Fire Command Staff is currently exploring options to maximize efficiencies including cost recovery, related to emergency ambulance transport services. This is a follow-up Staff Report addressing City Council questions of moving forward with a Brea-only deployment or a shared deployment with the City of Fullerton Fire Department.
Brea and Fullerton Fire Departments contracted with AP Triton in 2016 to conduct an Emergency Medical Services (EMS) Study analyzing the cities’ current practices and recommendations to share emergency ambulance transport services. AP Triton are the EMS subject matter experts within California and have handled this process for several Orange County cities such as Anaheim, Fountain Valley, and Fullerton.
The emergency ambulance transport options for the Brea Fire Department and to assert our obligation to administer ambulance services under Health and Safety Code Section 1797.201 are as follows:
1. Contract with Private Contractor:
Brea would issue a Request for Proposal (RFP) for a private ambulance contractor. This would mimic the service we are currently engaged in, but through a competitive process. This scenario would designate a monetary pass through for our Advanced Life Support (ALS) services. The private ambulance contractor would be responsible for the billing, apparatus, and personnel. There would be no outlay of funds from the City. The private ambulance contractor captures most of the available insurance revenues and passes through the designated ALS amount to the City. In this scenario, the private ambulance contractor takes the lead on billing.
2. Public/Private Partnership:
Brea would issue a RFP for an ambulance subcontractor for personnel and apparatus and a separate RFP for a billing company subcontractor. The billing subcontractor would handle the billing for Brea for a flat fee or percentage of monies collected. Brea would also pay a negotiated contract amount to the ambulance subcontractor. This scenario allows Brea to capture all of the available insurance revenues and then pays its two subcontractors. Please note that some insurance reimbursements aren’t available to private companies. In this scenario, the City takes the lead on billing.
3. In-House:
Brea would issue a RFP for a billing subcontractor only and the City provides the ambulances and personnel to run the program. This allows Brea to capture not only all available revenues, but also the overhead built into an ambulance subcontract agreement. In this scenario, the City takes the lead on billing, the initial capital outlay of apparatus and equipment, and the creation of a new employee classification.
Below are the questions from the August 18, 2020 City Council meeting and the corresponding answers:
- Can AP Triton provide a proposal for Brea only to deliver emergency ambulance transport services?-Yes. The attached proposal outlines the same three phases providing the valuation of Brea only and corresponding deployment options, RFP for a private contractor, subcontractor, and/or billing subcontractor. The cost will be $125,000. Including estimated travel costs and after reimbursements explained later in this report, the net cost to Brea is estimated to $42,250.
- If a joint proposal between Brea and Fullerton is approved and Brea decides to move forward on their own based upon the proposed deployment models, does Fullerton still agree with splitting the costs of the proposal?-Fullerton is partnering with Brea in this process with the intent to move forward with a shared emergency ambulance transport service. If Brea determines that it is in their best interest to handle this service on their own, then Brea would reimburse Fullerton, $21,000 for the difference between Brea's share of the Phase I cost under the joint proposal ($9,000) and the Phase 1 cost of the stand alone proposal ($30,000) and continue with Phase 2 and 3.
- If a joint proposal between Brea and Fullerton is approved, can AP Triton invoice each city separately for their designated cost?-Yes, AP Triton can invoice as requested.
Please see the two attached proposals from AP Triton for Brea only and shared between Brea and Fullerton. Both proposals include services in three phases: 1) an EMS system valuation study, 2) assistance with an ambulance services subcontractor RFP, and 3) assistance with a billing subcontractor RFP. It is important to note, that in both proposals, the costs for Phases 2 and 3 are anticipated to be reimbursed to Brea and Fullerton from the successful bidder(s) in the RFP process.
AP Triton Proposal between Brea and Fullerton Fire Departments (Joint Proposal)
Brea and Fullerton Fire Departments will split the costs associated with the phases above based upon each city’s transport volume, which equates to a 25/75 percent split.
- 2019 EMS transports from Fullerton: 6,613 (75% share)
- 2019 EMS transports from Brea: 2,209 (25% share)
Below outlines the details of AP Triton’s proposal for Brea and Fullerton Fire Departments:
Phase 1 – EMS System Valuation Study
- Review the cost/revenue analysis that was done in 2016 (including an assessment of the region’s insured and non-insured payer mix categories relative to cities/counties with similar populations and demographics) for various delivery models.
- Recommend a path forward, compile data into a report for the two departments, and develop presentations for the departments, City Councils, citizens, etc.
Cost: $36,000 (discounted to take into account the previous work that was done jointly in 2016)
Phase 2 – Ambulance Services Subcontractor RFP
- Develop and assist with the issuance of an RFP to solicit private providers.
- Assist in reviewing the responses, development of scoring sheets for the interview process, establish a review/interview panel, and assist in developing a contract.
Cost: $85,000
Phase 3 – Ambulance Billing Subcontractor RFP
- Develop and assist with the issuance of an RFP to solicit private providers.
- Assist in reviewing the responses, development of scoring sheets for the interview process, establish a review/interview panel, and assist in developing a contract.
Cost: $10,000
The total cost of the services listed above is $131,000. The costs listed above do not include travel which may be required. Any travel costs shall be pre-approved by Brea Fire Department and invoiced separately at actual costs. Staff is recommending an amount not-to-exceed 10% of the total contract amount or $13,000 be authorized for any travel costs approved or other contingencies for a total contract amount not-to-exceed $144,000.
The total cost will be shared based on the 25/75 percent split between the City of Brea and City of Fullerton Fire Departments. Brea’s portion of the total not-to-exceed cost is $36,000. Additionally, it is anticipated that the contract costs (excluding the out-of-pocket costs) associated with Phases 2 and 3 ($95,000) will be reimbursed from the successful bidder(s). Brea’s 25% share of the reimbursement would be $23,750. This results in a net cost to Brea of $12,250.
AP Triton Proposal for Brea Fire Department
The Brea fire Department will assume all costs of the proposal with the intent of choosing one of the three options for emergency ambulance transport. Below outlines the details of AP Triton’s proposal:
Phase 1 – EMS System Valuation Study
- Review the cost/revenue analysis that was done in 2016 (including an assessment of the region’s insured and non-insured payer mix categories relative to cities/counties with similar populations and demographics) for various delivery models.
- Recommend a path forward, compile data into a report for the Brea Fire Department, and develop presentations for the department, City Council, citizens, etc.
Cost: $30,000
Phase 2 – Ambulance Services Subcontractor RFP
- Develop and assist with the issuance of an RFP to solicit private providers.
- Assist in reviewing the responses, development of scoring sheets for the interview process, establish a review/interview panel, and assist in developing a contract.
Cost: $85,000
Phase 3 – Ambulance Billing Subcontractor RFP
- Develop and assist with the issuance of an RFP to solicit private providers.
- Assist in reviewing the responses, development of scoring sheets for the interview process, establish a review/interview panel, and assist in developing a contract.
Cost: $10,000
The total cost of the services listed above is $125,000. The costs listed above do not include travel which may be required. Any travel costs shall be pre-approved by Brea and Fullerton Fire Departments and invoiced separately at actual costs. Staff is recommending an amount not-to-exceed 10% of the total contract amount or $12,500 be authorized for any travel costs approved or other contingencies for a total contract amount not-to-exceed $137,500.
It is anticipated that the total cost of $95,000 for Phases 2 and 3 will be reimbursable to the Brea Fire Department from the successful bidder(s) in the RFP processes. This results in a net impact for the Brea only option to the City's General Fund of $42,500.
EMERGENCY AMBULANCE PROPOSAL
Emergency Ambulance the current Brea provider for EMS transport has provided the City with the attached letter proposal for consideration. The City Attorney's office has indicated acceptance of this proposal does not conform with Health and Safety Code 1797.201 (201 Rights) as these services must go through a cooperative bid proposal. The letter proposal mirrors the public/private partnership we are seeking to achieve; however, as previously stated the City must bid this service out. |
The intent of working with the City of Fullerton on a shared emergency ambulance transport service is to capture the economies of scale associated with determining the financial feasibility of delivering this service, partnering with a larger organization with a larger associated call volume to create a more flexible, self-reliant transport system, and to utilize this partnership to deliver a professional service in the most responsible manner.
It is recommended that the Brea and Fullerton Fire Departments share this proposal and enter into an professional services agreement with AP Triton for Emergency Medical Services system valuation study, recruitment of emergency ambulance transport service and billing subcontractors for a contract amount of $131,000, plus up to 10% of the contract amount for travel or other costs for a total not-to-exceed amount of $144,000. The costs would be shared and billed separately to Brea (25%, not-to-exceed $36,000) and Fullerton (75%, not-to-exceed $108,000). Additionally, it is anticipated Brea would be reimbursed $23,750 for the cost of Phases 2 and 3 services from the successful bidder(s) in the RFP processes.resulting in a net General Fund Impact to Brea of $12,250. |