August 12, 1998

To:Emergency and Protective Services Committee

From:Acting General Manager, Toronto Ambulance

Subject:Critical Care Transport Unit Program - Definition of 'Cost Recovery-Plus'

Purpose:

To provide additional information to the Emergency and Protective Services Committee regarding Toronto Ambulance's June 15, 1998 report describing the Critical Care Transport Program initiative, specifically the meaning of 'cost-recovery plus' within the context of the report.

Funding Sources, Financial Implications and Impact Statement:

There are no immediate financial implications or requirements related to this initiative. Part of the benefit to the Department and the City will be the realization of a positive net revenue flow. Amounts will ultimately depend on the degree to which this program is utilized by Toronto and area hospitals.

Recommendations:

It is recommended that this report be received for information.

Council Reference/Background/History:

At the July 14, 1998 meeting of the Emergency and Protective Services Committee, Toronto Ambulance had a report outlining a service initiative it is exploring with interested Toronto and area hospitals. The Committee adopted the report, but requested that the Department further define the elements of 'cost-recovery plus' as described in Recommendation No. (3) of the report.

Comments and/or Discussion and/or Justification:

Partly as a consequence of hospital restructuring and closures, many hospitals are finding that they no longer afford to send the staff and equipment resources necessary to be able to accompany critical patients on inter-hospital transfers. As described in the Department's June 15, 1998 report, Toronto Ambulance has established a provisional partnership with Sunnybrook Health Sciences Centre to undertake the process of upgrading certain paramedics to the skill level required to service these emergency transports. In addition, Sunnybrook has agreed that, under the auspices of such a program, it will provide ongoing medical control, risk management and quality assurance.

The Critical Care Transport Unit Program is mandated to fully recover the costs of service delivery including wages, benefits, vehicle and equipment costs and suitable administrative overhead. Regular ambulance coverage to the City will not be compromised, as costing will include backfilling with the resources necessary to ensure uninterrupted regular service.

'Cost-recovery plus' simply implies that it is the Department's intention to secure a positive net revenue in the delivery of the program, where possible, and as it expands. During initial start up it is anticipated that the program will operate on a cost recovery basis, at a minimum. As the business volume increases, the current pricing is expected to result in a surplus of revenues over expenditures, which will in turn be applied as a revenue to the Department and the City.

It is not the design of the program to be solely profit focussed. There will exist other benefits or 'pluses' to it. For example, the Critical Care Transport Units (CCTUs) will only be used by the participating hospitals when requested. At other times, they will be available to service regular emergency calls within the community, and the patients they serve will benefit from any of the new skills that their paramedic crews have acquired.

Similarly, as the program continues to expand, it is hoped there will be seen a slight easing of the congestion in certain parts of participating hospitals, which in turn may have an positive impact on ambulance service delivery (i.e. ambulances may, in the long run, find themselves being redirected from 'closed' hospitals less often).

Conclusions:

The potential advantages to the Critical Care Transport Program are many. The rewards will be partly related to revenue (a positive revenue source), but will also be related to enhanced service delivery throughout the entire city, and in the hospital community. In addition, Toronto Ambulance is taking a proactive step toward establishing a greater linkage with a community-based and integrated health care system model where opportunities for cost and service efficiency can be optimized.

Contact Name:

Ron KeluskyPhone: 397-9240 Fax: 392-2115

Ron KeluskyBarry Gutteridge

Acting General ManagerCommissioner

Toronto AmbulanceWorks and Emergency Services