The Washoe County Board of County Commissioners commissioned the TriData Division of the Systems Planning Corporation (TriData) to review and provide recommendations on the efficiency and effectiveness of the regional Emergency Medical Services (EMS). The study culminated with TriData submitting to Washoe County, the City of Reno, the City of Sparks, and the Washoe County District Board of Health the Emergency Medical Services Systems Analysis – Final Report dated August 2012 (TriData Report).

The Executive Summary of the TriData Report states:

“Overall, Washoe County EMS providers at all levels provide timely, high quality response in a professional manner. It is easy to notice the dedication of each participant within the system. The combination of fire first response, with either commercial or fire-based EMS transportation is an appropriate method to provide service. We note throughout the report that most challenges stem from the lack of EMS oversight, with the system operating on a fragmented basis. The lack of system transparency, distrust between system participants, and failure to take advantage of technologies that could solidify system cohesiveness are at the root of most administrative, operational, and financial issues.”

Source: TriData Final Report-August 2012, page 1.

The TriData Report addresses the REMSA Franchise Agreement as follows:

“Evaluation of REMSA Franchise Agreement

We are very concerned about the status of the REMSA Franchise Agreement. Since 1990, most of the negotiated changes have clearly favored REMSA, limiting the DBOH oversight authority. The EMS system is supposed to resemble a PUM with an independent oversight organization (REMSA), and an independent contractor (RASI). In practice, it is difficult to tell the difference between organizations, with REMSA functioning as a private EMS contractor.

The agreement allows for either a contract rebid or a market share analysis to determine whether the current contractor is retained. Regardless, no more than seven years should go by without a competitive provider selection process. Several metrics identified by the agreement does not provide enough information to fully evaluate the performance of the contractor. Also, the required $200,000 performance bond is inadequate to protect the citizens from system failure. The minimum performance bond or irrevocable line of credit should be $1,000,000.

Using arbitration to decide EMS transport fees is an unnecessary surrender of DBOH authority. The oversight agency should have complete discretion of granting a fee increase. If alternative dispute resolution is needed, it should be limited to mediation.

Sections 30 and 31 are of concern. Issues concerning successor financial liability cannot be directly answered because there are many possible succession models. EMS services are encouraged to seek their local legal counsel for guidance. There is a major issue concerning the administrative acknowledgement of DBOH-REMSA modification agreements. We offer suggestions to handle these agreement gaps.

The DBOH-franchisee agreement is in need of a complete overhaul. There must be appropriate checks and balances that assure a fair process that ensures oversight while providing an environment for good patient care in a business friendly environment.”

Source: TriData Final Report-August 2012, pages 4-5.

The TriData report goes on to state, “Washoe County now has the time, place, and opportunity to make significant changes to the EMS system that will facilitate future growth and success. The current providers are dedicated to providing excellent patient care in a professional manner. Strengthening the EMS system can occur by empowering an oversight agency with the authority to oversee all aspects of EMS. Redesign of the EMS franchise agreement is necessary to shift the balance of power to the oversight agency.”

The TriData Report included 38 recommendations for the improvement of Emergency Medical Services (EMS) delivery system for the Washoe County region including the updating of the current Franchise Agreement with the regional ambulance provider, the Regional Emergency Medical Services Authority (REMSA).The status of the 38 recommendations was provided in detail at the Concurrent Meeting on June 10, 2013.

At the concurrent meeting held on June 10, 2013, the elected and appointed officials of the four jurisdictions directed their respective managers to negotiate a “renewed” Franchise Agreement with REMSA within 120 days (see the motion above). The 120 days is scheduled to expire on October 2, 2013.

The EMS-WG has reached consensus on a large number of the TriData Report recommendations. Several recommendations are moving forward in organized meetings between the local jurisdictions Managers and REMSA. The 15 outstanding recommendations in need of negotiation of the TriData Report recommendations at the June 10, 2013 Concurrent Meeting remains as follows:

TABLE 1 – Outstanding TriData Report Recommendations

Summary of the EMS-WG’s current progress on the implementation of the 38 recommendations from the TriData Report was presented to the Concurrent Meeting via the Executive Summary dated June 30, 2013. The outstanding 15 recommendation in need of further negotiation prior to implementation are shown above in Table 1.

While the issues outstanding prior to the June 10th Concurrent Meeting has been actively discussed by the EMS-WG on a frequent basis with all parties present, the specific negotiation points being developed by the Managers are still a work-in-progress due the complexity of the current REMSA Franchise Agreement; the current regional EMS environment; patient needs; and the numerous topics needing full discussion to renew and modernize the agreement and implement the recommendations in the TriData Report.

To meet the policy requirement from the action taken by the Sparks City Council in the June 10, 2013, motion on this topic (see above), a subcommittee assigned by the EMS-WG Managers has determined a working outline on the franchise agreement’s details to serve as a scope of work for developing a comprehensive renewal of the current agreement between the Washoe County District Board of Health and REMSA, which is acceptable to the City of Reno, City of Sparks, and Washoe County. The scope of work being completed to renew the current agreement between the local jurisdictions and REMSA taking into consideration the outstanding issues in Table 1 above and the other TriData recommendations includes but is not limited to the following:

• Definitions

• Obligations of the parties to the agreement

• Scope of Services

• Fees, Rates, and Procedures

• Programs and Services

• Surety, Indemnity, Liability

• Transfer, Assignment, and Subcontracting

• Default and change in law

The Managers are finalizing their respective thoughts on the scope of work and would submit meeting the October 2, 2013 deadline provided by the elected and appointed officials is not feasible due to the complexity of the numerous outstanding issues to bring closure to a renewed agreement. An extension of time is requested to move from an outdated and somewhat generalized franchise agreement to one that is modernized and specific in its requirements and defined responsibilities. This is necessary in order to provide greater transparency and the ability to manage overall EMS system performance in conjunction with the other EMS provider agencies and provide the meaningful oversight proposed by the TriData report.

Staff is recommending an extension of 120 days from October 3, 2103 through January 31, 2014 to bring the proper elements to the table for negotiation with REMSA.

1. The Council may choose to accept the recommendations of staff on the renewing of an Emergency Medical Services agreement with REMSA by extending the negotiation period for 120 days to January 31, 2014.

2. The Council may choose not to accept the recommendations of staff on the renewing of an Emergency Medical Services agreement with REMSA by extending the negotiation period for 120 days to January 31, 2014, and provide other direction to the City Manager.