HomeMy WebLinkAbout20111431.tiff Gino
Greeley
. . ‘
May 24, 2011
Mr. Slade Davis
3703 West 7'h Street Road
Mr. David Main
Ms. Michelle Main
5803 West 29'h Street Road
Greeley, CO 80634
Dear Mr. Davis and Mr. and Ms. Main:
I want to thank each of you for your interest in attending City Council on May 17'h and
providing City Council with your input.
You may not be aware, but City Council has been working on reducing the costs of
government for several years. Some examples of this effort include the consolidation of
several departments and the review of privatization of some services. In the same vein,
City Council established a work program item this year to review Emergency Medical
Services when questions were raised during the last budget cycle. As clearly
communicated by the Mayor, the City Council is in the data-gathering phase of this
work program item and has not made any final decisions. The Request for Proposals
(RFP) is the means they have chosen to specifically determine how the private sector
could provide ambulance transport services to Greeley. Prior to beginning this effort
the City Council informed the Weld County Commissioners at one of their joint quarterly
meetings. The City Council envisions sharing the results of its study with the Weld County
Commissioners prior to making any final decisions. I think it is very important to note that
the City Council is not displeased with the work of the Weld County Paramedics Service
(WCPS) anymore than they were displeased with the services of our Recreation and
Culture Departments before they were merged in 2006 or with the Parks Department
before it was merged with the Public Works Department in 2010.
City Council advised that you would receive answers in writing to your questions. To
that end, I tasked staff with this responsibility and offer the following:
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Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 2
Questions from Mr. Davis
1. Per the RFP the City will fine the private for-profit contractor for certain performance
standards if not met, and also collect fees from them for things like supplies, fire
department riders/drivers, etc. Do you truly believe that a private, for profit contractor
will not pass these fees along to us in the form of increased ambulance bills?
Answer: Costs for supplies and Fire Department assistance during transport is not
being recovered now. The cost of these services is currently borne by the Greeley tax
payer. Contracting with a provider to reimburse the City for supplies and manpower for
patient transport would be spread to the citizens and non-citizens using the transport
service. Yes, we believe the contractor will include a small increase in fee structure to
account for the reimbursement to the City. Obviously, the intent of the RFP is to
ascertain the specific charge(s) and compare those to the current system. The research
performed prior to publishing the RFP indicated that Performance-based fees,
reimbursement for medical supplies and manpower during transport are common in
other cities across Colorado.
2. According to the Greeley Tribune article you state that you preformed your own
study, which was not done by an independent outside source, comparing ALS base-
rate fees of Weld County Paramedic Services to that of other cities which use private, for
profit ambulance companies. Did your study actually collect data on the bills sent to
patients to include more than just the base fee? For example: the fees charged to a
person having a heart attack that would include items such as, transport mileage,
medications, procedures used, etc.
Answer: Our study specifically looked at ALS base rate. Based on the information
gathered from the research, base rates were considerably higher in the City of Greeley
compared to other comparables. We also looked at total cost of transport services and
found that the cost of bundled services that is used by the current provider versus line-
item billing used by the contracted agencies in the comparables was still higher per
transport. This seems to be supported by the Longmont price list that you provided.
3. Also according to the RFP you prefer the private, for-profit contractor to work the
same shift schedule as the GFD, which is currently 48 hours straight on shift. What kind of
care do you think you are going to receive at 4:00 in the morning from a Paramedic
that has been on shift for the last 45 hours and has little to no sleep between calls?
Answer: The RFP does have the request for the contractor personnel to work the
same shifts the GFD currently uses. The reasoning behind this request is to increase crew
integrity. Crews that work together all the time and train together have shown to
improve patient care and decrease information being lost during transfer of the patient
to the transporting agency. Shift work is closely monitored by the shift supervisor. If there
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 3
are any safety concerns for patient care or personnel, adjustments are made. There are
several occupations that require long hours. One being Resident Doctors who work 36
hour shifts and can work over one hundred hours a week. This request is simply a request
and not a requirement of the contractor. Negotiations on this matter are welcome.
4. How many more Paramedics is the city going to have to hire to ensure there is one at
every station, for every shift to be Incident Command or Medical Control on scene as
per the RFP? This seems like an additional cost to the citizens. With that said, the RFP
states the private, for profit contactor will staff its ambulances with a minimum of a
Paramedic and an EMT. So why are our taxes dollars paying for fire department
paramedics in the first place?
Answer: The GFD has been providing advanced life support services since 1998.
GFD currently provides this service with EMT-I and Paramedic firefighters on all first
response engines. The purpose behind ALS engine companies is based on numerous
standards. Fire stations are strategically located within the City to provide rapid
response to all hazard emergencies. ALS personnel staffed on all front line engines
provide the citizens' of our community with early life saving treatment during medical
emergencies. Studies have shown that survival from life threatening emergencies
increases with early ALS intervention. There are times that response times from the
current transport provider are extended. There are currently no dedicated transport
units to the City of Greeley. ALS personnel responding on fire apparatus can work on life
saving measures until the transport unit arrives. The RFP does specify that GFD will be
Incident Command on all emergency scenes. It also states that the first arriving
Paramedic will have medical control. This could be the contractor personnel or GFD
personnel. One of the main questions, City Council is trying to address, through its'study,
is the level of life support qualifications of GFD personnel. This decision is in part a
function of the response time of the transport provider as well as the dedication of units
to the City of Greeley.
Questions/Comments from David Main
1. In everything that has been written, there was never a mention that the services of
Weld County Paramedic Services are in question, only the cost.
Answer: As mentioned in my introduction, there has never been any question
about the quality of service the patient receives while being treated by WCPS. The City
Council is pleased with this service and proud of GFD in this team effort. Council has
expressed concern over the cost of that service compared to other municipalities as
well as potential inefficiencies regarding the need to dispatch multiple public safety
vehicles and personnel to medical emergencies. These concerns are derived by their
own observations and the observations of their constituents. The RFP also addresses
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 4
items like response time standard, training together with GFD personnel, and incident
management. All these items would help improve patient care.
2. Quality though, whether it is in healthcare or any other arena, costs more. If you
have $2000 to buy a car, you aren't going to get a brand new car. In the same way,
according to the Safety Committee's own statements, it would be with a private
ambulance service.
Answer: The Public Safety Committee is concerned about quality of service.
Quality patient care is the standard. The PSC is sending out the RFP to find out what
other experts in the field of ambulance transport can provide and at what cost to the
citizen.
3. Private ambulance services pay considerably less than what the Weld County
Website states the pay is for EMT's and Paramedics. Weld pays $16.46 per hour for EMT's
and $23.69 per hour for Paramedics. Pridemark Paramedics pays $9.62-$11.15 per hour
for EMT's and $16.17-$17 .48 per hour for Paramedics. That is more than 25% percent less
that privates pay than Weld.
Answer: There was no information obtained during the research to date that
looked at wages for employees. It appears you are connecting the hourly rate to
qualifications. I don't know if that is ultimately a correct assumption. Regardless, I am
confident that City Council will be basing its decisions on the overall quality of patient
care.
4. This is largely because private ambulances are for profit and will pay lower for less
quality and keep retraining.
Answer: There is no evidence to show that a private provider quality of patient
care is less than that of a public sector provider. The provider's level of experience can
have some influence on the quality of care and I am confident City Council will be
evaluating this factor.
5. Weld County is not for profit and actually has people able to retire in their service.
6. While working at the Private Ambulance Service, the service had high turnover and
was considered a "stepping stone" for employees to advance into other fields or more
stable departments than a private ambulance service, i.e. physician assistants, medical
doctors, nurses.
Answer: I concur that turnover rates are a concern with any provider. This will be a
topic of discussion during the evaluation process when the RFP is reviewed.
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 5
10. This creates a situation where there is always training of new employees and
therefore, employees unfamiliar with the area, the system, and the departments they
are working with. These result in lack of trust and ultimately, less than the best patient
care for the patients. This also creates a situation that has much lower quality overall for
both the citizens and the fire department.
Answer: The RFP was designed to incorporate training between the contractor
and GFD. It is hoped this cooperative training should improve patient care.
11. A problem that I have with the RFP is a fee for the "cost of the Fire Department
member(s) assisting the Contractor personnel, the cost of the Fire Department member's
fire apparatus which is placed out of service during the ambulance transport, the cost
of the two or three other Fire Department personnel assigned to the same fire apparatus
who cannot respond to other emergency calls during the transport, and administrative
costs." The City of Greeley and its Fire Department are already compensated for these
costs through property and sales taxes. To ask or demand reimbursement for those
services from another provider is double dipping and a violation of ethics. Just as,
according to the constitution of the United States, a person cannot be tried for the same
crime twice, so why should the Fire Department get paid twice for the same job? The fire
department and Paramedic Services are in place for the public safety and patient
care!! If the city is so worried about money in the midst of helping critical patients, then
they need to get out of the public service arena and get into stocks, bonds, small
business, or something other than what they are in now. Money is necessary to pay the
bills, but any money that is sought after over the care of the patients health and welfare
is BLOOD MONEY!!
Answer: The RFP is designed to ask the contractor for reimbursement on supplies
and personnel costs for assisting with transport to account for the cost of the service
back to the individual receiving the service. Currently, this cost is paid by the Greeley
tax payer. If the City Council decides to contract for ambulance transport, the cost of
these services would be paid by the citizens and non citizens that use the transport
service. Again, this will be a negotiable item during the RFP process and ultimately City
Councils' decision.
12. If this RFP isn't just about money and power, then explain why the contractor would
have to have "monthly on-duty EMS continuing education training for the Contractor
employees and the GFD employees, three times per month, two times per shift (6
trainings), continuous education training to the City employees for first aid and CPR.
Replace all disposable items used on scene by GFD?"The city doesn't even want to pay
for the training of their own fire department.
Answer: The RFP is designed to have a cooperative training program. Both GFD
and the contractor personnel would design and deliver the continuing medical
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 6
education for all personnel. If both agencies are getting the same training, the patient
care quality will improve.
13. The fee list in section III, subsection G is merely money making. There has been no
mention that Weld County Paramedic Services is not making any response times. In
fact, according to the data released by Greeley Fire, they aren't meeting the national
standard for response times themselves so how Is it right for them to hold anyone
accountable for something they themselves aren't accomplishing?
Answer: GFD sends a report to the City Council that shows overall response times.
This report does not take into consideration all elements of response, i.e. EMD done by
the dispatcher and the response mode for the apparatus can vary. After taking those
elements into consideration, the national standards for emergent and non emergent
responses, GFD complies with all the response times listed in the RFP and the City
Manager's work program.
14. The vague and ambiguous statement that Weld County Paramedics responses are
inefficient needs to be clarified. If there is a problem with response times, bad
medicine, insufficient equipment on scenes, give specifics. This is important since this
was part of the basis for the RFP in the first place.
Answer: WCPS is currently not required to follow any response time criteria. There
are currently no dedicated transport units for the City of Greeley.
15. Another basis for the RFP was that there wasn't oversight from the city council
regarding transport costs or performance standards. Once again, this is misleading at
best. There are performance standards for Weld County Paramedics just as there are for
Greeley Fire personnel. They are on the Weld County website under medical protocols.
Answer: WCPS is currently not required to follow any response time criteria. The
medical protocols do have criteria dealing with time on scene with trauma and
medical patients, but nothing is mentioned in the protocols for response time to the
scene. This issue, at least in part, is the rationale behind GFD employing EMT-I and
Paramedic firefighters on all first response engines.
16. Not to mention that WCPS has been in the Tribune numerous times for the great work
that they do. They are part of a nationally renowned cardiac alert system that is far
better than any other especially in Northern Colorado. And the city wants to get rid of a
service that is the best? Once again, it is politics, politicians, and money that are trying
to rear their ugly heads at the expense of the citizens of Greeley.
Answer: WCPS has provided quality patient care in the City of Greeley. The
Cardiac Alert Program was started after the GFD acquired 12 lead EKG monitors. WCPS
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 7
followed a year later by purchasing the 12 lead machines. The early development of
the Cardiac Alert program was a collaborative effort with NCMC, WCPS and GFD. We
should all be proud of our team effort in this regard. The program has been very
successful. If a different contractor is selected to provide ambulance transport, the
Cardiac Alert Program will continue with the new contractor for the citizens of Greeley.
17. I was taught to not just present a problem, but also to come with a possible solution
to the problem.
18. I propose that in order to save the City of Greeley money, and to make the City of
Greeley safer for its citizens, all ALS equipment be removed from fire department
apparatus and all firefighters maintain and function only at the EMT-B level. I also
recommend that they mothball the tiller, a 3/4 million dollar piece of equipment,
except for actual structure fires. Put the crews into multiple BLS response cars to handle
the non-emergent 9-I-I calls or DON'T GO ON THEM AT ALL. The City of Boulder, which
Greeley Fire likes to quote so often, has a BLS apparatus that handles medical calls with
two firefighters to decrease the cost in both maintenance for a full engine and less staff.
Fire department response is not necessary for a number of calls and this could save the
city a boat load of money.
Answer: City Council and GFD continually review emergency response in the City
of Greeley. Changes are made to improve the quality and cost effectiveness of the
services provided. This RFP process is another step in that review process. The ladder
truck is a requirement of maintaining the City of Greeley's ISO rating. Additionally, The
City of Greeley is a home rule community and by its charter responsible for emergency
response within the city limits of Greeley.
19. By not having the equipment, medications and the necessary training to maintain
the ALS provider level in the fire department, there is a great savings to the city.
Answer: Removing the ALS training and ALS equipment could put our citizens at
risk without an agreement in place that assures certain response times and other
protocols for patient care.
20. Firefighters are trained for numerous things. They fight fires, trench rescue, hazmat,
extrication, fire prevention, inspections, car seat Installation, provide medical care and
I'm sure other things. Unfortunately, this makes them the jack of all trades and the
master of none. We have set the fire fighters up to fail. Even physicians are split into
specialties. No one physician can do it all. You wouldn't go to a podiatrist for a head
problem. We need to help the fire department succeed by taking some of the
responsibility back and giving it to the people that focus only on patient care, the
paramedics in the ambulances that transport the patients.
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 8
Answer: Cross trained Firefighters are becoming the standard in the fire service.
Timely response to emergencies from strategically located fire stations, early treatment
for life threatening conditions, and all hazard response is constantly trained and
performed by firefighters. Again, the results of the RFP will help City Council set the level
of medical qualifications it deems appropriate for GFD personnel.
21. If the Fire Fighter's Union is the one that is pushing for this, then I propose that we get
rid of the union. A union looks after only one thing, the welfare of the employees. While
this is important, there are other things that take higher priority. If we do the things that
are best for the citizens of Greeley, build the department based on those priorities, the
employees and the citizens benefit.
22. As for the safety and service without ALS on the fire department, there is evidence to
prove that the survival rate of cardiac arrest outside of the hospital would potentially go
up with only a paramedic on the responding ambulance.
Answer: As referenced above City Council has requested that this item be on the
2011 work program. Again, the RFP is meant to provide data for the City Council to
determine what it believes is the appropriate mix of trained personnel responding to
various emergency situations.
23. I have multiple studies that prove that 24 hour shifts or longer are dangerous to
provider and patient. They are local and national and prove that fewer paramedics
actually increase survival rates in cardiac arrest. Due to time constraints, I will not read
them but they are here for your inspection.
Answer: There are several factors that contribute to the amount of hours worked
by rescue personnel. There are several checks and balances built into the system to
prevent dangerous situations for personnel and patient care. Shift supervisors and
company are constantly staying on top of these issues and addressing them if need be.
Cardiac arrest survival rates are improved by following treatment nationally recognized
guidelines, medical protocols, and working together as a team. Training together,
practicing together and continuous quality improvement programs make a significant
difference in patient outcome. Multiple paramedics on scene working together can
have a positive impact on patient care. Thank you for providing the notebook of
studies they will be helpful in our analysis.
Questions/Comments from Michelle Main
I am a small business owner in the city of Greeley; a mother of two small children; a
taxpaying, law abiding citizen of the City of Greeley and am here to oppose the RFP put
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 9
forth by the Greeley Fire Department. It is my hope that you will listen to, and further
investigate, what I am sharing with you in the way of information. With this information, I
believe you will find the decision to move forward with this proposal not to be in the best
interests of any and all who are in the City of Greeley.
I am a former employee of a private ambulance service and my expertise as it pertains
to this industry involves patient billing. I have unique information that privileges me to
understand how a bill for an ambulance transport is calculated.
In reference to information laid out in the RFP, comparing the base fees of ambulance
services for ambulance transport is misleading, as billing the actual patient bill involves
other charges in addition to the base rate.
There is bundle billing which includes but is not limited to; the use and administration of
narcotics; procedures and the level of training the provider has that is administering
care...
There is itemized billing which includes but is not limited to; all interventions &
procedures, diagnostics or medications; as well as supplies and personnel utilized
during the care of the patient. It is my understanding after reviewing relevant portions of
the RFP that Greeley Fire honestly believes by changing the current ambulance
provider that one of the benefits would be lower cost overall. This is not the case.
For example: While the base rate of an ambulance in Longmont was $946, or Boulder for
$790, that likely wasn't the final bill. I have with me a comparison of what two different
calls would have been billed for during the care of common patients.
Please review these comparisons at your leisure as they offer significant insight into the
truth about the final cost going out to taxpayers in the City of Greeley.
Please consider that my presence here this evening is in representation of the Heart felt
opinion of many, many other citizens who truly find the current ambulance provider to
be outstanding and trustworthy. Upsetting this element in a somewhat volatile economy
further decreases this general populous' opinion of local governing bodies. I personally
appreciate the difficult position you find yourselves in and find it important to
encompass you with much needed support in making informed decisions.
Please take the time to weigh all that has been brought to you this evening by reading
and considering what you now have in your hands.
Mr. Slade Davis
Mr. David Main and Ms. Michelle Main
May 24, 2011
Page 10
Answer: I believe this information was talked about previously. We recognize there
is bundled billing and line item billing. When you compare the two different patient bills
presented, there is still a significant cost difference to our citizens. Again, these will be
negotiable items during the RFP review process. The information you provided was
important and timely. Once again I thank you for taking the time to address the City
Council.
SinFare fy,
Roy H. CAtto��
City M nager
xc: Greeley Mayor and City Council
Board of Weld County Commissioners
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