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18 March 2015 Cabarrus County EMS Elimination of Non - Emergency Services Transportation Alan Thompson, EMS Director Statement of Intent: We propose the move away from providing non - emergency transport services and transitioning the existing non - emergency personnel to positions that will be required with the transition to 12 -hour emergency shifts. We propose the privatization of this non - mandated element of EMS through the assignment of a franchise agreement to a primary non - emergency provider. Cabarrus EMS has been providing non - emergency transportation services since 2003. The move to the services was a result of the non - availability of dedicated non - emergency transport providers. The service was initiated with one transport unit and has remained at the same level since its inception. The requirements for non - emergency transportation and associated billing have grown more stringent over the years and increased liability for employers. Physician certification statements and medical necessity forms must be completed and verified prior to transport and billing. Transporting non - emergency patients and billing insurance agencies for services that are not consistent with federal guidelines increases liability for the service. Federal requirements have made it much more difficult for agencies serving dual roles (emergency and non - emergency) to provide and collect for these services. While the demand for non - emergency services has grown slightly, the medical necessity requirements have created greater burdens. Additionally, the recent non - signing of the agreement between United Healthcare and Carolinas Healthcare System will result in a greater demand for out of county non - emergency transport services to Novant facilities. The scheduling and billing process has grown more complicated as has the demand for non - emergency services during off hours of our non - emergency unit. Our emergency units have been tasked with providing this service during off hours and at times when the non - emergency unit has multiple calls during short time spans. Additional ambulance staffing and scheduling provisions will be required to maintain efficiency of the non - emergency transport program if the program is to be maintained. The current resources are not able to meet system demand for non - emergency transports. The cost benefit analysis for the provision of non - emergency stretcher transportation reveals little net revenue. In comparison, the emergency call demand has grown significantly as well as opportunities to promote community wellness while making best use of the advanced training possessed by paramedics. Unit hour utilization for paramedic units has grown to concerning levels. The proposal to eliminate non - emergency services and use the positions to fill upcoming emergency vacancies will yield the following benefits: • Provide additional emergency response resources • Reduce emergency unit hour utilization • Eliminate the need to add additional non - emergency staff • Focus paramedic efforts on emergency response and wellness • Reduce liability associated with non - emergency services • Eliminate non - emergency classification Attachment number 1 F -5 Page 70