1. OFD Fire-Based OFD Fire-Based EMS Transport

2. OFD Transport Timeline OFD TRANSITION TO FULL ALS & AUTO ACCIDENTS 90 DAY BILLING COLLECTION LAG TIME BEGIN 1 YEAR OFD TRANS- PORT EVAL- UATION 12 MONTH EVALUATION PERIOD EVAL- UATION OF DATA AND RFP PREPAR - ATION RFP FOR BLS TRANS- PORT PROVIDE R BEGINS RFP PROCESS 90 CONTRACT EXTENSION* (Available for any possible RFP challenges) Feb 2011 Mar 2011 Apr 2011 May 2011 Jun 2011 Jul 2011 Aug 2011 Sep 2011 Oct 2011 Nov 2011 Dec 2011 Jan 2012 Feb 2012 Mar 2012 Apr 2012 May 2012 Jun 2012 Jul 2012 Aug 2012 Sep 2012 Oct 2012 Nov 2012 Dec 2012 Jan 2013 Feb 2013 Mar 2013 Apr 2013

3. Transport Evaluation Criteria Operational Evaluation: Did the addition of Fire-Based EMS Transport impact the high quality of service already being provided to the citizens and visitors in the City of Orlando? Financial Evaluation: Did the addition of Fire-Based EMS Transport generate sufficient revenue ?

5. How we got here. OFD History Ambulance RFP Safer Grant Fire Based EMS Transport Proposal

6. OFD History Leaders in EMS in Central Florida Mid 70’s introduced Advanced Life Support (ALS) Introduced ALS Engines in the 80’s All Stations ALS and then all Units in the 90’s OFD has always provided the “Back Up” transport system

7. Ambulance RFP Orange County Fire took over Transport (2008) Orlando contracted with Rural Metro for services (2008) First full RFP for Ambulance Service

8. Safer Grant OFD submitted for 46 personnel Equal to the number of persons in the required budget reduction IAFF and City worked together for the Grant 2 year Grant Awarded for the 46 personnel

9. Fire Based Transport Proposal Since OFD doing most of the work on scene, we proposed doing transport No expansion of personnel OFD proposed ALS and Auto Accidents Transport BLS calls to a Private Provider Approximate 2/3 to 1/3 split of Transports OFD added Rescues 6, 9, &15 from redistribution of manpower

10. What did we do?

11. Start up preparations Capital Purchases Medicare/Medicaid Billing Company EMS Reporting System Ambulance Support Contract

12. Start Up Preparations Established Working Committees on – Operations Changes Fire/EMS/Transport – Supply/Logistics Trucks and Stations – Training both in EMS Transport and Hospitals – Quality Assurance, Report Writing and Treatment – EMS Policies – General Policies – HIPAA

13. Capital Purchases New Rescue Trucks On Board Computers for Dispatch and Mapping Power Pro Stretchers Lifepak 15’s All needed equipment and supplies

14. Medicare/Medicaid Average time to receive is 9-12 months + Medicare submitted in December and received Medicare # in March First payment received in May Medicaid submitted after Medicare award First payment received in June

15. Billing Company OFD needed an experienced Billing Company OFD Piggybacked on an Orange County contract for services Advanced Data Processing Inc (ADPI) leaders in EMS industry on billing and recovery

16. EMS Reporting System OFD Report system was inadequate for EMS Transport reporting Changed to a mobile reporting system on ruggedized laptops Crews able to complete reports at the hospitals & obtain signatures from hospitals and patients for billing

17. Ambulance Support Contract City Contracted with Rural Metro for BLS/ALS backup support Contract Includes: – Supplied Dedicated Units to the City – Units dispatched by OFD – Has the same Computers in units as City – Able to talk on our radio system – Full time Dispatcher in OFD Communications Center

18. Operational Statistics

19. Transports Daily average transports Ratio OFD /RMA Transports Compliance summary Service Level Mix Transport Related injuries and complaints

20. .

21. .

22. Compliance System Goal to provide a transport unit on the scene in 10 minutes or less 90% of the time Study Period May 2011 to April 2012 OFD Average is 95.92% RMA Average is 93.80% System Average is 94.86%

23. OFD Service Level Mix

24. .

25. Financial Statistics

26. Billing Summary Medicaid/Medicare Adjustments Payer Mix Comparisons Revenue Collected

27. Billing Summary May 2011 to April 2012 Total Billable: $18,263,927 Gross Adjustments to Billable: $4,351,904 (Medicaid/Medicare) Net Adjusted Billable: $13,912,023 Total Deposits in Bank: $ 4,800,394

28. Medicare/Medicaid Adjustments Medicare and Medicaid are capped by Law BLS ALS1 ALS2 City Rates are $700 / $900 and $1000 Medicare pays $268 / $319 and $462 Difference $432 / $581 and $538 Medicaid pays $136 / $190 and $190 Difference $564 / $710 and $810 Differences are reported as adjustments

29. Agency Pay Class Comparison

30. Total Billable For the study period, OFD has submitted $18,263,927 in gross billable Transports This results in a gross average of $1,521,993 in billable transports per month After Adjustments the average is: $1,159,335 in billable per month

31. Total Revenue Collected For the study period $4,800,394 has been deposited in the EMS Transport Account The results in an average of $400,032 a month deposited (cash in the bank) Sent to Collections: $1,131,269

32. Where do we go from here?

33. Where do we go from here Continue the same model of service Allow billing account to fully mature Begin the RFP process for Ambulance Support Monitor call volumes for future needs Continue the high excellence of service

34. Saving Lives and Protecting Property