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Consultant offers third plan for EMS system
Draft report provides operational analysis of EMS and fire deployment
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Emergency calls from five cities - St. Petersburg, Clearwater, Largo, Pinellas Park and Seminole - account for 72.5 percent of all calls coming into the system. Fourteen of the smallest districts account for only 10 percent of calls.
A report Pinellas County officials had hoped would point the way toward creating a more affordable emergency medical services system was released May 28.

The 140-page draft report from Fitch and Associates LLC., of Platte, Mo., included analysis of a plan proposed in 2011 by Integral Performance Solutions, as well as a plan proposed the same year by Capt. Jim Millican with Lealman Fire Rescue and Lt. Scott Sanford, firefighter/paramedic with Palm Harbor Rescue.

In addition, Fitch offered its own plan that could save the system as much as $6.3 million a year.

County officials have been embroiled in a dispute with local fire departments since IPS, a consulting firm hired in 2009 to study the issue and recommend ways to curb rising costs of first responder service, released its report.

Eventually the state Legislative Delegation got involved. Pinellas County’s current EMS system is governed according to rules set up by the Special Act that created it. Changes would require an amendment by the state legislature.

The delegation listened to testimony from both sides as well as the public during a Nov. 30, 2011 meeting before agreeing that the county should pay for another study by an independent nationally recognized accounting firm that would analyze the costs and potential revenue of IPS recommendations and the plan proposed by local firefighters.

The legislative delegation asked that the study be completed by July 1, 2012. That study has not yet begun.

Instead, county staff insisted that a study was necessary to assess the operational feasibility of the two systems prior to a financial analysis. The Fitch study was intended to show “what would work within Pinellas County,” County Administrator Bob LaSala said Sept. 6, 2012 when county commissioners approved the contract with Fitch.

Fitch’s mission

In the executive summary, the Fitch report said, “Pinellas County’s emergency medical services system is widely recognized as one of the most clinically sophisticated in North America. In recent years, however, concerns related to the system’s financial sustainability have been growing.”

Those concerns include depletion of the EMS fund reserves, resulting in millage rate increases to pay for the system.

Fitch used a “sophisticated simulation process” to analyze and compare IPS recommendations against the firefighters’ proposal and to develop a third plan.

The executive summary said, “The intent of the third plan was to align community-wide resources to enhance efficiency, maintain service levels and result in a more efficient system, position the system for anticipated ‘accountable healthcare’ funding models, while also facilitating long-term financial sustainability.

“Maintaining the current system’s high level of pre-hospital care for patients and fire protection for the public was a top priority in all cases.”

IPS plan

Fitch concluded that the recommendations by IPS, endorsed by the county administrator and staff, would allow the system to continue to meet response times mandated by county ordinance.

The plan would take 25 rescue units out of service and require 150 fewer firefighters to provide service, bringing personnel costs down to $90.8 million. The plan would increase operational costs by $5 million, due to the loss of the rescue units and increased service by the larger fire trucks and engines, which are more expensive to run, maintain and purchase.

According to Fitch, the IPS plan would save money while allowing the county to maintain its standards for service. But, Fitch did not green light the plan.

“In short, this model is theoretically achievable but lacks the realistic approach to make it implementable,” the report said. “Pinellas County fire and EMS are not in a state or disrepair that would require such as drastic cut.”

Sanford-Millican proposal

The plan from local firefighters, and endorsed by some fire departments, would remove the county’s private ambulance service, Sunstar, from the system. Ambulance service would be provided by local fire departments and fire districts.

The Fitch study pointed out that the current centralized administrative and infrastructure functions would become the responsibility of 18 independent agencies, at an unknown cost. Fitch did not include a change in costs for those functions in its study.

Two different implementations of the Sanford-Millican plan were part of the simulations in the Fitch study – SM-1 and SM-2. Both showed that mandated response times could be met; however, Fitch concluded that the proposed staffing for SM-1 were not safe due to the proposed workloads for medical transport units and 24-hour rescues.

“Both of these crew utilizations are considered unrealistically high and dangerous,” the report said. … “The Pinellas EMS medical director has expressed strong concerns related to fatigue from long shift lengths and excessive unit hour utilization as a contributing factor in medical errors.”

Personnel costs for SM-1 of $110.8 million are almost equal to the costs of the current system, which uses Sunstar employees at a lower cost to provide transport.

Crew costs for SM-2 increase to $120.9 million, but address the concerns about excessive workloads.

Fitch’s recommendation

Finding both IPS and the firefighters’ plans lacking, the consultant proposed a third plan, referred to as Community Alignment of Resources for Efficiency and Service (CARES).

The CARES plan also maintains response time targets, it reduces personnel costs to $105.7 million and matches equipment inventory to call demand. The plan uses the same administrative structure currently in place.

“The IPS and SM proposals represent the extremes in the continuum of possible approaches to make the system more efficient,” the study said.

Development of a third approach, including hybrid models, which was something specifically requested by county commissioners, “was a difficult task given the core mandate not to negatively impact clinical or other service levels,” the study said.

Personnel costs for CARES are less than the current model, but more than the cost if the IPS plan was used.

Priority dispatch

While not part of the discussion when the contract was approved, Fitch did look at the county’s Medical Priority Dispatch. The controversial Phase 3 dispatch system was set to be implemented June 1. Phase 3 calls for dispatch of Sunstar only for low priority emergencies. Local fire departments would be notified, so they could respond to those calls at their own discretion.

Some local fire departments object to Phase 3, citing responsibility for the residents within their districts. Fitch’s CARES plan continues to use fire units to respond to all medical calls, which would reduce the number of calls going to Sunstar – the for-profit arm of the system contracted by the county to Paramedics Plus.

Fitch concluded that the use of Sunstar only for low-priority calls did not “translate into any demonstrative cost savings.”

“Fitch therefore opted to maintain the FD (fire department) role and community involvement on these calls while potentially positioning the system under a future accountable healthcare delivery model,” the study said

Future meetings

County Commissioners are scheduled to discuss the draft report at two work sessions. The first is scheduled on Friday, July 19, and the second on Thursday, Aug. 1. Work sessions begin at 9:30 a.m. in the fifth floor assembly room of the Pinellas County Courthouse, 315 Court St., Clearwater.

Time will be allocated for public comment. A copy of Fitch’s draft report is available at www.P­inell­asCou­nty.o­rg. Look for the link under the special interest topics on the front page.
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