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Home My WebLink AboutIR 8139 INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8139 ,11TE To the Mayor and Members of the City Council June 16, 1998 ti Subject:kREA METROPOLITAN AMBULANCE AUTHORITY OPERATION 1873 (AMAA) The City of Fort Worth is a member of a 12 City authority, which receives emergency medical services through the Area Metropolitan Ambulance Authority (d.b.a. Medstar). The authority board recently engaged a consulting firm (Polaris) to assist in a review of the structure of the authority, the changing financial dynamics of the medical industry, and to review other operational and functional issues in preparation for a contract bid to be effective at the end of the current term, July 31, 1999. The Fort Worth Fire Fighters Association has raised issues concerning the Medstar system and the business structure, which provides for a private contracting provider for ambulance service. The AMAA board is currently working as a committee of the whole on the issues, which will be necessary to assure a financially viable and reliable emergency medical service system in the Medstar service area. The purpose of this report is to provide the City Council with information regarding the AMAA and its role. I. Creation The AMAA was created on April 18, 1988 when the City Council of Haltom City approved the EMS Interlocal Cooperative Agreement with the City of Fort Worth and the Uniform Emergency Medical Services Ordinance. The multi jurisdictional authority began operating as such on August 1, 1988 with nine cities as members (the opportunity was afforded to all cities in the county as well as the Tarrant County Rural Fire District to become members, which would have effectively provided a county wide EMS system). The AMAA was an expansion of the Fort Worth Ambulance Authority, which had been created to provide service within the City limits of Fort Worth in 1986. 11. Authority Responsibilities The agreements created a system, which was designed to assure the citizens of the member cities a state of the art, high performance pre-hospital emergency medical system with stringent medical control, accountability and adequate response times. The agreement designated a single provider of EMS service within the service area to maximize the economies of scale. The model is known as a "public utility model". f rl Or n X" IV ................. ......._J�"� ISSUED BY THE CITY MANAGER FORT WORTH,TEXAS INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8139 To the Mayor and Members of the City Council June 16, 1998 Subject: Page 2 of 3 fX► AREA METROPOLITAN AMBULANCE AUTHORITY OPERATION (AMAA) The Authority under the agreement: 1.) Set response time standards for the service area. 2.) Provides (through contract) each member city with advance life support service. 3.) Requires the contract to be re-bid no less often than every 11 years (currently underway). 4.) Offer member cities a price/subsidy option to provide the opportunity for each jurisdiction City Council to determine the level of subsidy, which reflects in a reduction in the cost of service for that respective jurisdiction, or higher rates. 5.) Offer a member subscription to each household within the jurisdiction to prepay all uninsured portions of a medically necessary ambulance service. The agreement also provides for a myriad of other options for jurisdictions to join and withdraw in the future and other business points. II1. Governance 1. AMAA Board The agreement provides for the creation of a Board of Directors (up to 9 members). The board is comprised of four appointees by the Fort Worth City Council, one appointee selected by the other jurisdictions, and the Medical Director of the Emergency Physicians Advisory Board (EPAB). (The agreements provide for re-structure of the selection process when the authority exceeds 880,000 population). 2. Emergency Physicians Advisory Board (EPAB) is created in the Uniform EMS Ordinance. It is composed of the medical director of each hospital emergency room within the service area and five (5) additional physicians appointed by the Tarrant County Medical Society. The system's medical director is employed by EPAB. EPAB recommends to the board medically appropriate response time standards, establishes standards for ambulances and first responders, develops protocols for the first responders, develops and revises control center protocols, conducts medical audits, certifies system ambulance personnel, provides educational materials within the system, inspects ambulances, monitors response time standards, reviews the system performance relative to specific clinical issues and other medically related issues. The member cities indemnify and hold harmless the EPAB members for suits brought against e them while they are acting within the sco p e of responsibility outlined n the ordinance r (EPAB members are not compensated by the s y stem. The medical employee). .J C V ISSUED BY THE CITY MANAGER FOR 44, TT�i ` INFORMAL REPORT TO CITY COUNCIL MEMBERS No. 8139 �'�''ATeeFO To the Mayor and Members of the City Council June 16, 1998 Subject: Page 3 of 3 �s "" AREA METROPOLITAN AMBULANCE AUTHORITY OPERATION (AMAA) IV. Other Items The member jurisdictions are obligated to provide trained first responder services in order to be eligible for membership. The First Responder concept allows the more expensive advance life support units to be strategically located to meet response lime standards. Historically, each city has utilized Fire personnel as first responders, which is an effective use of the public expenditures already being committed. Fire stations are by design more numerous and centrally located which meet the first responder objectives. Cost of service has been the most criticized component of the public utility model. However, it should be remembered that this model was designed to be supported primarily through user fees. Since its inception, the Medstar system has undergone the same finance challenges as other medical care providers and this remains a major challenge in the future. The sole provider allows the authority co capture the guaranteed revenues for non-emergency services, which help offset the expense of providing emergency service. The Fort Worth City Council has historically chosen to offer minimum subsidy to the system, which has resulted in the fees for services to be more reflective of actual cost. In 1988 the City of Fort Worth provided the authority with an operating subsidy of $1,188,287 and although for business reasons this amount has varied over the life of the authority, the current year subsidy (1997-1998) is $1,248,058 which when adjusted for inflation represents a reduction of 31.3% in the subsidy rate. Summary The AMAA Board is currently working through the very difficult task of analyzing the changing medical care industry, the various types of service and provider options available and many other issues in preparation for addressing EMS service within the system at the end of the current contract term. It is important to recognize that many options are available and the board members are effectively attempting to educate themselves in order to assure that the level of service for the Medstar member cities has the same state-of-the art capabilities, as was the original goal. Mr. Jack Eades, Executive Director of AMAA has been requested to make a presentation to the City Council on June 23, 1998 to address specific contract issues. This report is presented for background and informational purposes. Should you have any questions contact Assistant City Manager Mike Groomer at (817) 871-6140. Bob Terrell, City Manager Attachment ISSUED BY THE CITY MANAGER FORT WORTH, TEXAS