1. Managing the Future September 23, 2009

2. Basic Life Support (BLS) Sudbury established ambulance service 1976 Emergency Medical Technicians – Basic (EMT-Bs) Statewide Protocols Bandaging, stabilizing, transporting Cardiac defibrillation Epinephrine – Epi Pen Glucose, albuterol

3. Advanced Life Support (ALS) Emerson started ALS service in 1982 One of 23 hospital-based services Emergency Medical Technicians – Paramedic (EMT-Ps) Statewide Protocols Intubation, 12 lead cardiac monitor, Intravenous (IV) fluid replacement, 44 medications, advanced assessments Loss Leader

4. Sudbury Runs BLS = 988 (2008) @ $576.07 per run ALS = 385 (2008) – adds $108.03 Cost of service ranges from $250 - $265 39% of calls are ALS 56% of ALS calls are billable 46% of billable calls are Medicare (101 calls) Total Sudbury Revenue for FY09 = $354,367.52

5. Emerson Hospital FY07 loss on operations $8.7 million (Boston Globe 3/21/08) ALS loss at least $100,000 per year No more loss leader Continue ALS operations until September 2010

6. Central Middlesex Emergency Medical Services Collaborative (CMEMSC) Established September 2008 13 Emerson service communities (with Emerson as member) Purpose – Design replacement regional ALS delivery system

7. Central Middlesex Emergency Rescue Authority (CMERA) Bullet Point 1 - Governing body of regional ALS service Bullet Point 2 - Centralized dispatch for “all-in” communities Bullet Point 3 - Vendor-provided regional ALS service Bullet Point 4 - Centralized billing Bullet Point 5 - Development of local fire-based ALS service buttressed by regional backup

8. Governing Body Executive board (including 3 member Fire Chiefs) Set rates, reimbursement Select vendors (with member approval) Establish regional rules

9. Centralized Dispatch ALS vehicles GPS equipped Choose closest response Valid data collection Data analysis and continuous improvement Manage by measuring

10. Vendor-Provided ALS Service Initial system ALS provider “Scaffolding” - provide backup to local, fire-based ALS services Training QA/QI – Quality Assurance/Quality Improvement

11. Centralized Billing Common rate Medicare + 200% Essential to fund system Bill for Assessments ALS service 30% of runs Assessments additional 30% of runs Expertise in billing under new paradigm

12. Development of Local, Fire- Based ALS Services Each community that desires will establish local, fire- based ALS system (Wayland model) Local ALS vehicles will be available for regional dispatch Regional reimbursement will go to local ALS provider ($400) Closest vehicle dispatched Regional ALS provider will “plug holes” with dynamically deployed ALS truck(s)

13. Service Participant Agreement (“All-In”) Abide by the rules established by the CMERA governing board. This board will be made up of three Fire Chiefs periodically elected by CMERA members from CMERA participating towns. Pay $450 (or other fee as may be voted on by CMERA) to the CMERA system per ALS service or assessment incident. ($400 for the ALS vendor; $50 for CMERA.) Conduct all billing through the CMERA selected billing vendor.

14. Service Participant Agreement (“All-In”) Utilize the CMERA established billing rate or other rate that may be voted on by CMERA in the future. This is presently Medicare + 200%. For those towns with no local fire-based ALS service - Direct all requests for ALS service through the CMERA ALS dispatch center.

15. Service Participant Agreement (“All-In”) For those towns with local fire-based ALS services, Make their ALS units available for regional dispatch. For regional dispatch, accept $400 as the regional reimbursement for services. For local dispatch in the member's community, Charge CMERA rate (presently Medicare + 200%) which will be kept by the local community. Alert central dispatch of local response and provide essential data for effective central record keeping. Install a GPS tracking device on ALS participating ambulance for use by CMERA in tracking and dispatching ALS calls. Installation, maintenance, and tracking costs to be paid by the regional ALS vendor. Each community will have remote access to GPS tracking system.

16. Selectmen Actions Endorse immediate increase billing rate to Medicare + 200% (previously voted) Provides funding for SFD ALS service development Increase revenue Offsets decrease in January 2010 Medicare rates Vote to be “All-in”