Plan could stop disputes over ambulance response times

Bill Compton, senior vice president for Grady Emergency Medical Services, is happy to deliver data on response times for his ambulances in one of the most vulnerable corners of the state: south Fulton. And why wouldn’t he be pleased?

Grady, he said, has shaved off 10 minutes from the previous ambulance service’s response times. “That’s my Reader’s Digest version,” he recently told an Atlanta committee of evaluators.

Meanwhile, not everyone is buying it, especially a competitor.

Compton’s data is “self-reported and not vetted,’’ Terence Ramotor, regional director for American Medical Response, told the Atlanta Journal-Constitution. That’s why he cautions against using the data to compare AMR’s performance of a year ago to Grady’s.

» MORE: Politics and conflicts mire EMS service in Georgia

Amid public uproars over long waits for emergency transport, debates over the accuracy of reported response times for ambulances are common across the state. While the measure falls short of defining the quality of emergency care, the time it takes an ambulance to arrive on the scene at times can mean the difference between life and death.

Now, a statewide committee of top EMS officials that advises state leaders wants to put an end to the data disputes and establish an objective process that could better ensure the public is getting the best service.

The Georgia Emergency Medical Services Advisory Council wants the state to require regional EMS councils to evaluate providers based on independent data that is tied to clinical and system performance. The proposal, adopted by EMSAC members late last year, is a top priority of a 25-page strategic plan that is aimed at overhauling the state’s EMS system.

“Sometimes, when you look at your own house, you don’t see the dirt,’’ said Courtney Terwilliger, a member of the Georgia Trauma Commission. “Sometimes, you need outside eyes.”

In June, an AJC examination found the state fails in its duty to ensure the quality, timeliness and reliability of Georgia's emergency medical services system. Many of the problems, the AJC found, stem from vague state rules for determining who is selected to provide emergency transport services and how they are vetted, leaving the system vulnerable to political pressure and conflicts of interest.

Over the last several months, state EMS leaders, including Terwilliger, have been pushing a host of reforms to lend more clarity to decisions. The state, meanwhile, has said it plans to improve oversight and develop rules to hold providers accountable.

In December, the state adopted a new rule that requires the regional councils to adhere to the open meeting law and to disclose conflicts of interest.

David Newton, who became the director of the state Office of EMS and Trauma about a year ago, recently announced that there will also be a push for a rule that would allow the regional councils to develop their own measures for evaluating the performance of ambulance providers.

Newton’s office just hired a data manager to produce reports to aggregate data from patient care reports, he said.

So far, none of the regional councils has made a formal request for the data to evaluate providers, Newton told the AJC.

Welcome involvement

More than a dozen fire chiefs in Fulton County would welcome the state’s involvement. In fact, leaders across the state have petitioned Newton’s office to allow municipalities to establish a reasonable standard to apply to evaluations of providers.

In south Fulton, fire chiefs from several cities said such a move would increase their level of comfort with the quality of service from an ambulance provider. Some have had concerns about their inability to hold providers accountable to pledges of good service.

“What fundamentally has to happen is that, in order to improve a system, we have to define what the desired outcome is,’’ Fire Chief Henry Argo, of the city of Palmetto, told the AJC.

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That outcome hasn’t been defined in an effective way by the councils or by the state, he said.

To start, the state could charge local leaders with establishing a clear definition for the response time statistic that must be reported.

Providers in the past have reported only average response times, a figure that doesn’t paint an accurate picture of the level of services, Argo said.

So, for example, he said, if most 9-1-1 calls happen in one area, a provider that concentrates resources in that area can keep average response times very low, even while response times are poor in outlying areas that account for a smaller percentage of calls.

A better standard, he said, would be a statistic that is required by elected officials in Palmetto.

Every month, Argo said he must report to his bosses if his medic-fire crews are arriving within eight minutes on 90 percent of calls. That is what elected officials consider a reasonable level of service for the community.

So why not define such a goal for ambulance providers?

“Until there is a common determination of what those statistics are,” the system can’t be evaluated properly, Argo said.

Data wars

Feuds, big and small, break out all over the state, thanks to attackable data.

David Loftin, a former EMS regional director in northwest Georgia, remembers one dispute in which he played the role of referee between two competitors. He spent days watching them as they sat across the table from each other, passing pieces of paper to fact check each other’s response times.

“We had to print out all the patient trip reports off the computer and they looked at each of the (response) times, at every single call, to make sure the other wasn’t telling fibs on trip reports,” Loftin said.

A similar dispute still festers in south Fulton.

» MORE: Ambulance delays continue to put south Fulton lives at risk

Argo said south Fulton fire chiefs have asked Fulton County EMS to provide verifiable data on response times in their respective cities. They prefer that to Grady’s self-reported data.

“That is something that collectively we feel very strongly about,’’ Argo said. “As long as it rests with Fulton County, we’ll get more of a true picture.”

Grady was selected as the ambulance provider for the area a year ago largely on the promise that it would provide a 9-minute response time. In January, Compton said it had delivered an average response time of about 11.46 minutes, based on a year's worth of Grady data.

Meanwhile, Fulton County reported an average response time that was close to Grady’s analysis, said Pete Quinones, chairman of the EMS Council ad hoc committee that evaluated Grady.

Quinones and Argo acknowledged that Grady had not hit the 9-minute average response time goal but said its service has been an improvement over AMR’s. Argo added, however, that he and other fire chiefs believe Grady’s service “could be better.”

Meanwhile, Ramotor, the AMR official, points out what he sees as gaps in the evaluation process.

Credit: Alyssa Pointer

A year ago, he bid a 12-minute response time for ambulances in south Fulton, where there is no financial support from the county and most trips are reimbursed at low rates. When the council reviewed the bids, he said evaluators appeared to cherry pick his company’s highest average response times in rural communities that are harder to access, including Chattahoochee and Palmetto. At the same time, they overlooked average response times that appeared better in the cities of College Park and East Point, which are in urban areas.

In response to some of the criticisms, Quinones, who was among the evaluators that voted to replace AMR, said leaders in EMS Region 3 have implemented a series of performance measures to evaluate providers like Grady.

Grady administrators, in response to questions, told the AJC that they have implemented modifications to improve performance.

In April, it plans to integrate its 911 Emergency Medical Dispatch Center with Fulton County’s computer-aided dispatch, which will allow Grady to have real-time information on the location of ambulances nearest to calls. A new deployment of crews also will boost the number of 24-hour units on the streets, administrators told the AJC.

‘Invaluable’

Georgia may be on the cusp of bringing objective data to bear on decisions as it also will face pressures like other states to adopt priorities set by the health care industry, others say.

The health care system, which includes EMS, is quickly moving toward value- and quality-based decision making, said Matt Zavadsky, president of the National Association of Emergency Medical Technicians, and chief strategic integration officer for MedStar Mobile Healthcare in North Texas.

It only makes sense to equip those regional councils that make determinations about providers to have access to data upon which to make their decisions, he said.

“Having the ability to prove quality and make decisions based on quality,” he said, “would be invaluable.”

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EMS meeting

Members of the Georgia Emergency Medical Services Advisory Council are expected to meet at noon on Feb. 20 at the Georgia Office of EMS and Trauma, 1680 Phoenix Boulevard, Suite 200, Atlanta. The meeting will be held in the large training room.

Among the topics of discussion will be a proposed document that regional council members would have to complete in order to disclose any potential conflicts of interest.

Another topic of discussion is expected to focus on “Strategic Plan 2020,” which has established seven goals for improving emergency medical services in Georgia. Among the goals is to identify meaningful performance measures for evaluating EMS providers, including ambulance companies.

Another top goal is to make data available to EMS providers. As part of that, one recommendation is to provide training to EMS agencies to help medics and others complete accurate and verifiable patient data trip reports.

David Newton, the state’s director of EMS, told the AJC that such training is already under way. His office also is tapping sources of funding to provide an online learning management system that will emphasize the importance of recording accurate, valid and complete data.

The system also will provide guidance to agencies on how to create documents for their use.

EMSAC is a statewide committee of EMS leaders that advises the state Office of EMS and Trauma. Newton, as well as other members of his staff, have a seat on EMSAC.

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