The EMS Administration Section is responsible for managing (a) the Allied Information Services (AIS) billing and revenue collection service contract, (b) medical records, (c) the administration of fee amendments, (d) emergency medical services electronic data collection and reporting, (e) the ALS/BLS/Early Defibrillation Continuous Quality Improvement (CQI) Program, (f) risk management, and (g) biomedical and other emergency medical services equipment. The Section is managed by an H-43 EMS Administration Section Chief, which is a single classification within the City.

The EMS Administration Section Chief has six direct reports:

· 1.0 FTE Classification H-33 Rescue Captain responsible for Federal and State CQI requirements, special CQI projects, clinical issue identification, unusual occurrence report prioritization, risk management, training bulletin preparation, and CQI instruction at the EMS Academy.

· 1.0 FTE Classification H-33 Rescue Captain responsible for research. However, because the EMS Division has not recently been involved in ongoing research projects, this position has concentrated instead on preparing and analyzing CAD data reports and dealing with CAD data problems.

· 1.0 FTE Classification H-1 Fire Rescue Paramedic responsible for CQI. However, because the incumbent is a former biomedical engineer who has filled this position for more than four years on light duty, this position produces Requests for Proposals (RFPs) for biomedical equipment; receives, distributes, and trains FF/EMTs and paramedics in the use of biomedical equipment; and performs biomedical equipment maintenance.

· 1.0 FTE Classification 2112 Medical Records Technician and 1.0 FTE 2110 Medical Records Clerk, jointly responsible for working with the Fire Department"s contractor on billing and revenue collection, archiving medical records, and responding to medical records information requests.

· 1.0 FTE Classification 1426 Senior Clerk Typist (position never filled).

In summary, the Classification H-43 EMS Administration Section Chief and the Classification 1426 Senior Clerk Typist provide management and support services at a total salary and benefits cost of $193,267 for only five staff members.

Other Fire Department Administrative Functions

Concurrently, other parts of the Department are responsible for similar or equivalent administrative functions for fire suppression:

· The Division of Finance is responsible for departmental purchasing, billing, and salary payments. The Division of Finance is managed by 1.0 FTE Classification 0931 Manager VII/Chief Financial Officer. Reporting to the Chief Financial Officer are (a) a Finance Unit comprised of 1.0 FTE Classification 1824 Principal Administrative Analyst and 1.0 FTE Classification 1820 Junior Administrative Analyst (both positions are currently vacant), (b) a Payroll Unit comprising 1.0 FTE Classification 1224 Principal Payroll and Personnel Clerk, 2.0 FTE Classification 1222 Senior Payroll and Personnel Clerks, and 3.0 FTE Classification 1220 Payroll Clerks, and (c) an Accounting Unit comprising 1.0 FTE Classification 1654 Principal Accountant and 1.0 FTE Classification 1652 Senior Accountant.

· The Bureau of Equipment is responsible for (a) equipment and appliance repair (7.0 FTEs), (b) the Procurement/Distribution Center (8.0 FTEs), (c) the Clothing Depot (1.0 FTE), and (d) the Breathing Apparatus Repair Facility and Mobile Air One (4.0 FTEs). An additional 1.0 FTE Classification H-2 Fire Fighter on light duty is the Resource Manager of the Procurement/Distribution Center responsible for implementation of a new inventory barcode system, which is designed to permit tracking of all incoming and outgoing fire suppression and emergency medical services equipment and supplies.

Alternative Structural Arrangements

By structurally separating its emergency medical services administrative functions from its fire suppression administrative functions, the Fire Department divides the management accountability for similar or equivalent administrative functions, impedes the smooth integration of these administrative functions, creates potential overlap, and reinforces an inappropriate distinction between fire suppression and emergency medical services. For example, staff in the Procurement/Distribution Center commented to us that channels of communication with the EMS Division over equipment ordering does not function smoothly. Another example is that the Division of Finance is already involved in certain accounting functions for emergency medical services billing and revenue collection, yet the core financial functions performed by the contractor are managed by the EMS Administration Section.

The EMS Administration Section"s responsibilities for (a) emergency medical services electronic data collection and reporting, (b) the CQI Program, and (c) risk management should be transferred to the proposed Strategic Policy, Planning and Analysis Unit where those functions can be integrated into both the Department"s fire suppression and emergency medical services functions (see Section 1.3). These functions are currently performed by the two Classification H-33 Rescue Captains assigned to the EMS Administration Section, as described above.

It is important that these functions continue. However, as described in Section 1.3, it is not necessary that they be performed by sworn personnel. In fact, the Budget Analyst considers that assigning these responsibilities to civilian staff, rather than to sworn personnel, would ensure that the data collection and reporting, CQI, and risk management functions are consistently applied to both fire suppression and emergency medical services. Therefore, the Budget Analyst recommends that the two Classification H-33 Rescue Captain positions be deleted, and that the resulting savings be reallocated to the proposed Strategic Policy, Planning and Analysis Unit to fund the new civilian positions. This is discussed more extensively in that section of this report.

Each Classification H-33 Rescue Captain position earns $110,662 in salaries and benefits. Therefore, the total amount of funding to be reallocated for new civilian positions in the Strategic Policy, Planning and Analysis Unit, would be $221,321.

The EMS Administration Section"s responsibilities for managing (a) the AIS billing and revenue collection service contract, (b) the related medical records, and (c) the administrative work related to fee amendments should be transferred to the Division of Finance. The Chief Financial Officer is already involved in setting fee levels and the Accounting Section is currently developing a revenue monitoring system. The 1.0 FTE Classification 2112 Medical Records Technician and the 1.0 FTE Classification 2110 Medical Records Clerk should be transferred to the Accounts Section to continue working with AIS on billing and revenue collection, to archive medical records, and to respond to medical records information requests. This transfer recognizes the contribution made by these two positions to the collection of a valuable source of departmental revenue. Irrespective of their reporting line to the Division of Finance, these two positions would also continue to supply important information to the CQI Program. Therefore, transfer to the Division of Finance would not impede the availability of the two medical records positions to work with CQI staff in the new Strategic Policy, Planning and Analysis Unit.

Since the EMS Administration Section Chief provides only limited oversight of the AIS contract, which would be monitored by the Accounting Section"s new revenue monitoring system, no further staffing resources would need to be transferred to the Division of Finance. To ensure appropriate contractual oversight, however, it would be important to fill the currently vacant Classification 1824 Principal Administrative Analyst and Classification 1820 Junior Administrative Analyst positions in the Finance Section.

The EMS Administration Section"s responsibilities for biomedical and other emergency medical services equipment should be transferred to the Bureau of Equipment. Currently 1.0 FTE Classification H-1 Fire Rescue Paramedic is responsible for: producing Requests for Proposals for biomedical equipment; receiving, distributing, and training FF/EMTs and paramedics in the use of biomedical equipment; and performing biomedical equipment maintenance. In order to undertake this variety of tasks, the 1.0 FTE Classification H-1 Fire Rescue Paramedic position should be transferred to the Bureau of Equipment as a direct report to the Bureau of Equipment Captain. This position would work closely with (a) the EMS Unit to evaluate, specify, and purchase new emergency medical services equipment and medical supplies, and (b) the Procurement/Disbursement Center to inventory, disburse, track, and maintain emergency medical services equipment already on the equipment inventory. The position would therefore act as an information conduit between the EMS Unit, which has the necessary technical expertise to determine what types of equipment and supplies are needed in the field, and the Procurement/Distribution Center which is responsible for purchasing, disbursing, and tracking equipment and supplies. This position also contributes to the CQI Program in terms of the first responder cardiac arrest program, the Advanced Airway Project, and the truck first responder defibrillation program. Transfer to the Bureau of Equipment would not impede the availability of this position to work with CQI staff in the new Strategic Policy, Planning and Analysis Unit.

Consolidating similar administrative functions and technical experts would streamline the Fire Department"s administrative structure and processes, would require two less positions, and would assist the integration of fire suppression and emergency medical services.

Eliminating the 1.0 FTE EMS Administration Section Chief, which has a salary and benefit cost of $131,696, and the 1.0 FTE Senior Clerk Typist position, which has a salary and benefit cost of $61,571 at the top step, would save a total of $193,267.

Conclusions

The Fire Department manages its emergency medical services administrative functions separately from its fire suppression administrative functions. This divides management accountability for various administrative activities, and reinforces an inappropriate distinction between fire suppression and emergency medical services.

The Fire Department should eliminate the EMS Administration Section and integrate its former functions into existing Fire Department administrative divisions. The EMS Administration Section"s responsibilities for emergency medical services electronic data collection and reporting, the Continuous Quality Improvement Program, and risk management should be transferred to a new Strategic Policy, Planning and Analysis Unit. The responsibility for billing and revenue collection, related medical records management, and administration of fee amendments should be transferred to the Division of Finance. The tracking, disbursement, and maintenance of emergency medical system equipment and supplies should be transferred to the Bureau of Equipment.

Consolidating similar administrative and technical functions would streamline the Fire Department"s administrative structure and processes, would support the integration of fire suppression and emergency medical services, and would eliminate two positions.

Recommendations

The Fire Chief should:

1.1.1 Eliminate the EMS Administration Section.

1.1.2 Delete 1.0 FTE Classification H-43 EMS Administration Section Chief position, and 1.0 FTE Classification 1426 Senior Clerk Typist position.

1.1.3 Transfer responsibility for emergency medical services electronic data collection and reporting, the Continuous Quality Improvement Program, and risk management to the proposed Strategic Policy, Planning and Analysis Unit.

1.1.4 Delete 2.0 FTE Classification H-33 Rescue Captain positions.

1.1.5 Transfer $221,321 in savings from the deleted H-33 Rescue Captain positions to fund civilian positions in the proposed Strategic Policy, Planning and Analysis Unit, who would perform data management and CQI functions.

1.1.6 Transfer the responsibility for the emergency medical service billing and revenue collection function, related medical records management, and the administration of fee amendments to the Division of Finance.

1.1.7 Transfer 1.0 FTE Classification 2112 Medical Records Technician position and the 1.0 FTE Classification 2110 Medical Records Clerk position to the Division of Finance.

1.1.8 Transfer the responsibility for tracking, disbursing, and maintaining emergency medical services equipment and supplies to the Bureau of Equipment.

1.1.9 Transfer the 1.0 FTE H-3 Fire Fighter Paramedic position, responsible for biomedical equipment, to the Bureau of Equipment.

Costs and Benefits

There would be no new costs to implement these recommendations.

Consolidating similar administrative and technical functions would streamline the Fire Department"s administrative structure and processes, support the integration of fire suppression and emergency medical services, and require two less positions.

Eliminating the 1.0 FTE Classification H-43 EMS Administration Section Chief position, and the 1.0 FTE Classification 1426 Senior Clerk Typist position would save a total of $193,267 per year.

An additional $221,321 per year in savings from eliminating two H-33 Rescue Captain positions would be available to fund civilian positions in the proposed Strategic Policy, Planning and Analysis Unit (see Section 1.3).