Enhancing EMS Deployment Strategies for Milwaukee City Budget

1. Alternative EMS Deployment Options --------------------- Prepared for theCity of Milwaukee Budget and Management Division  Jessica Gartner Teague Harvey Shaun Hernandez Jason Kramer Alex Marach Jason Myatt

2. Introduction • Current Environment • State of Wisconsin’s 2011-13 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

3. 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

4. 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)

5. 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)

6. BLS-Private NOTE: Private companies do not pay for dispatch services

7. BLS-MFD

8. ALS

9. 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

10. 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

11. Policy Options for MFD • Charge dispatch fee • Transport all ALS-Downgrades • Transport all ALS-Downgrades + some BLS-MFD calls • Transport all BLS-MFD +ALS calls

12. 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)

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

14. 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

15. 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.

16. Revenue generated per transport • $297.45 per transport on average • MFD bills more than is collected • Due to non-payment • Due to fixed reimbursement amounts

17. 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

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

19. 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

20. 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

21. 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)

22. 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)

23. 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

24. 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)

25. 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

26. Questions?Thank you!