Alternative EMS Deployment Options Prepared for the City of Milwaukee Budget and Management Division Jessica Gartner Teague Harvey Shaun Hernandez Jason Kramer Alex Marach Jason Myatt

Introduction Current Environment – State of Wisconsin’s biennial budget 4.5 percent decrease in intergovernmental revenue for the City of Milwaukee Property tax levy freeze on municipalities – Need for additional sources of revenue and enhanced efficacy of service delivery

Overview: EMS care in Milwaukee Provided through a public-private partnership – Milwaukee Fire Department (MFD) responds to more serious emergency calls with its 12 med units – Four privately owned ambulance services respond to calls involving non-life threatening situations Potential source of revenue gains and/or cost reductions

Policy objectives Maximize net fiscal effect Maintain quality of service Ease of implementation Public perception of EMS response – MFD and privates are at the same scene about 50,000 times per year (out of 93,383 calls)

Overview: EMS dispatch Two levels of emergency medical services defined by Wisconsin Administrative Code – Basic Life Support (BLS) – Advanced Life Support (ALS) MFD Dispatch divides EMS calls into three tiers – BLS-Private (lowest severity) – BLS-MFD (moderate severity) – ALS (highest severity)

BLS-Private NOTE: Private companies do not pay for dispatch services Call received by MFD Dispatch Center Dispatcher classifies call as ALS, BLS-MFD, or BLS-Private Classified BLS-Private: Private company responds, treats, and transports

BLS-MFD Call received by MFD Dispatch Center Dispatcher classifies call as ALS, BLS-MFD, or BLS-Private Classified BLS-MFD: MFD responds with engine ALS care required BLS-MFD-Upgrade: MFD paramedics dispatched and treat MFD med unit transports BLS care required BLS-MFD-Private: MFD EMTs begin BLS treatment Private company transports

ALS Call received by MFD Dispatch Center Dispatcher classifies call as ALS, BLS-MFD, or BLS- Private Classified ALS: MFD responds with paramedic unit and engine ALS care required ALS: MFD paramedics provide treatment MFD med unit transports BLS care required ALS-Downgrade: MFD paramedics begin BLS treatment Private company transports

Capacity for EMS care EMS personnel work 24-hour shifts Capacity: Amount of time EMS personnel can be in service. Current in-service time is just over 4 hours per med unit per day We analyze capacity of 6 and 8 hrs/day. Based on: Quality of care Current run times and standards

Data sources MFD Dispatch Data – All MFD unit dispatches from March 1, 2009, to February 14, 2011 – Includes information on unit status changes and responses (dispatched, en route, on scene, etc) Accountability in Management (AIM) Report – Private provider dispatch data – Includes number of private calls for 2011

Policy Options for MFD 1)Charge dispatch fee 2)Transport all ALS-Downgrades 3)Transport all ALS-Downgrades + some BLS-MFD calls 4)Transport all BLS-MFD + ALS calls

Policy Option #1 MFD charges a dispatch fee to private providers – MFD charges a $21 cost-recovery fee to the private providers for the dispatch services it currently provides Fee based on (total dispatch costs) / (# of calls dispatched)

Analysis of Policy Option #1 Net revenue increase of $1,706,000 – Based on (dispatch fee) x (calls dispatched to privates)

Transport status quo MFD transports about 12,000 calls yearly About 3,400 ALS-Downgrades transported by private ambulance companies About 18,000 BLS-MFD-Private transports

Policy Option #2 MFD transports all ALS-Downgrade calls – MFD begins transporting all of the calls it responds to as ALS calls reclassified on-scene as BLS calls – These calls currently turned over to private providers for transports.

Revenue generated per transport $ per transport on average MFD bills more than is collected – Due to non-payment – Due to fixed reimbursement amounts

Analysis of Policy Option #2 Net revenue increase of $1,024,000 – Based on (per transport revenue) x (added transports) Analysis of Policy Option #1 and #2 Net revenue increase of $2,558,000 – Based on (Option #2 net revenue) + (revised Option #1 net revenue) – NOTE: Revenue from dispatch fee is decreased due to fewer calls being sent to private companies

Policy Option #3 MFD transports ALS-Downgrades and some BLS-MFD calls, without adding personnel or equipment

Analysis of Policy Option #3 Net revenue increase of $2,396,000 (6-hr. capacity) Net revenue increase of $4,171,000 (8-hr. capacity) – Based on (per transport revenue) x (added transports) NOTE: Capacity assumption impacts estimate of the number of additional calls MFD can handle

Analysis of Policy Option #1 and #3 Net revenue increase of $3,699,000 (6-hr. capacity) Net revenue increase of $5,175,000 (8-hr. capacity) – Based on (Option #3 net revenue) + (revised Option #1 net revenue) – NOTE: Revenue from dispatch fee is decreased due to fewer calls being sent to private companies

Policy Option #4 MFD transports all BLS-MFD and ALS calls – Would need to hire additional EMS personnel and purchase additional equipment (4 or 9 med units)

Analysis of Policy Option #4 Net revenue increase of $1,625,000 (6-hr. capacity) – Requires 9 new med units and necessary personnel. – $524,000 annually per med unit. Net revenue increase of $4,245,000 (8-hr. capacity) – Requires 4 new med units and necessary personnel. – Based on (per transport revenue) x (added transports)

Analysis of Policy Option #1 and #4 Net revenue increase of $2,265,000 (6-hr. capacity) Net revenue increase of $4,885,000 (8-hr. capacity) – Based on (Option #4 net revenue) + (revised Option #1 net revenue) – NOTE: Revenue from dispatch fee is decreased due to fewer calls being sent to private companies

Recommendations Adopt Options #1 & #3 – MFD transports ALS downgrades and some BLS-MFD calls, without adding personnel or equipment – Implement a dispatch fee – Reexamine call to transport ratio and capacity efficiency issues Net revenue increase of $3,699,000 (6-hr. capacity) Net revenue increase of $5,175,000 (8-hr. capacity)

Implementation – Change dispatch methodology from closest first, to capacity sensitive dispatching – Slow, methodological scale-up of additional transports Allows determination of actual MFD capacity Manages risk of overloading med units and personnel – Determine best methods for maximizing capacity Utilize feedback from personnel Avoid personnel burnout Monitor response times

Questions? Thank you!