Tuesday, April 26, 2011

MY Minutes: 2011.4.25 – RC EMS Committee Meeting

Yesterday (2011.4.25), I had the opportunity to attend the Robertson County EMS Committee Meeting.

This was a special-called meeting to discuss the engagement of NorthCrest Medical Center (NMC) for a partnership of NMC and EMS. The proposal had been submitted to the committee members, but a couple of members desired to have more time to review the document.

What was decided on Monday night was that Robertson County would submit to an assessment period described here:
Prior to the execution of the contract there would be a thirty (30) day assessment period where the NorthCrest appointed representative, and designees, would evaluate all aspects of RCEMS operations.  Currently, the extent of need is largely unknown.  This operational assessment would allow NorthCrest to evaluate the current practices and acquire the needed insight to develop an accurate action plan.  By developing this plan, the time required to make a noticeable positive impact on operations would be lessened.  The operational assessment can be sub-divided into these focus areas:    
Financial Analysis.  This would reveal opportunities to gain efficiencies through process, and policy changes that affect the financial performance of RCEMS.  This analysis would include analysis of the revenue stream and identify factors that cause month to month variation in collections.  During this analysis, a historical perspective of monthly expenditures would be needed to determine the cost per Relative Value Unit (RVU) for each level of service provided.   
Billing Analysis.  Complete analysis of the billing practices, status of current accounts receivables to include an evaluation of the potential collections of current accounts receivable based on the age of the receivable.  The status of provider agreements to include negotiated rates, collection policy, medic documentation, and any variable that affects the billing cycle. 
Operational Analysis.  The operations of RCEMS would be reviewed for improvement opportunities.  This would include staffing efficiency, equipment, station efficiency, management effectiveness and willingness to embrace the proposed changes.  
Clinical Analysis.  This analysis would be performed by the proposed medical director.  The current practices and quality assurance cycle would be reviewed to identify opportunities that may be present.  The quality assurance feedback loop would be evaluated to ensure the medics are receiving the needed information to continue their professional growth.  The proposed medical director would also meet with the education officer to evaluate the current curriculum and identify future educational needs.  The current clinical protocols would be evaluated to determine adherence to the current pre-hospital standards of care.  This analysis would be accomplished through a combination of run sheet reviews, protocol review and interviews with RCEMS employees.
Internal Systems Analysis.  The internal systems would be evaluated to determine where check and balance procedures need to be implemented.  These systems include, but are not limited to, policy and procedures, standard operating guidelines, purchasing, time keeping practices, etc.   
The findings of the operational assessment would be reported back to the Robertson County Attorney, Mayor, and EMS sub-committee Chairman.  They would then be responsible for reporting back to the appropriate decision making body.
After the operational assessment is reviewed, both parties reserve the right to determine if the proposed agreement is in the best interest of the entity they represent.  Further, if it is found the proposed agreement is not in their entity’s best interest, either party may terminate negotiations and neither party is obligated to the other.
This assessment will begin immediately. I look forward to the results. With all of the turmoil these folks have endured, and more importantly, will all that the County has endured as a result – this is time for us to analyze what we are doing.
I do not want to belabor yet another discussion regarding this topic since I have previously shared my opinion. I just know some folks have asked me what “partnership” means, and just what it may mean for the future of EMS. I think that can best be represented by the proposal itself.
Here is the “Project Summary”:
The proposed contractual agreement would serve as the foundation for developing a close working relationship between NorthCrest and RCEMS.  To form a contractual agreement, whereby, NorthCrest would provide subject matter expertise on the clinical and financial operations of RCEMS.  This would be accomplished by NorthCrest appointing an administrative director to provide managerial oversight of the business and financial operations of RCEMS, while maintaining complete transparency through monthly reporting to the County Commission EMS sub-committee.  NorthCrest would also provide medical directorship to oversee the clinical care being provided by RCEMS personnel.  This proposed agreement would also allow RCEMS to maximize the efficiency of their operations, thereby, reducing the burden placed on the Robertson County general fund.
For a more detailed look at the proposal, feel free to contact me.


  1. Well done commissioners to take a progressive leadership role in providing this important service to the citizens of Robertson County. I believe this will also help establish a strong foundation towards fiscal responsibility.