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Emergency Medical Services (EMS) and Ambulance2021
Steve Boyack, Katie Andrews, and John Andrews
Ambulance Service History• 1985- Private providers were unable to sustain the
cost of operations. The County was asked to assist financially.
• 1987-Present The County established its own ambulance enterprise fund and contracted with Manteca District Ambulance (MDA) to provide staffing and oversee day to day operations. In July 2016, the MDA contract was negotiated for a five-year term, with an option for five additional one-year terms. The ambulance enterprise fund has total fiscal responsibility to operate a countywide ambulance system, including ownership of all assets, medical billing, and ambulance dispatching. The Fund also pays for the Manteca District Ambulance (MDA) contract that provides for Emergency Medical Technician/Paramedic level staffing.
• 1988- Present- South County voters have approved parcel tax assessments in order to maintain 24/7 advanced life support services in that area. In June 2018, voters approved the annual tax rate to $90 per improved parcel.
Personnel OrganizationTuolumne County Board
of Supervisors
County AdministratorTracie Riggs
Director of Health and Human ServicesRebecca Espino
Assistant Director of Health and Human
Services Steve Boyack
Director of Public Health
Michelle Jachetta
EMS CoordinatorClarence Teem/Katie
Andrews
Medical Director Kim Freeman
Assistant Director of Health and Human
Services Wendy Hoffman Brady
Agency Fiscal Officer Jad Kurdi
Senior Ambulance Billing Technician
Michele Sliker
Ambulance Billing Technician
Jamie Carrillo
Manteca Organization Board of Directors
Chief Executive OfficerWilliam Caldera
Fiscal Administration Billing ManagerMelissa Anaya
Administrative Assistant Stephanie Gutierrez
General ManagerJonathan Andrews
Shift Supervisors / CQIGeorge McKelvie, Rich
Gonzales, Katrina GarciaRelief: Dave Hamric, Jon
Miller, Vince Stroup
Station 50Medic 50Medic 53BLS 8258
Station 51Medic 51
Station 52Medic 52Medic 54
Tuolumne DivisonAdmin Supervisor
Russell Caldera
Shift SupervisorsJeremiah Andrews
Nick ZavodaRelief: Joe Malin
Station 10Medic 10Medic 12Medic 14
Station 11Medic 11Medic 13
Safety Cars
Station 20Medic 20
Station 41Medic 41
Clinical Services Manager
Jennifer Mundy
Fiscal OverviewAmbulance Adopted Budget, FY 2020-21: An Enterprise Fund
Total Revenue: $6,270,285 Total Expenses: $8,406,886
Institutional Care & Services
(Fees)88%
All other Revenues
12%
Revenues
Manteca Contract
51%
All Other Expenses
38%
Vehicles3%
Dispatch Expense
4%
Welfare Admin
1%EMS
Expense3%
Expenses
Medicare35%
Medi-Cal13%
Private Insurance
42%
Private Pay6%
Revenue Recovery
4%
Medicare Medi-Cal Private Insurance
Private Pay Revenue Recovery
Fiscal OverviewPayer Mix for Ambulance Patients FY 2019-2020
Billings Collections
$18,254,298 $5,985,971
Medicare61%
Medi-Cal20%
Private Insurance
14%
Private Pay5%
Medicare Medi-Cal
Private Insurance Private Pay
Ambulance Rate Increase Historyapprox. 30 years
Incremental Change Total
July 1992 12% 12%
January 2001/January 2002 15% / 5% 20%
July 2004/July 2005 20% / 10% 30%
January 2007/July 2008 8% / 8% / 8% 24%
August 2010/January 2011 6% / 6% 12%
July 2016/January 2017 12.5% / 12.5% 25%
Over 30 years, the increase Total: 123%
Fiscal OverviewTypical Advanced Life Support Call
$2,203
$441
$1,762
$122
$490 $334
$461
$346 $-
$500
$1,000
$1,500
$2,000
$2,500
Billed Third Party Insurance MediCare Medi-Cal Fee for Service Medi-Cal Managed Care
Billed Client Pays Insurance PaysClient Pays Medicare Pays GEMT PaysMedi-Cal Managed Care Cost to transport
$832
EMS Agency Responsibility• Plan, implement, evaluate and improve the local
EMS system including prehospital services and relevant hospital services
• Carry out regulations relative to the EMS system –State EMSA sets regulations
• Certify, accredit and authorize EMS Personnel
• Authorize and approve local EMS training programs
• Develop, and approve medical treatment protocols and policies for local EMS service providers
• In collaboration with Public Health, develop local medical and health disaster plans and coordinating medical and health response to disasters
• Designating trauma centers and other specialty care centers
• Determine ambulance patient destinations based upon hospital resources
• Collect, analyze, and report on EMS data and providing that data to EMSA electronically for statewide system evaluation
EMS System Organization
911
Dispatch
Response Assessment
Treatment
Transport Decon/ePCR
Billing
QA/QI & Training
911 and Dispatch• Within Tuolumne County, a citizen or visitor dials 911 and the call is routed to a Public
Safety Answering Point or PSAP.• Tuolumne County Sheriff's Office (TCSO) Dispatch is the local PSAP. • TCSO dispatchers are trained to use Emergency Medical Dispatch (EMD) protocols.
Response, Assessment, and Treatment
Units respond to calls for service when dispatched by the PSAP.Once on scene, crews will do a scene assessment to determine if other resources are needed and perform treatment.
TransportBased on a patient's condition and weather in the region, patients are transported by air or ground.
Destination decisions are made by the Paramedic on scene based on local transportation policies.
Destinations• Most patients are
transported to Adventist Health Sonora; however, some patients require transportation to Regional Trauma or STEMI Centers.
• STEMI = ST Elevation Myocardial Infarction.
• Tuolumne County currently has trauma and STEMI contracts with: Doctors and Memorial in Modesto, and UC Davis for pediatric trauma and burn patients.
DecontaminationAfter each call for service crews clean and decontaminate
the ambulance.
Patient Care Record
A patient care record or PCR is completed after each call.
With funding from CARES, Tuolumne County Ambulance was able to upgrade their PCR system to a more efficient ESO Solutions, a cloud-based system that submits data to the state on behalf of the EMS Agency.
Billing
Michele Sliker Jamie Carrillo
QA/QI
Quality Assurance and Quality Improvement meetings are held every other month with members from Manteca District Ambulance, Adventist Health Sonora, and Tuolumne County Emergency Medical Services Agency to ensure the system is meeting industry standards as well as continuously improving the EMS system.
Flight Nurses, Paramedics, Emergency Medical Technicians and Emergency Medical Responders in Tuolumne County must submit Continuing Education units to TCEMSA every two years when they recertify. Multi-agency trainings also allow EMS within Tuolumne County to build working relationships.
Training
Ambulance Stations and Response Area
LegendResponse Area 2,274 square miles
AMBULANCE STATIONS
Station 10Sonora
Station 20Mono Vista
Station 41Groveland
Station 11East Sonora
Vehicles:• 11 Advanced Life Support (ALS) equipped ambulances• 2 Safety Cars for the transport of psychiatric patients• 1 Ford Explorer 4WD
51395534
6140
6624 66916378
7754
5791
7859 7879 77858114
0
1000
2000
3000
4000
5000
6000
7000
8000
9000
2009 2010 2011 2012 2013 2014 2015 2016 2017 2018 2019 2020
Call Volume 2009-2020
Total Calls
3618
2219
1510
531
3556
1499 1469
612
3533
2036
1387
631
0
500
1000
1500
2000
2500
3000
3500
4000
Station 10 Station 11 Station 20 Station 41
Call Volume by Ambulance Station
2018 2019 2020
6418 6418
1633
65326530 6530
1807
7228
6743 6743
1371
5484
0
1000
2000
3000
4000
5000
6000
7000
8000
Scene Calls Scene Hours Comitted Transfers Transfer Hours Comitted
Time on Task
2018 2019 2020
The Future & Policy Considerations
• Fund Solvency• Change in Payer Mix• Super Rural Medicare
Rate• Enhanced Medi-Cal
Reimbursement• Capital Expenses• Budget Mandates
• Centers for Medicare and Medicaid Services Required Compliance Program
Questions or Comments?• Contacts:
Clarence Teem, EMS Coordinator: • 209-533-7460, [email protected]
Katie Andrews, EMS Coordinator• 209-533-7460, [email protected]
Bill Caldera, CEO, Manteca District Ambulance: • 209-533-5100, [email protected]
Kim Freeman, EMS Medical Director:• 209-533-7401, [email protected]
