Close Banner Health North Colorado Medical Center Paramedic Services (322) Date submitted: 2/13/2015

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1 Page 1 of 13 Colorado EMTS Provider Grant Request Close Banner Health North Colorado Medical Center Paramedic Services (322) Date submitted: 2/13/2015 Organization Information 1. Legal Name of Organization: Banner Health North Colorado Medical Center Paramedic Services 2. Business Name: Banner Health North Colorado Medical Center Paramedic Services 3. Federal Tax ID: Grant Contact: Megan Berkeimer Financial Analyst 5. Mailing Address: th Street 6. Primary Phone Number: Fax: Preferred method of contact: 10. Authorized Signature: Rick Sutton CEO Banner Health Northern Region Is the Authorized Official the chair or president of Yes the governing board for this organization? Grant Options 1. Organization Match Percentage: 50% 2. Is this a consolidated or multi-organizational No Application? 3. Select the counties that this grant project impacts: Adams Larimer Logan Morgan Weld 4. Does your organization provide services outside No the Colorado borders? 5. Please describe your overall grant request in ten sentences or less: The purchase of a new (2015) Ford E450 Gas Life Line Emergency Vehicle Superliner Ambulance. This is a unit consistent with the current fleet of ambulances for Banner Health North Colorado Medical Center Paramedic Services Categories Selected Category Total Price Match Entity Amount State Amount Amount Funded $198, % $99, $99,381.50

2 Page 2 of 13 Ambulance and Other Vehicles Total for All Categories $198, , $99, Ambulance and Other Vehicles Category Request Items Requested: Quantity Description Price Each Total Price Percent Match Entity Amount State Amount Ford E450 Gas $198, $198, % $99, $99, Life Line Emergency Vehicle Ambulance and other $198, $99, $99, Vehicles Category Total Amount Funded Service Needs: 1. Briefly explain what type of vehicle you are requesting and why this vehicle is needed Type III Ford E450 Life Line Emergency Vehicle Superliner Ambulance from Rocky Mountain Emergency Vehicles. The vehicle will replace or add onto the fleet of ambulances currently used to provide licensed emergency and routine response to calls for service throughout northern Colorado. 2. Is this vehicle a replacement or an addition to your current fleet? This vehicle is scheduled as a replacement; although due to the current average miles on the remaining fleet it may be an additional ambulance for a short period of time. 3. If this vehicle is a replacement, enter the number of days the unit to be replaced was out of service for repairs and explain what will be done with the old unit (sold, traded, donated, retired)? When vehicles in the fleet are retired from service they may be offered for donation throughout the RETAC to first response agencies and then to educational institutions for training. 4. What is the average length of service of vehicles operated, in miles or years? 250,000 miles and 4-5 years of service. 5. Briefly describe your vehicle replacement program. The ambulance fleet is monitored for cost per mile and hours on the chassis and motor / drive train. When costs / miles / hours create a cost per mile approaching $1.00 the units are prioritized for replacement or re-chassis. Historically this occurs within the neighborhood of 4-5 years; due to increasing miles and hours on the chassis it is now 4 years of service. 6. Describe your front line and back up rotations. Maximum daily deployment of eight (8) ambulances. Agressive preventative maintenance schedules are maintained and consistent standby requests for our services keep the vehicles rotating. 7.

3 Page 3 of 13 Describe local support for this project and how this support will help ensure successful completion. Performance contracts require realiable ambulances for response at all times. The geographical size of our service area results in an approximate 3 percent of the time that crews double load patients into the ambulances for transport from the scene of motor vehicle accidents. Local support for the access to the clinical environment by first response agencies and training centers in the service area is supportive of the large numbers of riders. Priority to Underdeveloped or Aged Systems: 8. Explain how this proposed project addresses an underdeveloped or aged component of Colorado s EMS and trauma system. The challenges of the varying requests for service continue to increase. Our fleet currently averages 148,500 miles per ambulance. The hours on the motors continue to increase as well in large part due to the service area size geographically. Cost Effectiveness: 9. Briefly describe the alternatives your organization considered and why this is the most cost effective alternative. The Paramedic Service fleet now includes two non-medical transport vans for non-medically necessary requests from the public and facilities for transportation services. These are being offered to prevent utilization of our ambulances and reduce costs of service to both the agency and the public. Again in an effort to meet performance contracts, reduce and contain costs and provide a more appropriate and timely service to the customer requesting various destinations throughout the service area. 10. Briefly describe the process used to select the vehicle vendor: upload the proposed vehicle vendor s cover letter that lists the estimated base price, any additional safety features selected and their cost, and the total overall cost of the vehicle. This cover letter is required and should state that for ambulances, the data recorder is included. Rocky Mountain Emergency Vehicles has been our vendor of choice for a number of years. They are responsive and stand behind their products. They are part of a team effort to deliver a quality product that is reliable and one that they service in a timely manner when requested. 11. How will this project be sustained financially in future years? Departmental budget will be adjusted to support the purchase going forward. Applicant's qualifications: 12. Explain how adequate resources and experience are available to help ensure successful completion of this project. The committment of Banner Health and North Colorado Inc. Board to maintain a high performance paramedic service for the community. The leadership team has a strong history of not only meeting but exceeding the requirements of the State EMS Grant Program along with strong working relationship with the State EMS Grants Program managers and department as a whole. There is a strong history of supporting other agencies in the region when equipment / vehicles

4 Page 4 of 13 are donated to first response agencies and training facilities versus being traded in or sold outright. 13. Explain how the applicant s qualifications will help ensure long term sustainability of this project. As listed above. The committment demonstrated in previous grant applications / awards, along with the efforts to make sure the region benefits from grant awards of a similar nature, demonstrate the sustainability of the funds over a long period of time. Systems Integration: 14. How does this project improve system compatibility and/or reduce duplication? This vehicle is consistent with current configuration of vehicles in the fleet. It provides a safe, quality and reliable clinical environment for the patient as well as the crew and students who ride within our sytem. Financial Need: 15. Explain why your organization needs grant funding to complete this project. The service delivery area is largely rural and frontier. The demongraphics demonstrate a large percentage of self pay, Medicaid and Medicare. Along with a substantial percentage of people who are medically indigent. Billed charges to revenue collected continues to be a challenge as it is for many EMS agenices who struggle to deliver services in the challenging setting. 16. What would happen if these grant funds were not secured? There would be a need to pursue other funding sources and result in a potential delay in replacing and / or adding to our servivce capabilities. File Attachments 17. Uploads vendor quote required, letters of support recommended: No files found Organization Profile for Banner Health North Colorado Medical Center Paramedic Services Organization Data

5 Page 5 of 13 A. Agency / Facility Information 1. Legal Name of Organization: Banner Health North Colorado Medical Center Paramedic Services ID Number: 322 Profile Year: 2015 Submission Date: 2/12/ Doing Business Name of Organization: Banner Health North Colorado Medical Center Paramedic Services 3. Physical Address: th Street Physical County: Weld 4. Mailing Address: th Street 5. Person Filling out this Profile: David W Bressler Title: Chief Paramedic 6. Primary Phone Number: Alternate phone number Fax Phone: Preferred method of contact 11. Web Site: 12. RETAC Affiliated With: Northeast Colorado 13. Primary urbanicity Rural Other urbanicities Rural B. Organization Types 1. EMS Response: Yes 2. Medical Facility: Yes 3. EMS Education Program: Yes 4. County officials issuing ambulance No licenses or County EMS Councils: 5 RETAC: No 6. Association / Foundation / Other: No C. Geographic Service Area 1. In one or two short paragraphs describe the geographic area serviced by this organization: Banner Health North Colorado Medical Center Paramedic Services is the primary advanced life support licensed transport agency in Weld County Colorado except in the following fire districts. Windsor / Severance - Provider is University Health. Milliken - Provider is University Health. Johnstown - Provider is University Health. Hudson - Provider is Platte Valley Medical Center

6 Page 6 of 13 Southeast Weld - Provider is Platte Vallery Medical Center and Southeast Weld Fire District. Lochbuie - Provider is Platte Valley Medical Center Frederick - Provider is Frederick Firestone Fire Department. Firestone - Provider is Frederick Firestone Fire Department. Mountain View Fire Districts - Provider is Mountain View Fire District. EMS Contacts A. EMS Organization 1. EMS Organization Name: Banner Health North Colorado Medical Center 2. Licensing: Is this organization a county Yes licensed ground ambulance service? Is this organization a Colorado licensed air ambulance service or currently applying for licensure? No B. EMS Service Director 1. Director's Name: David W Bressler Chief Paramedic 3. Primary Phone Number: Secondary phone number: Preferred method of contact: C. EMS Alternate Contact 1. Alternate Contact's Name: Mitch E Wagy Assistant Chief 2. D. EMS Medical Director 1. Medical Director's Name: Robert Lowe

7 Page 7 of Primary Phone Number: Secondary phone number: Colorado Medical License Number: E. Second EMS Medical Director 1. Medical Director's Name: 2. Mailing Address: 3. Primary Phone Number: Secondary phone number: Colorado Medical License Number:, F. EMS Data Administrator 1. EMS Data Administrator Name: David Goss IT Support 2 Primary Phone Number: Secondary phone number: Preferred method of contact: G. Emergency 24 Hour Contact 1. Emergency Contact Name: David W Bressler Chief Paramedic 2. Primary Phone Number: Dispatch Center Name Weld County Regional Communications Center Dispatch Center Contact Person: 24/7 Contact Number: Services and Structure 1. Organizational Structure: Hospital based 2. Corporate / Tax Status: Private nonprofit 3 Government Type: N/A 4. Funding Types: User Fees, Private Contract, grant 5. Billing Method: In-house 6. Primary service provided by your Scene response with transport EMS Organization: 7.

8 Page 8 of 13 Other services provided by your EMS organization: 8. What level of provider can your service send to EVERY call? Scene response without transport, Interfacility transport, Convalescent medical transport, ALS intercept Paramedic Personnel Category Full Time Part Time Volunteer Total 1. First Responder 2. Emergency Medical Technician (EMT): 3. Advanced Emergency Medical Technician (AEMT): 4. Intermediate 5. Paramedic Nurse 7. Physician 8. Administrative / Other Full-Time Equivalent Count: 63 Requests for EMS Services A. Requests for Services 1. Emergency Response with 11,888 Transport: 2. Interfacility Transports: Emergency Response, no Transport: 6, Emergency Response Care 78 Transferred / Transport by Other: 5. Standby: Cancelled Calls: 1, Total: 21,231 B. EMS Financial Resources 1. Total Annual EMS Budget for this $14,599, Organization: 2. Billing: 2a. Total Annual EMS Charges Billed: $20,597, b. Contractual Allowances and $15,283, Discounts (if known): 2c. Net Annual EMS Charges Billed: $5,314, $4,319,412.00

9 Page 9 of 13 Total Annual EMS Charges Collected: 4. Collection rates: 4a. Crude Collection Rate: 20.97% 4b. Adjusted Collection Rate: 81.28% Counties Licensed In 1. List all counties where this agency is licensed for Ground transport services: Larimer, Weld EMS Ground Demographics A. Demographics of Service Area for Ground Transport 1. Employment Type: Paid 2. Number of stations for this Service: 5 3. Average Call Time (Dispatch to minutes Back-In-Service:): 4. Average patient mileage per 8.32 miles transport: 5. Total square miles of your primary 3,992 service area (land & water): 6. Estimated permanent population of 269,785 your primary service area: 7. Population Density of Service Area: B. Ambulances in Service 1. How many EMS transport vehicles (ambulances) does this organization own or lease? 2. Given typical conditions, please estimate how many EMS transport vehicles with appropriate staffing could this organization deploy to a state or national emergency outside of the local area? 13 1 C. EMS Ground Billing Rates 1. BLS Emergency - HCPCS Code $0.00 A0429: 2. $0.00

10 Page 10 of 13 ALS Emergency - HCPCS Code A0427: 3. ALS Level 2 HCPCS Code A0433: $ Specialty Care Transport HCPCS $0.00 Code A0434: 5. Mileage Rate HCPCS Code A0425: $0.00 D. System Participation 1. Is your agency National Incident Management System (NIMS) compliant? Yes Vehicles Unit Make / Model / Year Box Make Mileage Equipped Number For All Wheel Drive Type kkk.1822 Bought with EMS Funds Status 31 Ford / E-350 / 2006 Braun 231,929 ALS III In Use 37 Chevy / G4500 / 2009 Braun 171,033 ALS III Yes In Use 38 Chevy / G4500 / 2009 Braun 158,879 ALS III Yes In Use 39 Chevy / G4500 / 2009 Lifeline 163,135 ALS III In Use 40 Chevy / G4500 / 2009 Lifeline 175,215 ALS III In Use 41 Chevy / G4500 / 2009 Lifeline 174,130 ALS III In Use 42 Chevy / G4500 / 2009 Lifeline 179,490 ALS III In Use 43 Chevy / G4500 / 2009 Braun 122,064 ALS III Yes In Use 44 Chevy / G4500 / 2010 Lifeline 117,346 ALS III In Use 45 Chevy / G4500 / 2010 Lifeline 132,845 ALS III In Use 46 Chevy / G4500 / 2010 Lifeline 127,464 ALS III In Use 47 Chevy / G4500 / 2011 Lifeline 110,275 ALS III Yes In Use 48 Chevy / G4500 / 2012 Lifeline 66,155 ALS III Yes In Use Facility Information A. Facility Service Information 1. Facility Name: North Colorado Medical Center 2. Facility ID (from the CDPHE trauma F6201 registry): 3. Does this medical facility regularly Yes receive patients by ambulance? 4. If Yes, select your designation II level: 5. Corporate / Tax Status: Non-Profit 6. 56,000

11 Page 11 of 13 Emergency Department Annual Patient Volume B. Hospital Administrator 1. Hospital Administrator's Name: Rick Sutton CEO 3. Primary Phone Number: Secondary Phone: Preferred method of contact: C. Trauma Program Manager 1. Trauma Program Director's Name: Toni Moses Trauma Program Manager 3. Primary Phone Number: Secondary Phone: Preferred method of contact: D. Trauma Nurse Coordinator 1. Nurse Coordinator's Name: Valorie Peaslee Trauma Outreach Coordinator 2. Primary Phone Number: Secondary Phone: Preferred method of contact: E. Trauma Medical Director 1. Medical Director's Name: Sam Saltz 3. Primary Phone Number: Secondary Phone: Colorado License Number: DR

12 Page 12 of 13 D. Key Trauma Program Staff No staff on file EMS Education Information A. EMS Education Program Information 1. EMS Education Program Name: Banner Health North Colorado Medical Center Paramedic Services 2. Is your training program Yes recognized by the Colorado Emergency Medical and Trauma section? If yes, which groups or centers does Colorado currently recognize: Basic group AEMT group Intermediate group Paramedic group B. EMS Education Program Director 1. Program Director: David W Bressler Chief Paramedic - Director 3. Primary Phone Number: Secondary Phone: Preferred method of contact: C. EMS Education Program Medical Director 1. Medical Director's Name: Rob Lowe 3. Primary Phone Number: Secondary Phone: Colorado License Number: D. Key Education Program Staff No staff on file

13 Page 13 of 13 Past Years Grant History Year Category Total State Amount Funded Amount Spent Requested 2015 Ambulance and Other $193, $96, $96, $0.00 Vehicles 2014 EMS and Trauma Equipment $468, $234, $234, $233, Ambulance and Other $158, $79, $79, $79, Vehicles 2012 Ambulance and Other Vehicles $154, $138, $138, $138, Financials and Other Attachments Financial Questions 1. Briefly Describe how this organization is funded and why it may require EMTS grants: Banner Health NCMC Paramedic Services is funded through fee for service. There is no subsidy or special district funds avaiable for the services provided by Banner Health throughout the region. 911, Emergent and Routine Transfers both in and out of facilities, along with Behavioral Health and Medical Transportation Services challenges the resources available. The demographics of Medicaid and Medicare being the largest percentage of customers served present the challenges of federal fee schedules combined with the medically indigent population. 2. Briefly describe any affiliations or partnerships this organization has with any parent or subsidiary organizations: Banner Health works with the North Colorado Medical Center Inc. Board to provide high quality Paramedic Services to the surrrouding community and region. Additionallly the North Colorado Medical Center Volunteers provide funds through a application process for the community. Attachments 1. Required attachments: 2015 Statement of Work.pdf Banner 2015 Grant line item.pdf Banner Grant Pricing 2015.pdf Banner Safety Items pricing 2015.pdf W PDF Close

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