SAN JOSE CAPITAL OF SILICON VALLEY

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1 PSFSS AGENDA: 9/17/2015 ITEM: (d) 6 CITY OF SAN JOSE CAPITAL OF SILICON VALLEY TO: PUBLIC SAFETY, FINANCE, AND STRATEGIC SUPPORT COMMITTEE Memorandum FROM: Curtis P. Jacobson SUBJECT: FIRE DEPARTMENT EMERGENCY DATE: September 10, 2015 MEDICAL SERVICES PATIENT TRANSPORT FEASIBILITY STUDY STATUS REPORT (a) Accept the status report on the feasibility of the San Jose Fire Department assuming emergency medical services patient transport responsibility within Santa Clara County. (b) Authorize the Fire Department to issue a Request for Qualifications (RFQ) for a potential public/private partnership for emergency medical services patient transport. (c) Refer the Fire Department Emergency Medical Services Patient Transport Feasibility Study Status Report to the full City Council for the October 6, 2015, City Council Meeting. BACKGROUND Santa Clara County maintains jurisdictional responsibility to provide Emergency Medical Services (EMS) and Advanced Life Support Services (paramedic services), including patient transport within the county. Rural Metro was awarded the County contract and 2011 and currently provides patient transport. Under the current contract, the San Jose Fire Department provides the "first response" paramedic services to emergency medical calls in San Jose, and often provides patient stabilization and treatment until the Rural Metro ambulance arrives. The current contract expires June 30, 2016, and the County is considering whether to extend the current contract or issue a Request for Proposals for this service. It is the Administration's position that a contract extension is not considered an acceptable option for a number of reasons. Over the past several years, the current, contracted ambulance provider has been struggling operationally and financially. As a result, the County has found it necessary to provide financial relief through a number of contract amendments, supporting the conclusion

2 PUBLIC SAFETY, FINANCE, AND STRATEGIC SUPPORT COMMITTEE September 10,2015 Subject: EMS Transport Feasibility Study Page 2 that the current model is not financially sustainable. Additionally, the current system lacks coordination and integration between the contracted ambulance provider and Fire Department first response units. The Santa Clara County Fire Chiefs' Association (FCA), representing a coalition of 10 agencies, has also weighed in with concerns regarding the existing system and their desired outcomes of the EMS system in its letter to the Santa Clara County Emergency Services Agency providing input regarding the Exclusive Operating Area Request for Proposal (see FCA letter attached to this memo). This letter states that the FCA "seeks to create a stable, and exceptional EMS system by developing a customer-focused and sustainable ambulance delivery model that improves clinical quality, creates operational efficiencies, leverages existing emergency response resources, eliminates redundancy and increases standardization." Please note that the San Jose Fire Department has assumed the lead role in this coalition. In its letter, the FCA identified RFP recommendations that represent the combined interest of all of the agencies within Santa Clara County. Given the concerns with the current service delivery and potential opportunities for a more efficient and effective service delivery model, the Mayor's March Budget Message for Fiscal Year , as approved by the City Council, directed the City Manager to work with other local public safety agencies to craft a Feasibility Study of the Fire Department's assumption of patient transport, and report the findings to the Public Safety, Finance and Strategic Support Committee before fall The Santa Clara County Fire Chiefs agreed to participate in an Emergency Medical Services (EMS) Feasibility Study and AP Triton LLC was selected as the vendor to conduct the feasibility study which is currently in process. ANALYSIS The current EMS Provider Agreement between Santa Clara County and Rural Metro is due to expire June 30, At this point, it is not clear whether the County will extend the current Agreement or release an RFP. The goal of the EMS Transport Feasibility Study is to determine if participating in a future Santa Clara County Ambulance RFP would be in the best interest of the Department, the City of San Jose, and the residents of Santa Clara County. Components of the Study include determining the economic value of the EMS System, providing an analysis of several EMS transport delivery model options to determine the feasibility of participating in the County's RFP, and identifying necessary remedies for a sustainable system, both financially and operationally as noted in the attached Fire Chiefs' Association letter. A well-functioning and financially sustainable EMS system must include a rate structure that will recover costs and minimize risk. The service rates necessary to deliver the service must be carefully considered and properly aligned with costs. Also, operational sustainability and improvements as related to innovation, reliability, system coordination, and improved patient outcomes are critical elements to a successful service delivery model. It is important to note that there are risks that must be considered when considering any service delivery model. Based on the work to date on the Feasibility Study, four service delivery models were identified for consideration:

3 PUBLIC SAFETY, FINANCE, AND STRATEGIC SUPPORT COMMITTEE September 10, 2015 Subject: EMS Transport Feasibility Study Page 3 Option 1: The San Jose Fire Department provides 100% of the ambulance service using cross-trained Firefighter Paramedics. Under this model, the San Jose Fire Department would assume responsibility for transport services for the entire Santa Clara County. Given the significant start-up costs, extended timeline to implement this option, and operational considerations, this option is not considered viable at this time. Option 2: The San Jose Fire Department provides 100% of the ambulance service with Single Role Paramedics (non-sworn paramedics and emergency medical technicians (EMTs)). Under this model, the San Jose Fire Department would assume responsibility for transport services for the entire Santa Clara County and would hire Single Role Paramedics to supplement the existing fire personnel. As with Option 1 above, this option is not considered viable due to the significant start-up costs, extended timeline to implement this option, and operational considerations. Option 3: The San Jose Fire Department partners with a private ambulance company and shares transport responsibilities. Under this model, the San Jose Fire Department and a private ambulance company would share responsibility for transport services for the entire Santa Clara County. This model would require the San Jose Fire Department to increase staff and purchase ambulances and equipment to implement. This option is also not considered viable due to the significant start-up costs, timeline to implement, and operational considerations. Option 4: The San Jose Fire Department partners with a private ambulance company and the ambulance company would provide transport services to the entire Santa Clara County; the Fire Department would maintain control of the Exclusive Operating Area (EOA). Under this model, San Jose Fire Department would manage the contract with the private ambulance company to provide transport services to the entire County, and the Fire Department would be responsible for billing services. Assuming there was an interested ambulance company, this is an option that could be viable because there would likely be less start-up costs and it could potentially implemented within the County RFP timeline. It should be noted that a fire-based EMS patient transport model was recently approved for award in Contra Costa County, consistent with Option 4 described above. Copies of the successful proposal, including financials can be accessed using the following link: publish.cfm?id=&mt-all&get month=7&get vear=2015&dst>= agm&seq=22638&rev=0&ag=622&ln=44262&nseq=&nrev=&pseq=22531&prev=0#returnto NEXT STEPS Based on the Feasibility Study work to date, Option 4 described above merits additional analysis. In order to determine if there is a potential ambulance company that would be interested in partnering with the San Jose Fire Department, the Administration recommends issuing a Request

4 PUBLIC SAFETY, FINANCE, AND STRATEGIC SUPPORT COMMITTEE September 10, 2015 Subject: EMS Transport Feasibility Study Page 4 For Qualifications. This is a necessary step to better understand the feasibility of this option as well as position the City to potentially bid on an RFP for this service (if one is issued by the County), if appropriate. The Department will provide updates on this process, including the results of the RFQ and the County's position regarding extending the current contract or issuing an RFP, as soon as the information is available. COORDINATION This report was prepared in coordination with the City Manager's Office and the City Attorney's Office. /s/ CURTIS P. JACOBSON Interim Fire Chief For questions, please contact Ron D'Acchioli, Deputy Director, at (408) Attachment: Letter from the Santa Clara County Fire Chiefs' Association to the Santa Clara County Emergency Medical Services Agency regarding Santa Clara County Fire Chiefs' Association Input on the Exclusive Operating Area Request for Proposal dated August 20, 2015

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