STATE OF WEST VIRGINIA
UPDATE OF THE
PRELIMINARY PERFORMANCE
REVIEW OF THE

EMERGENCY MEDICAL SERVICES ADVISORY COUNCIL
EMSAC is in Full Compliance with the Recommendations of the Preliminary Review
OFFICE OF LEGISLATIVE AUDITOR
Performance Evaluation & Research Division
Building 1, Room 314-W
State Capitol Complex
CHARLESTON, WEST VIRGINIA 25305
(304) 347-4890

Issue Area 1: Low Participation in the Emergency Medical Service Advisory Council Inhibits it from Adequately Fulfilling its Advisory Role.

1995 Recommendation 1

The OEMS should reinstate the measurement of EMS performance that was discontinued in 1991 so that the effectiveness of the overall performance of the statewide EMS system can be accurately gauged. The new director of OEMS has already expressed an intention of doing so. Further, a formal procedure for the directors of OEMS and BPH to request advisory opinions from the Council, and for the Council to transmit opinions to the directors should be created. Once the communication process is implemented, the director of OEMS can develop a performance measurement system using the following six step approach. First, affirm the Council's mission, goals, target population and needs. Second, identify the uses and users of the performance information. Third, select what to measure and choose benchmarks for comparison. Fourth, develop a measurement system by refining selected measures with regard to unit of measure, appropriate methodology, data availability, cost beneficial collection and ease of verification. Fifth, establish a monitoring system to track, analyze and report about performance, comparing the actual performance to the benchmark. Finally, make decisions based on program performance and adjust programs where necessary.

1997 Level of Compliance: Partial Compliance
At the time of the 1997 update, the Office of Emergency Medical Services (OEMS) was in the process of studying EMS Run Report data compilation alternatives, preparing to promulgate a legislative rule to enforce its new licensure function over EMS agencies (a process involving considerable performance measurement), reinstating Hospital Trauma Registry data collection and development of ambulance call data retrieval from Regional Medical Command Centers.

1998 Level of Compliance: In Compliance
The 1995 Recommendation encouraged the Office of Emergency Medical Services to measure Emergency Medical Services performance. The thrust behind this recommendation was that the EMSAC needs information about the status of the emergency medical services delivery system before it can be effective in offering advice to the OEMS. In addition, the OEMS needs feedback on changes it makes to the delivery system, in response to EMSAC recommendations or other cues. The lack of performance information in the past may have discouraged active participation among Council members.

At the January 8, 1998 meeting, the Council delivered advice on methods of evaluating EMS performance. Specifically, the Council considered several alternatives for entering run report data and formally recommended that the OEMS pursue the approach which is currently in pilot testing. The pilot Run Report program involves several ambulance services entering their Run Reports electronically. Feedback from the pilot process will be used to improve the process before going statewide.

The three main ways the OEMS measures the performance of the emergency medical services delivery system is through the Emergency Medical Services Agency Licensure Program, the personnel certification process and the Run Report data collection process. This information is useful in helping the Council to decide where to focus its attention and measuring the impact of Council recommendations which have been adopted by the OEMS.

The OEMS routinely provides performance data to the EMSAC. For example, EMSAC members are provided licensure data as soon as it becomes available. According to the Director of OEMS, "Occasionally, EMSAC members will recognize implications of the data, risks, areas needing improvement or additional information requirements that OEMS staff has not identified."

1995 Recommendation 2

The OEMS should solicit organizations represented on the council to provide the Governor with nominations for all existing vacant positions and such vacancies as will occur in 1995 and 1996. These nominations should be provided before December of 1995. This will allow the Senate to take action on nominees' confirmation during the 1996 Session. With the exception of the nominees to succeed terms which expire in June 1996, these nominees should assume the position and duties of membership immediately upon confirmation by the Senate. In the future, nominees should be forwarded to the Senate for confirmation before the session immediately preceding the expiration of the existing term. For example, those positions that will expire in June 1996, should have the successor confirmed during the 1996 legislative session, in order that the successor may assume the duties at the beginning of the next term (July 1, 1996). This would eliminate the period of 6 to 8 months of vacancy that occur when the successor is not nominated until after the expiration of the term.

1997 Level of Compliance: In Compliance
In October 1995, five nominees were confirmed by the Senate during an extraordinary session of the Legislature. The Council currently has a full complement of 15 members with no vacancies (changed from 13 members during the 1996 legislative session). A quorum of 12 was obtained at the January 13, 1997 meeting.

1998 Level of Compliance: In Compliance

The Council does not have full membership as of March 1998. The Council lacks a member representing the WV Hospital Association. However, the Office of Emergency Medical Services wrote a letter to the Hospital Association asking that it recommend three individuals, as required, to the governor. After two more follow-up contacts, the Hospital Association has not yet responded. While the Council lacks a member, it is our judgement that the Council is in compliance with the spirit of the recommendation. As a 15 member body with representatives recommended by several organizations, appointed by the Governor and confirmed by the Senate, some vacant positions on the Council are inevitable. Because the appointment process requires Senate confirmation, the Council will lack this member until the 1999 regular session. (Membership rosters are available in Appendices A and B).

The current council meets quarterly, and as evident in the minutes of council meetings, makes recommendations. Council members attend meetings faithfully and guests are always present at the meetings. The level of participation is high. The Council's lack of full membership is through no fault of its own.

1995 Recommendation 3

To facilitate the recommended evaluation of 1996, the council should hold the first of its mandated two yearly meetings prior to July of 1996, so the Legislative Auditor's Office can more accurately judge the council's activities.

1997 Level of Compliance: Non-Compliance

The Council did not meet in 1996 due to legislation passed during the 1996 Regular Session. The legislation changed the composition of the Council requiring the appointment of new members.

1998 Level of Compliance: In Compliance
The Council met in January 1997 and decided to meet quarterly. The by-laws state that the Council will meet at least four times a year. (By-Laws are available in Appendix C). They met again in April 1997, July 1997, November 1997 and January 1998. Since January 1997, the Council has been very active, participation is high and results are evident. The Legislative Auditor's Office is satisfied that the Council is in compliance with the spirit of the recommendation.

1995 Recommendation 4

The Emergency Medical Services Advisory Council should be continued for one year. Another preliminary review should occur in the second half of 1996 to ascertain whether these changes have affected the participation of the council members. If at that time it is determined that the council is still ineffective, termination should be considered.

Level of Compliance: Requires Legislation
In the Regular Session 1996, 1997 and 1998, the legislature continued the Emergency Medical Services Advisory Council for one additional year to allow for compliance monitoring as provided in the Sunset Law, 4-10-5a of the West Virginia Code, as amended. In light of the increased participation and activity of the Emergency Medical Services Advisory Council, the Legislative Auditor's Office concludes that the Council is functioning effectively.

1998 Recommendation

The Legislature should consider continuing the Emergency Medical Services Advisory Council for six years, as provided for under the provisions of West Virginia Code 4-10.