Ambulance Ambulance Response TimesResponse Times

Tim Meyer, DirectorTim Meyer, Director

North Dakota Department of North Dakota Department of HealthHealth

Division of EMS and TraumaDivision of EMS and Trauma

December 2, 2008December 2, 2008

North Dakota Ambulance North Dakota Ambulance ServicesServices

139 ground ambulance services 139 ground ambulance services 120 BLS, 19 ALS120 BLS, 19 ALS

5 air ambulance services5 air ambulance services ALS services do 72% of all calls in ALS services do 72% of all calls in

ND.ND. Over 3,400 EMS workers in NDOver 3,400 EMS workers in ND

88% are volunteers88% are volunteers Average age is 42; 17% are over 65Average age is 42; 17% are over 65

What Are the Costs of What Are the Costs of EMS?EMS?

It costs between $250,000 and It costs between $250,000 and $300,000 per year for each ambulance $300,000 per year for each ambulance service (estimated at $40m to $50m per service (estimated at $40m to $50m per year statewide).year statewide). Labor.Labor. Vehicle expenses; depreciation, fuel, Vehicle expenses; depreciation, fuel,

maintenance.maintenance. Medical supplies.Medical supplies. Personnel training.Personnel training. Building/facilities.Building/facilities.

Who Pays for EMS?Who Pays for EMS?

$2.8m in local taxes on behalf of EMS. $2.8m in local taxes on behalf of EMS. $1.25m state staffing grant (625k per $1.25m state staffing grant (625k per

year).year). $1.24m state training grant (620k per $1.24m state training grant (620k per

year).year). Volunteer labor (est. $17m to $21m per Volunteer labor (est. $17m to $21m per

year).year). Third party payors: Medicare, Medicaid, Third party payors: Medicare, Medicaid,

Blue Cross Blue Shield, etc. (est. $23m to Blue Cross Blue Shield, etc. (est. $23m to $33m per year).$33m per year).

Data CollectionData Collection

Data regarding each ambulance call must Data regarding each ambulance call must be submitted to the Department (NDAC be submitted to the Department (NDAC 33-11-01.2-10(5)).33-11-01.2-10(5)).

Web-based system called SOAR Web-based system called SOAR (Statewide Online Ambulance Reporting).(Statewide Online Ambulance Reporting).

Our dataset matches national Our dataset matches national requirements.requirements.

In 2007 we received data from over In 2007 we received data from over 57,000 ambulance calls.57,000 ambulance calls.

Response Time DataResponse Time Data

We collect the following times:We collect the following times: 911 call time.911 call time. Time notified by dispatch.Time notified by dispatch. Time enroute.Time enroute. Arrive scene time.Arrive scene time. Depart scene time.Depart scene time. Arrive at facility time.Arrive at facility time. Time available for next call.Time available for next call. Time back in quarters.Time back in quarters.

Response Times Data Response Times Data ProblemsProblems

Subjective – self reporting.Subjective – self reporting. Probable errors:Probable errors:

Frontier counties have an average response Frontier counties have an average response time of over 55 minutes (DOT FY 2007). time of over 55 minutes (DOT FY 2007).

Multiple entries of over 1.5 days.Multiple entries of over 1.5 days. Not uniformly using a 3Not uniformly using a 3rdrd party (dispatch) to party (dispatch) to

record times.record times. Services are not reporting all calls to us.Services are not reporting all calls to us.

Cancelled runs, no transports, stand-bys, Cancelled runs, no transports, stand-bys, DOA, etc.DOA, etc.

Who Cares?Who Cares?

National push for public reporting of National push for public reporting of health quality data:health quality data: Health plans - 1998Health plans - 1998 End stage renal disease facilities - 2001End stage renal disease facilities - 2001 Nursing homes - 2002Nursing homes - 2002 Home health - 2003Home health - 2003 Hospitals - Hospitals - April 2005April 2005 Clinics – Clinics – forthcomingforthcoming EMS – within next 5 yearsEMS – within next 5 years

Quality and Pay for Quality and Pay for PerformancePerformance

2005 – 2007 hospital Medicare payment 2005 – 2007 hospital Medicare payment updates (periodic increases) tied to updates (periodic increases) tied to quality; “Pay for Performance”.quality; “Pay for Performance”.

Ambulance services will be reimbursed Ambulance services will be reimbursed in this manner in the future.in this manner in the future. Response times will be a quality indicator Response times will be a quality indicator

for ambulance services.for ambulance services. 2007 Legislature requires us to establish 2007 Legislature requires us to establish

response time standards for ambulance response time standards for ambulance services. services.

What if We Do Nothing?What if We Do Nothing?

Aging workforce will eventually = less Aging workforce will eventually = less volunteers.volunteers.

Failing to meet basic quality indicators Failing to meet basic quality indicators will = less payment to ambulance will = less payment to ambulance services.services.

Less funds will = less ambulance Less funds will = less ambulance services.services.

Less ambulance services will = longer Less ambulance services will = longer response times for the public and more response times for the public and more burden on remaining ambulance services.burden on remaining ambulance services.

Our PlanOur Plan

Encourage EMS system development.Encourage EMS system development. Improve the quality of the EMS delivery Improve the quality of the EMS delivery

system.system. Assist ambulance services in establishing their Assist ambulance services in establishing their

own quality assurance processes.own quality assurance processes. Monitor patient care benchmarks.Monitor patient care benchmarks. Establish response time standards.Establish response time standards.

Educate EMS providers to improve communications Educate EMS providers to improve communications with dispatch.with dispatch.

Give the public the best possible emergency Give the public the best possible emergency care.care.

What can PSAPs do?What can PSAPs do?

PSAPs are the gate keeper of PSAPs are the gate keeper of response time data – Objective Third response time data – Objective Third Party.Party.

Is it possible to get an export file on a Is it possible to get an export file on a monthly basis?monthly basis? 911 call time, time notified by dispatch, 911 call time, time notified by dispatch,

time enroute, arrive scene time, depart time enroute, arrive scene time, depart scene time, arrive at facility time, time scene time, arrive at facility time, time available for next call, and time back in available for next call, and time back in quarters.quarters.

ContinuedContinued

The Health Department would do all The Health Department would do all QA activity.QA activity.

We will work to improve the We will work to improve the communications of EMS agencies.communications of EMS agencies.

Questions????Questions????

Tim Meyer, DirectorTim Meyer, Director

Division of EMS and Division of EMS and TraumaTrauma

North Dakota Dept. of North Dakota Dept. of HealthHealth

600 E. Blvd. Ave., Dept. 600 E. Blvd. Ave., Dept. 301301

Bismarck, ND 58505-0200Bismarck, ND 58505-0200

701-328-2388701-328-2388

tmmeyer@nd.govtmmeyer@nd.gov

ndhealth.gov/emsndhealth.gov/ems

Lindsey Narloch, Research Lindsey Narloch, Research AnalystAnalyst

Division of EMS and Division of EMS and TraumaTrauma

North Dakota Dept. of North Dakota Dept. of HealthHealth

600 E. Blvd. Ave., Dept. 301600 E. Blvd. Ave., Dept. 301

Bismarck, ND 58505-0200Bismarck, ND 58505-0200

701-328-2388701-328-2388

lindseybnarloch@nd.govlindseybnarloch@nd.gov

ndhealth.gov/emsndhealth.gov/ems