Travis County Commissioners Court
March 22, 2005
Item 9
Number 9, receive first quarter report on performance measures for Travis County starflight and e.m.s. Ground services.
>> we have a few more folks that are going to join us as we go through this. This is I think exciting because we're not going to be providing you quarterly reports and information on both the starflight and the e.m.s. Interlocals. And if you will remember, Commissioners court, we spent about a year going through and developing and putting together the interlocals. And you approved that recently. And so as a result of that, we now want to give you some feedback. Now, we do realize that because this is the first report that we probably are going to need in the future to do this in a work session because there's so much information. So y'all are pretty good about cutting me off, so i'll just go with the flow and we're going to try to summarize, but i've already gone through this so many times that I really do feel like the work session will be really good so we can spend more time on it. We do not have some of the folks that we wanted to have today, although we feel like we have the most important folks here that can take care of this. And so let me just introduce if I can, heather cook, who most of you know works, of course, for e.m.s., city of Austin, and heather is the principal planner. And was instrumental, of course, in us in negotiation of the interlocals. And I really do appreciate her constant effort and her hard work with us. Also to her left is chris dilly, who is the clinical coordinator. And he will be in place of ed rock today, which is big shoes, but he is going to be here to review with us some of the performance measures and the clinical measures which, believe me, you would not want me to go over those with you. I believe that's everyone. Let's just start, if we can, and I知 going to go by page number if you don't mind, that way we keep track of where we are.
>> why are we going over this now if this has been resolved, other than the fact that you've got everybody over here? If this was done in the work session?
>> we wanted there to be a day that everybody could come. Last Tuesday not everybody could be here. Although now that we're -- with the time frame, i'll be back in about 30 days for the second quarterly report. Anyway, let's go ahead and begin and go through it and see what we've got. On page 2 you're going to see that as far as introduction we're going to provide financial operations overview to you regarding starflight and ground e.m.s. Remember, now, that in the past we did have one agreement. Now we have two separate agreements, starflight and e.m.s. And so we're going to go over those with you. And then we want to, of course, have discussion and comments with you today as you desire. Page 3, here is what we're going to breakout for you, the actual versus ledger expenditures, the first quarter revenues as well as performance measures. Starting with starflight, if you would go to page 5, and here you will see -- of course, I don't need to remind you, this is a separate interlocal which means that we actually have the costs individually as when we get to the e.m.s. In a few minutes you will see that we're part of the system, so we will have total system cost. But there's a 1.1-million-dollar budget. And here you see the actuals. And then you see the projected expenditures. And the bottom line is we're going to come out right now, we're projecting that welcome out and make the budget. However, I want to highlight a few things for you in that last column projected variance. What you will see there is that it appears that we are $110,812 over in the personnel line item, and this is something that I知 having to learn as I go through this process, and that is that with both starflight and e.m.s., they don't actually look at it like you would a normal budget, and that is that you're taking 112 and that everything equals out to 112. It doesn't work that way. Starflight and e.m.s. Of course as you know are based upon unique situations and conditions seasonal situations. The very first quarter what happened, it's the holidays, the fall of the yeerks it's usually bad weather. What you see here is reflected in the personnel. As you know, we had a lot of flooding, and so there were a lot of calls and there were a lot of operational needs in regards to starflight. However, based upon their experience and what they're telling us that this will all even out. So you will see that the numbers change as we go to the next quarters. I do want to make note, though, under expenditure refunds, and that is that that's 69,784, which goes against that 110, so you're really $30,000 in variance instead of 110. What that is is they actually will use the medical folks, and, of course, this budget involves around -- I believe it's 12 people, staff and that's, of course, casey, five flight nurses, five flight medics and one clinical manager. And then what they will do is on occasion they will actually go and work on ground units, and they've been doing that for quite some time to where they stay up and abreast of what is required both up in the air as well as on the ground. So they will actually go and work on ground units. As a result of that we get a refund for that. So that's why you're seeing the 69,784. The bottom line here is that we are projecting a zero balance, which means we are going to meet the budget.
>> the 12 people total in the starflight operation, is that in the interlocal?
>> as far as the interlocal, there's also the mechanics, but that's a separate budget, which is the Travis County budget. But here we're talking about strictly the medical side.
>> at this stage if we look at the million 23, that's effectively 12 people?
>> that's effectively 12 people. Yes, sir. And medical supplies and those things that are provided as part of the interlocal.
>> but that's -- that's.
>> that's not just personnel cost.
>> it is personnel cost. That's what it says. So you're really talking about an average of 80 grand a person.
>> (indiscernible).
>> okay.
>> if you will on page 6 you will see how we are standing in the first quarter regarding revenue. And, of course, Commissioner Gomez isn't here, but if you just look at this first list, you have a tentative look at this one because why are we bringing in more revenue? The way that we collect, if you remember, through billing, is that we allow 90 days before it goes to collectibles. So it was 120, but we moved that back. You remember during the negotiations to 90. So we're not going to reflect a lot of revenue this first quarter; however, let me give you two pieces here. The first piece is that what you see on page 6 is the revenue from October through December. However, we also collect revenue from prior years. And so in this first quarter, what you need to do, and i'll add this the next time I do this chart, is that we're showing 35,994 that we've collect frd October to November. However, we've also collected $237,359 that also is reflected in the first quarter based upon prior years. So I知 hoping I知 explaining that, but there's a delay in how you do your billing here, and so we are doing quite well. Something I would like to make note at the bottom, a little asterick that says 12 month collection rate is 51.1%. That's a very good rate compared to collectibles. Around this area and around the state. And that was based upon the October '03 to December '03 when they do a calculation of how we did because that delay factor, they will take a 12 month period and then come up with what the overall percent is. So we're quite proud of the fact that starflight is at 51.51%. The system as a whole is actually less than that, 51.29. So we feel like we're doing quite well in that area. Going to page 7 we'll get into the starflight performance measures.
>> let me ask you a question.
>> we shared the information and they're anywhere from 25 to 50%. There's nobody above where we are. That's just kind of the average.
>>
>> [one moment, please, for change in captioners]
>>
>> ...we do have historical data on it. Just we are tracking them in a little bit different way. As an example, we do have the number of patients we have transported from in county, it's just that the mechanism that we are doing it is a little bit different. That's why it's saying a new measure. Also, as danny talked about, these are cylcic as far as the number of patients that we see. Fall and summer are busier months, if you take these times four, they obviously won't come out, but we are getting into a busier season with the lake traffic beginning, we will see that volume increase. As danny said during the second and third quarter, we will start to see those numbers reconcile.
>> can I make a request here. A lot of the stuff that we are going through, which is important, it's really -- it's the output and in terms of what I think everybody is really want being to know because of the new performance measures are the outcomes. Kind of cut to the chase. How well are we doing in terms of picking up the call, responding to the calls, being in the scene, getting them in the chopper or the ground unit and do they have a pulse when they get there. That's really the essence of what these performance measures are all about. It's kind of like in terms of focusing way too much on the revenues. It needs to be there, kind of like when susan spitarro and her gang give the first estimate. So preliminary, nice to know where we are at, but doesn't really mean anything until we get to the third, fourth revenue estimate and the fifth. Really the heart of this report is the performance measures in terms of are we picking up the cause, the patients, are they alive when they get to the hospital. Is it possible to focus on that's really the performance measures that folks are wanting to hear. Or that I want to hear.
>> Commissioner, I can let casey and willie give you a brief summary of that regarding star flight, I think you are going to see when we get to the e.m.s. Performance measures they get real specific in regards to those areas.
>> that's -- we are going to -- we are already butting up against the legislative stuff.
>> all right. Let's move on. I get your message. Let's go to page 10 if we could. Now we will get into the e.m.s. Ground. I'll go through this quickly. But here you see an approved by -- remember, in we are now part of the overall system, 28.75% of the system, here we are looking at overall system costs, of course our 7.3 million, 8.2 at the bottom is that 28.57. What you see here is the -- however in the projected variance, you will see that the projections are, it's only the first quarter projections because as the Commissioner you just said it could change, but right now $245,000 to the good. We are projecting we will be $245,000 under budget. That's based on overall formulas and percentages that we now have in the interlocal that allows us to have certain savings over certain things. So we are projecting $245,000. But again judge Biscoe I know that you were quite concerned about the quarterly revenues, that is only a first quarter revenue estimate. We anticipate that -- that changing as we go through the quarters. Right now we are looking good. Going to page 11, you will see the 12-month collection rate is 59.88%. Again that's a pretty good collection rate. And so we are doing well there. And again in this one you are looking at only from 79,625 is only the projection from October to December. Going to page 12, let's just go into it then, let's look at some of the performance measures. And why don't we just start on page 12 and who wants to take that one?
>> I would be happy to.
>> okay.
>> this is just a call volume for the ground, so we won't dwell on that much. The call volume is looking higher than last year. We are on a new cad system, comparisons to last fiscal year will not be apples to apples. Call volume is looking fine, showing slightly higher percent of call volume in the county versus the city than from the old cad. Going on to page 13 starting to sfwet into more of the performance I think Commissioner Sonleitner that you are talking about. This does cut across star flight and ground particularly in the communications center. Which obviously dispatches star flight as well as ground. The grade of service that's the percent of calls answered within 10 seconds of first ring, this is very excellent performance, 95%. Was the goal. 94% has been achieved and that's been pretty consistent across the board for us going back historically. Then going on from there, again that's for e.m.s. Communications staff people within the communications center, answering those calls. Then our average call processing time, the amount of time it takes to actually from a -- from when the call is first answered by e.m.s. Communications until an ambulance is actually dispatched is 67 seconds for the system, a little bit even better for the counties, 65 seconds, for the city 67 seconds. And then the average time, this is a new measure that you haven't seen before, average time from call to dispatch of an esd, what that is, is -- is when our call takers get a call for an esd that's dispatched through the private providers, I believe this is correct, are you familiar with this, casey? Amr is the majority of the ones. Where we send a page off to that private provider. We don't have data on how long it's taking that private provider to actually take the call from there. This is 56 seconds from us to get the call over to the dispatching agency. Now there are a number of esd's that are dispatched by the Austin fire department. That is virtually instantaneous amount of time. That's automatic within the cad. It's obviously in the cad system. This is actually for those esd's that are not dispatched by the fire department, Austin fire department. Moving on to page 14, this is our basic average response time. This again is from the receipt of the call by the e.m.s. Communications medic who by the way can immediately start medical care over the phone. We have delivered babies by phone, we have done cpr by phone, we do have medical priority dispatch capable communications medics, which not every system, most systems in the state cannot say. So but again our average response time for the system has been 8 minutes 42 second. For the first quarter of '05. For the county, outside the city of Austin, it has been 11 minutes, 28 seconds and within the city of Austin, city limits, 7 minutes 51 seconds. Obviously station placement is a factor in this response time. We do have a new software system that we are scheduled to have online by the end much June of this year. And that should give us an unprecedented level of ability to do modeling on why future station placements, whether we teed to perhaps look at relocating some existing stations, where new stations might help response times, all of that. That's going to be a wonderful tool for us to have, we should have that very soon.
>> I think the perspective that's lost here is that the -- before we started putting in county based e.m.s. Stations, because I had to take this statistic to lago vista, which was the first station out there. The average response time back in the '97-'98 time frame was 24 minutes. However best we could get it off of the old traffic serial numbers. That was average. Which means that there were places such as lago vista where it was closer to 40 minutes because the closest e.m.s. Station was at duval and 183. Can you imagine getting up 183 and then going all the way distance. So for us to come down from those kinds of numbers to literally cut it this half and it's only gotten better and if we needed to get a cause effect of was the investment worth it, in terms of bringing down those response times, this is exactly what we are looking for and it's -- we need to make sure that we are all, you know, continuing to improve. I know the city has had that kind of magic 8 manuscript mark has a little been kind of their gold standard to be able to get somebody on scene. So this is amazing.
>> system-wide is 8 minutes 42 seconds.
>> that's the entire system.
>> outside of the city limits, that's the system.
>> the system includes city of Austin and outside the city for just outside the city it's 11 minutes 28 seconds. All right? Thank you, Commissioner, for those clarifications. Then moving on, page 15, this is the trauma scene time. Now this does include star flight. And this is for the most critically injured patients who have life-threatening injuries. We do exclude entrapped patients who need a jaws of life to get them out of the vehicle. Obviously that's a whole other procedure. Excluding those, while we have star flight involved in the calls, we had a total of 110 trauma operators, so please bear in mind this is a very small set of data. So the numbers are not -- as you go out over time, you see a full year's worth of data, it becomes statistically more significant. 110 patients system-wide, 10 minutes 34 second was the total average scene time, from when the medic arrives until they are in an ambulance rolling to the hospital. And the goal there is under 10 minutes. So system-wide we are doing, we are very close to meeting the target. Now, out in the county, we do have, again, looking at a very small patient set of 15 patients, it's 13 minutes, 47 seconds, again that includes star flight. We will go through the stats without star flight. Obviously waiting for star flight, can take a little longer to wait for a helicopter to land safely, get the patient on board. So typically those numbers are higher when we include star flight. And then within the city, we are looking at -- at 10 minutes and 4 seconds, average trauma scene time of 95 patients. And going on to the next page, we have without star flight, we are looking at system-wide performance of nine minutes 43 seconds, 103 patients. The county measure looks a lot better, 10 minutes, 47 seconds, that's just 11 patients that star flight was not involved in those calls and then nine minutes 35 seconds for patients within the city of Austin. And finally, the cardiac data, which is what you've all been waiting for. We are doing well there. Our projected goal for 2005, this is system-wide, for -- for percent of cardiac arrest patients delivered to medical facility with a pulse, which means they are still alive, at least their heart is still beating, is -- is 26-point 90%. That was -- 26-point -- 26.09%. Outside of the city of Austin, that number is 20%, which represents 4 patients out of a total of 20, so again bear in mind this is a very small category. Should make you feel better to know that if you look at total year data for last year, and this is comparable because this has nothing to do with our cad system, so this data is comparable from year to year, the county performance was actually 26.79% for the year. The city performance was 24% for the year. And those totals were for the county 30 patients out of a total of 112, again this was all fiscal year '04 versus for the city, 84 patients out of 350. So while this first quarter may look somewhat, you know, of concern, we do know that looking out over time, larger patients set where we don't believe there's any real serious cause for concern at this point. And then the -- well, we already went through the city response or the city cardiac performance, 27.37%, 26 patients out of 95. Do you have any questions?
>> questions? Thank you.
>> thanks.
>> the last two slides, they will be just real quick is that we wanted to say how are we doing? Well, on revenue we are on course to meet our estimates, expenditures on course to meet estimates by the fourth quarter, performance measures on course to meet projections, so the overall report is consistent for both star flight and e.m.s. We will be back, as I said, probably sooner than after the first quarter because we now have the format down and we will be back to you shortly to give you our second quarter report.
>> okay. Thank you.
>> thank you, dan.
>> I would like to do one quick thing. In the letter that I sent you in regards to the prior item, judge, it says you approve add six-month moratorium. However, if you look at the letter it says from March through September, that's seven months. So I would like to ask what your feelings are in regards to my recommendation is that we would make it April 1st through September. And since this is already in March, that we definitely make it a six-month moratorium and not a seven month.
>> yeah.
>> I agree.
>> I agree. We are for the going to cross over fiscal years then as well. That makes it a nice clean end. The one thing that I --
>> change the letter?
>> I will need to -- I need to change or whatever your pleasure is as to how we need to -- you did approve a six-month moratorium, I would be glad to change the letter or whatever direction you wish to give me. There wasn't a letter that you approved. I知 saying in the backup I wrote a letter, in that I had March through September, that's seven months. It may be no conflict whatsoever here. I just want to make it clear to you that it's six month moratorium that we are doing, not a seven month.
>> I would ask melissa as a clarification to the motion in terms of the six-month moratorium it's beginning April first. That should clean that up. One thing that I would like to say to close here this is the first time in the 10 years that i've been on this Commissioners court when people say so how are we doing on star flight and e.m.s. We can get beyond just the sheer numbers of how often do we dispatch. We can actually get to the performance measures, to me this absolutely backs up the tremendous investment that Travis County has made, we always had it there for star flight, but in terms of there was a time that this Commissioners court invested about $300,000 in ems. It's now millions of dollars in e.m.s. And the partnership that's we have developed with our esd's and small cities and the city of Austin, building upon an amazing system that the city of Austin built. This shows in terms of the statistics, it's making a difference and we are saving lives because of it. Thanks.
>> thank you very much.
>> thank you very much. The motion was six months, right?
>> yes.
>> okay.
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Last Modified:
Wednesday, March 23, 2005 10:22 AM