Consultants hired for EMS assessment deliver an incomplete draft report
This week, Mono County residents felt a bit like a kid on Christmas morning who has been anticipating a Red Ryder BB Gun, but winds up with a pink bunny suit instead.
For months the County has been eagerly awaiting the results of the Fitch & Associates [the consultant] Emergency Medical Services (EMS) Assessment Report, but when the goods were delivered in draft form, they left much to be desired.
“Everyone has been waiting for the Fitch report to do something,” said Supervisor Vikki Bauer at Tuesday’s Board meeting. “But with the gaps in information, I’m not comfortable moving forward with it.”
Fitch and Associates representative Rick Keller pointed out that Tuesday’s discussion was part of the process.
“That’s the purpose of a draft,” Keller said, to discuss any gaps and fill them. But with an $85,000 price tag, many County residents were expecting more bang for their buck.
The need for the report comes from the ever-growing EMS budget line item. Currently, the cost to the General Fund for the EMS program is $2.9 million.
“The cost is dramatically increasing and we need to put a brake on this,” said Supervisor Byng Hunt.
“We have been here at least five times in the last 25 years because it’s a big expense and it’s not mandated,” added Supervisor Bauer.
County EMS staff is currently made up of 24 medical personnel, the majority of which are paramedics, with just one or two EMTs.
While the Board doesn’t want to change the department from the “Cadillac, primo department that it is,” according to Hunt, it is looking for ideas that would make it more efficient and stop the fiscal drain without impairing service.
One idea the report suggested, at least for a long-term direction for Mono County, would be to consider Community Paramedicine.
According to a March 2012 report from the U.S. Department of Health and Human Services, “Community Paramedicine is an emerging field in health care where EMTs and Paramedics operate in expanded roles in an effort to connect underutilized resources to underserved populations,” which sounds a bit like what the Mono County EMS program currently does.
“Mono County is an ideal place for Community Paramedicine because it is not a cookie cutter program.” Keller said.
Another solution suggested in the Fitch report, which has been a bit more controversial, is to change the system so that an EMS rig would be manned with one EMT and one Paramedic, rather than the current setup of two medics. This switch would be done over time through attrition. Since EMT salaries are approximately 20% less than paramedics, according to an estimate from Mono County District 2 Supervisor-Elect Fred Stump, this would in theory help shrink the strain on the General Fund.
Rick Mitchell, a Paramedic in the County for 28 years and a resident for 38, said the EMT/Paramedic set up had been tried before.
“That’s the program that I was hired under [as an EMT],” Mitchell explained. “I was told, jokingly, at the time that I would have to wait for someone to die to get a job as a medic.”
Mitchell waited, and indeed, it was not until a former Paramedic passed away that he was bumped to a Paramedic position.
“If you go with that scenario, you won’t have another medic hired until 12 people leave,” Mitchell said, referring to half of the current 24-member EMS department.
Another Mono County Paramedic, Julien Lecorps, pointed out that this could lead to a negative situation for the County.
“I left Mammoth Mountain Ski Area five years ago to pursue a career as a Paramedic and I was able to stay in Mono County and do so,” Lecorps explained. “If you have a Paramedic/EMT setup, people will have to either leave the area or not pursue a medic position. You will lose young people who want to stay in the area and pursue this career.”
Another issue is whether or not to continue to train Paramedics with some firefighting skills.
“We want to make the program as valuable as possible,” Mitchell explained, which he why he believed the firefighter training should remain.
Supervisors Larry Johnston and Tim Hansen agreed.
“I think it’s OK to have it [EMS] be a General Fund Department, but public employees should be able to do more than one thing, especially in rural areas,” Johnston said.
“We need to utilize the paramedics however we can, otherwise they’ll be watching TV all day,” Hansen added.
It appears that a lack of connection with all parties involved made the Fitch report less valuable than expected. The lack of outreach became alarmingly clear when Mono County Sheriff Rick Scholl approached the podium.
“The report quotes the Sheriff, but I have never seen nor commented on the report,” Scholl said. He added that Sergeant Mike Booher of the Mono County Sheriff’s Department had met with someone from Fitch, but that he told Scholl the report did not accurately reflect the procedures of the Sheriff’s department.
Mitchell pointed out that the medics had not been approached either in order to give input.
In addition, Fitch touted that it would be going out to the community to gather input from the public on what it wanted in its EMS Program. However, as Stump pointed out to the Board on Tuesday, there was little to no publication of the times and places of the public meetings, which were held this week in case you hadn’t heard. (See the sidebar below for the meeting that The Sheet found out about at the last minute and was able to attend.)
“Perhaps we need to have another round of public outreach with better announcements,” Stump suggested to the Board.
The report also lacked any discussion of the County going to a private EMS system, and it completely failed to discuss Mono County’s coverage of Hwy 6.
“This document needs to carry us into the future,” Bauer said. “So we need to go back to the table and do it right. We need to get our notes in order and move forward.”
In the meantime, the County is also in the midst of contract negotiations with EMS personnel.
EMS public hearing missing “public”
A public meeting Monday evening with Fitch & Associates, the consulting group, which rolled out its Draft Emergency Medical Services Assessment Report, included several industry professionals and Dr. Rick Johnson, Inyo and Mono Public Health Director, but no members of the public.
Fitch representative Rick Keller, who facilitated the discussion of the report’s recommendations, said that the Mono County Board of Supervisors is interested in collecting “perspectives,” and that the draft is being circulated for input before finalization, but most in the room agreed that the public was not adequately advised of the meeting, and suggested another round of meetings be held.
Other “Town Hall” meetings were held in Crowley, Chalfant and Bridgeport.
At the Mammoth meeting, Keller advocated the trend toward “Community Paramedicine,” which would help the County focus on healthcare needs relative to its community, and essentially disregard the vast majority of one-size-fits-all state approaches.
“Winter accidents, for example, are certainly different in Mono,” he said rhetorically. “You have 14,000 people living in the county and average 1,600 [EMT] runs a year. That’s too small a sample size to extract much in the way of trends and percentages, but Mono’s weakness is also its advantage. You have good critical access to hospitals, but limited clinics and home-based healthcare.” It’s easy to sell the state, he said, on a Community Paramedicine pilot program, since Mono is “an excellent candidate,” especially in light of a recent tribal clinic closure, leaving basically none in operation on county tribal lands.
Keller said the industry is pursuing the program idea as one way of trying to figure out how healthcare will evolve under Obamacare
“Yolo and Contra Costa counties want a pilot program, but Mono might be more of a no-brainer or no-risk option,” Keller added. Lack of definition on how the program will be funded, as well as a lack of any formal regulations or codes drew some hesitation from paramedics and hospital staff.
“Reimbursement is a factor to be worked out,” Johnson noted. “Some of that could be realized from hospital savings, or increased revenue on the pre-hospital side [i.e. certain on-site treatment and transport fee increases] could be the other part.”
Some models being considered as funding options: reimbursements based on quality of care, using metered customer satisfaction responses. “Those types of things are coming,” Keller advised.
While the report incorporated a fair amount of data, according to Keller, one major need that seemed to be reoccurring was for more data and dispatch information, and a central way to correlate individual agencies’ response logs, including on scene communications and run times. How that would impact the Mono Sheriff’s Department, which handles the bulk of the County’s central 911 dispatch duties, remains to be seen.