities set different response time performance standards in their ambulance contracts. For example, Scottsdale’s contract with Maricopa Ambulance requires the following, which are common parameters in emergency ambulance contracts:
8:59 minutes - Priority 1 (Life Threatening Emergency)
14:59 minutes - Priority 2 (Non-Life-Threatening Emergency)
PMT currently reports the following average response time in Paradise Valley:
7 minutes and 5 seconds
Backup Ambulance(s). PMT provides one ambulance and crew, staged within the Town limits on a 24/7 basis. This ambulance and its crew are dedicated to 911 ambulance service in the Town. Having one dedicated ambulance is consistent with the level of service the Town has had since the agreement with Rural/Metro beginning in 2000.
From time to time, there may be the need for more than one 911 ambulance in the Town. For example, multiple ambulances may be needed at one incident or the dedicated ambulance may already be in service when another call arises. At the time of its initial contract with the Town in 2007, PMT was also the emergency ambulance provider for Scottsdale. Backup ambulances for PV were available from various locations in Scottsdale when PMT served both communities.
Beginning in approximately February 2018, Scottsdale changed ambulance providers and contracted for emergency ambulance services with Maricopa Ambulance. Scottsdale changed its model and contracts for BLS service only. With that change, PMT no longer has multiple ambulances available from Scottsdale fire stations or other service locations in Scottsdale, and the Maricopa Ambulance ambulances do not provide ALS service. However, PMT has contracts to provide intra-facility transports for providers in Scottsdale. The intra-facility ambulances are ALS equipped and provide back-up if the dedicated ambulance is already in service. PMT stages an ambulance near the hospital located on Osborn Road and Drinkwater Blvd., and this is the unit that would typically respond to the Town when a backup is needed, assuming it is not in service. On any given day, PMT reports that it has three or four intra-facility ambulances in Scottsdale.
PMT reports that in the 12-month period ending 3/1/19, there were 22 incidents where more than one ambulance was assigned to an incident in PV, but were unable to break out how many of these occurrences were served by a PMT ambulance versus another provider. Anecdotally, Phoenix has reported that “on a handful of occasions,” a PMT ambulance was not readily available and to ensure a prompt response, a Phoenix ambulance was dispatched.
Phoenix Fire reports that PMT service is highly professional, and that their crews are knowledgeable and integrate well with Phoenix Fire Department protocols and employees.
LEASE
Beginning in 2010, PMT has leased the Town-owned house located at 6517 East Lincoln Drive. The house is used to provide living quarters for the PMT ambulance staff and an ambulance staging location. The term of the lease is concurrent with the term of the ambulance services contract. The monthly rent is $3,000 and has not changed since the lease’s inception.
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