Emergency Medical Services A Systems Approach

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Emergency Medical ServicesA Systems Approach

• EMS Code Task Force
• 2006 to 2009

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Executive Summary

• Recent historical events changing the landscape
  of EMS in Idaho
• Medicare reimbursement cuts (2002)
• Repeal of local governmental authorization in
  rule by EMS Bureau (2003)
• Big Sky vs. Sagle Fire District (2004)
• IOM report (2007)
• Ada County vs. Kuna Fire District (2007)

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History of Task Force

• Began as a Idaho State Fire Commissioners
  Association task force to rewrite fire district
  law to include the provision of EMS.
• Realization that 3 separate sections of law are
  intermingled and must be addressed together.
• Fire District statutes (Title 31, Chapter 14)
• Ambulance District statutes (Title 31, Chapter
  39)
• State EMS statutes (Title 56, Chapter 10)
• EMS Rules
• New task force created under 3rd party
  facilitation coordinated by the EMS Bureau

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EMS Code Task Force

• Idaho Association of Counties
• Association of Idaho Cities
• Idaho State Fire Commissioners' Association
• Idaho Fire Chiefs Association
• Idaho Hospital Association
• State EMS Bureau
• EMS Physician Commission

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Whats the problem?

• No Mans Land
• Conflicts with overlapping jurisdictions
• Inconsistent levels of care and coverage
• Conflicting medical direction
• Ambiguous and archaic statutes
• No framework for collaboration
• Funding issues and disputes

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Purpose of Task Force

• Recognition that many different types of
  organizations provide EMS services
• Coordination of EMS among counties, cities, fire
  districts, and medical community
• Assure system accountability and retain local
  agency autonomy
• Develop an EMS System of interdependent EMS
  agencies
• Draft legislation to create EMS Systems

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EMS System Vision

• Optimal patient care through structure and
  collaboration among elected officials,
  administrative leaders, and the medical community
  across all EMS agencies within a geographic area

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Process

• Forming Storming
• Norming Performing
• Task Force stakeholders reached consensus in the
  interest of patient care

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Results

• Formation of EMS Systems that encompass all EMS
  agencies
• Patient-Centered
• Effective
• Efficient
• Countywide or greater coverage throughout Idaho
• Stakeholder representation and coordination
• Proposed legislation

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EMS System Organizational Structure
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Governance

• All counties form an Emergency Medical Services
  System (EMSS) District
• All ambulance districts become EMSS districts
• The governing board of the EMSS district
• County commissioners
• OR
• 3-5 Freely elected EMS Commissioners, elected
  during a general election after a petition is
  filed with the BOCC.

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Governing Board

• 3 Member Board
• BOCC
• or
• 3-5 Freely Elected Commissioners

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Governance trigger point

• When a majority of the majority (two or more
  groups) of stakeholder groups petition the BOCC
  for the alternate form of governance.
• -Majority of Cities AND/OR
• -Majority of Fire Districts AND/OR
• -Majority of County Commissioners
• Once a valid petition is received, the BOCC will
  begin alternate governance implementation process.

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Governing Board Duties

• Approves levies
• Charge and collect fees
• Fiduciary agreements
• Adopt rules and regulations
• Enforce orders and rules
• Acquire necessary personnel and equipment

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Administrative Authority

• Administrative Council
• Board
• EMS transport representatives
• EMS non-transport representatives
• Medical Authority
• Hospital/Clinic

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Administrative Authority

• ADMINISTRATIVE COUNCIL -- COMPOSITION. All
  members of the administrative council must have a
  service area within the authority boundaries. The
  members will include the following
• The members of the authority board described in
  section XX-XX15,
• A representative of a clinic district or hospital
  that regularly receives patients from the
  authority,
• The chief administrative official or designee of
  each licensed ambulance providing 911 service
  operating within the authority area,
• The chief administrative official or designee of
  each licensed non-transport EMS agency providing
  911 service operating within the authority area
  if one or more exists, and
• The chairman or designee of the chairman of the
  medical directorate described in section XX-XX55,
  Idaho Code for the authority.
• Additional members may be appointed by the
  authority board at the authority boards
  discretion.

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Administrative Council Duties

• Responsible for the EMSS district budget
  management and operations plan
• Recommends EMS agency changes in clinical or
  transport capability
• Recommends whether new EMS agencies should be
  permitted to function in the district

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Medical Authority

• Medical Authority
• All Medical Directors within the District
• Medical Authority appoints a Chairperson

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Medical Authority

• The District must have a medical authority
• May be configured several different ways
• Unresolved disputes within the medical authority
  may be referred to the EMS Physician Commission

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Medical Authority Duties

• Develop Medical Supervision Plan
• Determine scope of practice
• Assess clinical impact
• QA/QI programs

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System Funding

• An EMSS district levy is optional
• One time option to adjust levy to the level
  allowed by current law (.0004)
• Option to move to .0006 by 2/3 vote of the people
• After establishment, budget increases subject to
  existing law

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System Funding cont

• The governing board sets the user fees charged
  for EMS agency responses
• EMSS district revenues (user fees) are deposited
  into the dedicated district fund for EMS services
  (See Section 10)
• Existing EMS resource allocation by other
  stakeholders may be continued

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Individual Agencies

• Every EMS agency is accountable to and
  responsible for participation in the system
• Every EMS agency is grandfathered at their
  current licensure level
• No current EMS agency can be eliminated or
  reduced without unanimous decision of the
  Governing Board

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Statutory changes

• Ambulance district law becomes EMS district law
• Fire district laws will have modifications
• EMS rules and licensure process will change
• EMS rules will provide additional guidance
• Fines will be the primary method of penalty for
  agencies failing to conform to district or state
  requirements

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Whats next?

• Provide education
• Solicit feedback
• Finalize legislative language
• Secure legislative sponsors and support from
  stakeholders
• Work together to pass legislation

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Questions?

• EMS System Vision
• Optimal patient care through structure and
  collaboration among elected officials,
  administrative leaders, and the medical community
  across all EMS agencies within a geographic area

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The current position of the IFCA

• IFCA members recommended opposing legislation
• UNLESS the following sections can be amended
• Change XX-XX03. ESTABLISHMENT OF EMERGENCY
  MEDICAL SERVICES SYSTEM AUTHORITY EMPLOYEES OF
  AMBULANCE DISTRICTS. The IFCA believes there
  should be complete autonomy between the political
  authority and any agency/group of employees. We
  do support the authority having administrative
  support staff if needed.
• Clarify XX-XX31. ADMINISTRATIVE COUNCIL --
  OPERATION. Voting authority on all matters is
  limited to the authority board except as
  delegated to the council. Re-word to ensure every
  council member has a vote if granted on an issue
  by the authority.
• Clarify XX-XX29. ADMINISTRATIVE COUNCIL --
  COMPOSITION. All members of the administrative
  council must have a service area with in the
  authority boundaries. Re-word to ensure only
  those agencies providing 911 service are council
  members. Non-911 agencies could be added as
  ad-hoc members without voting authority.