Travis County Commissioners Court
November 30, 2004
Item 23
Item 23 is to consider and take appropriate action on an interlocal agreement
between the city of Austin and Travis County for use and management of starflight.
24 is to consider and take appropriate action on an interlocal agreement between
the city of Austin and Travis County for emergency medical services.
>> judge, while they're setting up over there, there's just
a very brief introduction here because they will be the last persons to state
about this. This is the culmination of an amazing amount of work by not only
our staff, but the city of Austin. And not only these folks that are sitting
on the table here need to be congratulated. Barbara put in an amazing amount
of work, danny and bonnie were our designated point persons. Carol will always
be the historical person as well because she helped us out with starflight
and that whole kind of interim governance. I also want to make sure that allen
miller is given appropriate accolades as well because you will see his work
on the financial model to basically get us to a point where we are looking
at something from a system perspective as opposed to trying to screw up individual
line items. And I think this is a model that will not only work well on the
e.m.s. And starflight agreements, but one that can be transferred over to
central booking or whatever it is we want to look at, it's a system where
you've got several governmental partners and not it's the city city it's the
county. I want to say congratulations to these folks and over at the city
of Austin and the thoakz up there. I want to make sure that julie joe and
barbara wilson also just put an amazing amount of work in on this. And you
all need to be congratulated.
>> thank you very much. I really do appreciate you making
those comments, Commissioner, because there are so many people that are involved
in this. And what I would like to do today is just simply do an overview for
you, we would like to do an overview for you. So you have hopefully a handout
that I just gave you. And for those who are watching by television, hopefully
you will be able to see this overview as well. We are glad to be where we
are today, and that is after months and months of discussion and negotiation,
we are finally here. And I do thank all of those as well, Commissioner, that
were involved in this process. The introduction on page 2, we do want to provide
an overview in regards to those recently negotiated agreements, both starflight
and e.m.s. We do want to have discussion and comment today with you, and we
want to recommend to you that we approve these agreements, realizing that
you're going to take an action next week. Page number 3 on topics of discussion,
to begin with, the court authorized us as a team to go into the negotiations
with certain issues, and so today I want to go over with you the status of
those issues. I also want to share with you -- we want to share with you the
non-financial benefits of the new agreements. We want to share with you the
starflight, the independent review panel recommendations, and this is where
carol comes in as the Commissioner just mentioned. Benefits of the new county
e.m.s. Financial model, we feel like that is a significant change from what
we have been working with as well as performance measures. And barbara sealy
is here today to review that with you. On page 4 we'll just start with the
court approved issues. We came here I guess it was back in November or December
and we came off of the subcommittee which the names the Commissioner just
mentioned awhool ago were on that, as well as some other folks I need to mention.
Kimberly cal ton and shaun o'neal were also part of this, so I really appreciate
their efforts. But we came up with some issues that we felt like would be
important to the negotiations. And the first one has to do with the e.m.s.
Program as a system concept. The Commissioner just mentioned that. And that
is we now want to look at this system a little differently, and that is that
we are all providing the same service. And we're doing that by the system,
and not by just simply looking at each other as independent agencies serving
the public, because when the citizens -- the Travis County citizen receives
emergency services either in the air or on the ground, it's from a concerted
effort, whether it be first responders through esd's, the emergency services
districts, or whether it be the city of Austin or whether it be tcso, whether
it be the city of Austin. All these work together. So that's our system concept
that is throughout both agreements. Also, the designation of a county staff
person, and y'all approved that. I volunteered to go ahead and assume the
role, but in both agreements you'll see that there is now a county e.m.s.
Manager that is going to work directly with both the starflight program as
well as the ground emergency services program. And that's already started
and kicked off through the negotiations, and now you're seeing a closer relationship
between all the parties, including the first responders as well as the city
of Austin. The development of separate agreements, this is something where
when the committee -- the subcommittee first looked into this, it was -- it
made more sense by looking through the one agreement than we need to have
two. And for a number of reasons which we'll go through today, but they are
now in two separate agreements. The role of the e.m.s. Advisory board. We
feel like that's important to keep in the agreement because if this particular
board can work as it should work, then it will add many, many things as far
as the overall programmatic, financial, many, many things involving both agreements.
So we're asking that the e.m.s. Advisory board stay in the agreement, and
it is, and you'll see that in section 2. Cost reimbursement. This the another
area that you asked us to look into. We did. And you'll see that there are
some things in the agreement that reflect that. However, there were also some
things which we had to get educated on, and we went and found out why we do
certain things the way that we do them. So we feel like that we've approached
that one in the right manner, and we hopefully will see some benefits from
that review. Apportionment of liability. This is one where barbara and julie
spent some extra time towards this, but you'll see that that's now been written
into the agreement, especially on the ground side as far as who is going to
be liable for what. Going to page 5, non-financial benefits. This divides
starflight services and ground services into two separate agreements. You
will now be able to determine not only operational things, but also financial.
You're going to be able to see clearly for the first time who is doing what
and what it cost to do what. And we felt like that's very important. Agreements
include new performance measures, and i'll let barbara get into that in a
moment. I won't get into that. We feel like that's really been a good enhanced
project is new measures. Incorporates first responder agreements and unified
management plan. We wanted to put that one in here because awhile back there
was a mediation done regarding the first responders and the city of Austin
e.m.s. Folks. And that was they developed a first responder agreement. It's
a good agreement. They also accepted the national unified management plan.
And why is that important? It's important because when you get to a scene,
you've got to know who is going to do what so it will move as smootsz as possible.
So we attached that to the agreements just for you to see and for you to look
through and we hope you will do that next week. They're thick documents, but
they're very important to the people who provide medical services. I was going
to take six benefits continued. Training options for county first responders.
I had many discussions with our esd chiefs in regards to what this means to
them. And for the past few years we've been supplying some training money
as well as supply money. But one of the things he they wanted to have was
more flexibility in the way they choose their training. You will see in agreement
where they will have the option of any way we want to go as long as it's legitimately
used for emergency services. But I think that's going to open up some doors
for them that they requested. Supports interlocal between Travis County and
esd. This is brand new, but not really new in the sense that it hasn't been
discussed before. And that is that as we have this agreement between Travis
County and the city of Austin, then we also now want to promote looking at
an agreement between Travis County and the esd, the first responders. Why
is this important? Because again when you're looking at the system concept,
then we all need to be connected in some way. And right now you do not have
that direct connection by an agreement between the first responders and anyone.
And because we deal so much as Travis County with the first responders, there
are many things of which we need to be doing with them and they with us that
I think will benefit the entire system. And so we're going to be recommending
that we go forward once we approve these agreements that we now go forward
and look at agreements with the first responders. By the way, you already
are aware of the fact that we already have an e.m.s. Agreement between Travis
County and the small cities, so now it's only appropriate that we do that
with the first responders. Multi-year agreements, renewable for three years.
This saves us the trouble of having to come back every year, so again it's
an option that's thrown in. It's a one-year agreement with three one-year
options. That the other thing that we want to try to do here is make something
where all we want have to do is shore amendments if we needed to do that and
not have to come back and do the entire agreement every year. Exhibits have
flexibility to be updated annually. Fits what I just said. You will go back
and update the exhibits, not the entire agreements. Now let me turn it over
to carol in regards to starflight panel recommendations. She was very good
at making sure that that was protected as we did our negotiations.
>> this actually goes back to March 2003 when the Commissioners
court and city council decided to hire an independent review panel to come
in and give their recommendations on what they felt would be the best organizational
structure for starflight. So these are the key recommendations that were included
in the interlocal based on those recommendations. And the first one is clear
delineation of management authority. And in exhibit g you can see it clearly
shows what our general management authority and what is aviation's authority
and the general management of course is a program manager and aviation is
director of aviation operations. The second one is a separate problem solving
problem. This is for aviation. One of the recommendations was if it is an
aviation problem that needs an expert, the experts are consulted for clarification
or input on whatever the problem is. The third one is the creation of a county
e.m.s. Manager and danny has already talked about that. He's serving in this
capacity at this time. Last is creation of starflight policy and procedure
manual. And there are a lot of unique issues to starflight, so it was felt
that it was this that the program -- if they had a specific policy and procedure
manual which addressed these issues. It is written in the interlocal that
the manual be developed within I think the first three months. There's a time
in the interlocal when the manual --
>> do we have such a manual?
>> not at this point. I think we're waiting for this approval
and then it will be written.
>> there is a policy and procedures manual, but with these
added enhancements, judge, they're waiting for this to be approved.
>> we're not starting from scratch. A lot of it will be a
rewriting of what we have incorporated and the recommendations from the peer
review.
>> do we have in place the same manual that we had in place
when the panel made these recommendations?
>> yes, sir. We have in place the same manual that we had
at the time these recommendations were made.
>> is the implication that the panel found that manual to
be insufficient?
>> I do believe they felt that some additional issues needed
to be added to it that were not in there exactly, and those -- some of them
are even spelled out in the interlocal which ones need to be added.
>> we'll be working on the manual in the days to come.
>> yes, sir.
>> go to page 8. New e.m.s. Financial model benefits. One
we have developed, and I really want to thank allen miller and shaun o'neal
for this particular model, we actually went through various models before
we came up with this one i'll show you this one in a few moments that captures
the system cost as I mentioned earlier, and hopefully it will be a more cleanly
and accurately management for growth, provides reimbursement for personnel,
savings and contractuals and is more equitable distribution of revenue. If
we can, we'll go to the next page, number 9, because I want to get to the
chart. This new model allows for allocation of new costs over future years
without requiring an annual renegotiation of the agreement. It continues to
segregate starflight cost for expense and revenue to the county. You will
see both of these agreements now more in line with each other with regard
to expenses and revenues.
>> is there certain language in the contract that does this?
Are there certain paragraphs in the contract we can turn to to do the narrative
as to how this is done?
>> it's going to be exhibit c in starflight. And I think
it's exhibit f in the other one, but I?m not sure. But the exhibit goes through
and discusses that, yeah.
>> that's another reason why we beefed up the exhibits because
those are the ones we want to come back and if there are amendments to be
made we go to the exhibits and not the entire agreement. If you look at the
exhibits, judge, that will give you ferg I?m talking about today.
>> in the e.m.s., Exhibit d, we switched things around and
consolidated some exhibits.
>> so in starflight it's exhibit c, and in e.m.s. It's exhibit
d.
>> okay.
>> looking at page 10, which is the old versus new financial
model comparisons, I think this is where you actually get to see a visual,
but also see the numbers attached. And that is getting to the system concept,
and that is we now become part of the overall system. It is a situation where
we try to praik it out to where -- break it out to where we do pieces of the
system. We'll now be part of the entire system. So now you will see the percentages
change. You're also going to see the dollars change because of the fact that
we're now going to be looking at all costs, as before in the old agreement
you didn't really see those costs captured that way. You saw pieces of it.
Now what you're going to see is total costs, and our percentage is based on
the number of stations we have. We have eight stations. There are 28 stations
in all. So the percentage will change as the stations change. And I had mentioned
to you in a previous work session that the city of Austin is proposing that
in '06 that they open up a new station in del valle. In '07 a new station
at scoirk. So as -- circle c. So as we see those stations come online, you'll
see our percentages go down. However, we add stations our percentages go up.
It's just the way the system works. What you see, though, for the first time
on the e.m.s. Side is that because of the fact that we're now paying the expenditure
side, we're now going to be collecting our own revenue. And so revenue now
comes directly back to the county. So what you see reflected in these costs
are the differences in the old and new model, you'll see an increase in the
cost, but you have to go down and look at page 11, which is the collection
of revenue, and there you'll see the offset. And the way this works is we
start in October. In fact, when you hopefully approve this interlocal next
week, you will see that the time clock starts in October of 2004. And when
you collect revenue in this business, you'll see that you're not going to
collect it all in one year. It overlaps. So the full revenue accounting will
be done in '06. So the estimation is there will be $1.1 million that will
be coming to Travis County in regards to revenue.
>>
>> [one moment, please, for change in captioners]
>>
>> we now see a balance between expenditures and revenue
and it's clear what we're paying and receiving. And I think that's a real
benefit. Real "the financial part, alan, correct me if I am wrong, starflight
stays pretty much the same so you are not going to see a difference there.
Moving on to page number 12 and i'll turn it over to barbara steven.
>> if I could, I would just like to quote the doctor because
he is one of the guiding saints of this. Basically he said he thinks for the
first time we're really measuring the whole system. And by that I mean not
only are we measuring the city, but we're measuring ourselves and so we may
find out some things we don't want to know, but we are definitely putting
the whole picture out there for the public. The concept behind the performance
measures is pretty simple. If you are a person who dials 911, we're going
to measure our performance from the minute you call 911 until the time you
are dropped off in the emergency room. We've broken it down into segments
so that we're going to know, you know, in each piece of the system, dispatch,
transport, on-scene time, at the emergency room, how we're performing and
how we're doing. In addition to that, dr. Rock has developed some clinical
performance measures which I think he's going to be looking at seriously updating
again in '06. I want to point that out as a real advantage. We don't have
to come back and renegotiate the whole agreement in order to update the performance
agreements. We can do that on an annual basis. It is one of the exhibits.
So that as we learn more information and realize we need to measure other
things, we can go ahead and --
>> we're having some problems with this mic.
>> sorry. We can easily come back and ajust those. In addition
to which because money is always important, we have financial measures which
we have developed with p.b.o. And the auditor's office to track how we're
doing with our billing system, to track how we're doing with our collection
system. So I think you are going to see measures you've never seen before,
you are going to see measures that were previously there. And I think, correct
me if I am wrong, but I think we're going to put these up on the web, aren't
we, so the public can see these. There is one new component. The city has
always done this. They survey their customers for customer satisfaction. We're
hoping to tack along on that survey so we're going to know how county residents
are satisfied with the e.m.s. Service. So I think we went through many, many
iterations with this, many people reviewed them. It was a wonderful collaborative
effort. And the best thing is as this system changes, we can easily adapt
the performance measures to come and show the changes in the system over time.
>> and so if you go to page 13, not that that's unlucky,
but that's our conclusion, and that is that we would like to recommend that
the court approve the starflight interlocal agreement as well as recommend
that the court approve the e.m.s. Interlocal agreement. And there is -- before
I end here today, and I?m going to forget if I don't bring it up, Commissioner
Sonleitner, there was one other person that kind of acted like our scribe
and you are familiar with her because she worked for the county and that's
heather cook. So I want to thank her for all of this work that she did in
this as well.
>> there is -- I would like to thing i.t.s. Too. I've never
actually done a power point presentation on channel 17 and they came down
and saved my life this morning. So I want to make sure. Thank you very much,
guys.
>> so how do we monitor achievement of the outstanding performance
measures on page 12?
>> I?m glad you asked. That is a situation where we are going
to have to sit down now and make a determination as to who does that on the
county's side. You have a county e.m.s. Manager. You are looking at that person
that's acting in that role now. What we will need to make a determination
with is do we need to add someone, either on my existing staff or add someone
that needs to be the e.m.s. Manager or assist me in being that e.m.s. Manager.
Because one of the things that's going to occur is that once we approve the
agreement, then the agreement is of no consequence if you don't follow up
with it and you don't complete the things you say you are going to need to
complete. One of them is performance measures. Now, we do have the benefit
based upon technology today to where you can access a lot of things off of
the web. In fact, in having negotiations with the city, one of the things
that I am going to have is access to a lot of the websites that they have.
They are going to be providing me as you see when you look at the back of
this and all the performance measures they are going to be providing me monthly,
quarrel as well as annual reports. They are going to be coming here and giving
you an annual report. And so I think you are going to see a lot of activity
that's going to be needed to take place here. Technology will take care of
some of it, but staff will are to be involved in it in order to stay up with
it because when you get into the advisory board, for instance, they are going
to require information. They are going to want to know particular statistical
information when they are trying to make recommendations. You are going to
want to know it. And so this is not going to be just that you approve it and
we live happily ever after. This means the work begins and rule I staying
with this contract, -- really staying with the contract, with the relationship
with the first responders and the city of Austin and all the aspects of that.
Judge, I?m glad you asked that question because that's an important one.
>> so the answer is we're still trying to determine how we
monitor and implement the performance measures.
>> we know how we want to monitor them. Again it's going
to be the people involved in doing. That that's the question. And as you know,
i'll do my very best to try to do it. If I can't, you know me, i'll come up
here and tell you that I can't.
>> but there are specific reports due in to the county either
on an annual basis or quarterly basis or monthly basis.
>> yes, a lot of this is going to be submitted to us so it's
not something we have to generate. It's something we have asked them to provide
us and it's listed under the performance measures and the timing of that is
listed. So again, a lot of it -- we don't have to go dig it up, judge, it's
coming to you, but once it comes to us, that's where staffing comes into --
>> [inaudible].
>> and how to respond.
>> will the committee be able to brainstorm on that particular
aspect of the presentation between now and next Tuesday and make a specific
recommendation to the court?
>> I would be more than happy to. We would be more than happy
to.
>> anything further on either of these items today? 23 or
24? Those will be back on the agenda next week. We appreciate the outstanding
work of the committee. And the various collaborators from clout the county.
-- from throughout the county.
>> thank you.
>> thank you.
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Last Modified:
Wednesday, October 26, 2005 2:47 PM