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Ambulance study offers little hope for regionalization

McGrath consultants stick to original recommendations

Jodi Summit
Posted 3/29/23

GREENWOOD TWP- An updated, and substantially modified, version of the McGrath Consulting Group study commissioned by Greenwood Township was released to the town board last week. While the revised …

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Ambulance study offers little hope for regionalization

McGrath consultants stick to original recommendations


GREENWOOD TWP- An updated, and substantially modified, version of the McGrath Consulting Group study commissioned by Greenwood Township was released to the town board last week. While the revised study includes an exploration of issues that township officials complained were lacking from the original draft, the consultant’s recommendations remain largely the same.
The township commissioned the study in hopes of finding ways to enhance emergency services, specifically provide Advanced Life Support services, instead of the Basic Life Support services now provided by EMTs from the Tower and Cook ambulances. Both departments call in ALS intercepts when they believe there is a medical need.
The study does not recommend either of the options suggested by the township, such as contracting with a “turn-key” EMS provider or pushing for a more regionalized EMS service.
Contracting with a private EMS provider would require the township to build a facility for housing apparatus and personnel. In addition, this option would require working with the EMSRB to have the current primary service areas for the ambulance district changed. The report highlights a company called Superior Ambulance Services, but the company is located in Illinois and does not currently operate any ambulance services in Minnesota.
The study largely dismissed the prospects for creating a regionalized system. “Regionalization is not a current option,” states the report bluntly. The reasons include the lack of interest from existing service providers, insufficient volume of 911 calls, too few opportunities for inter-facility transfers, and the geographic realities (distances in rural areas).
The study discusses how ambulance services are funded through a mix of private insurance, government insurance, and private pay. “For an ambulance provider to fiscally survive,” the study states, “they must have patients in their ambulance, and that main revenue source in most cases is inter-facility transfers.”
A regional service would need a centralized hospital that could support these inter-facility transfers, notes the report.
“Hospital-based ambulance services, as well as privately-owned ambulance services tend to look for areas to expand to that will support their current business model that balances the income/expense of 911 calls (which typically do not bring in enough funds to offset the expenses) with the income/expense of inter-facility transports (which may be profitable enough to cover the expenses of both the 911 and transfer calls.)”
The existing level of ambulance service in the Greenwood Township area would not support a regional ambulance service PSA, the study concludes. The geographic realities of the lake result in longer response times, so any regionalized service would require additional facilities, resources, and personnel. “Which, at this time, do not seem feasible,” conclude the consultants.
Regionalization could be an option in the future, but such an option would require starting with what ambulance resources are available, building relationships with the providers, recognizing volunteers, support for regionalized training opportunities, joint purchasing, and joint standard operating guidelines. This process would also include working with the EMSRB which can be a lengthy process.
“It is a rather complicated process to apply for and receive approval for PSA changes, especially if people at the local level are not willing to work together,” the study says. The original draft of the study had noted Greenwood’s history of troubled relations, both internally and with neighboring jurisdictions, but that language was removed from the final draft.
The revised report discusses the situation in the city of Buhl, which recently gave their ambulance service area to Essentia Health. The report noted that Buhl held the license of the PSA, so this was not as complicated a process as it might otherwise be.
“The same scenario is not true for Greenwood,” it says, noting that the township is in the PSA primarily covered by the Tower Ambulance, with portions covered by the Cook Ambulance.
“If there is an interest in working with a hospital-based ambulance or private ambulance service, Greenwood Township would first need to see which ambulance service providers would respond to a request for proposals, which would set the course to putting the township in the ambulance business. Next, Greenwood Township would need to apply for a PSA change from the EMSRB.”
“The consultants do not support or recommend that Greenwood Township request that the PSA be changed “Rather, all parties should negotiate in good faith to resolve any issues,” the study implores.
Recommended options
The study falls back on the four options originally recommended in the report’s original draft, including partnering with Bois Forte’s Vermilion Clinic and developing a community paramedic or EMT model, contracting with the Virginia Fire Department, partnering with an ALS provider, or having the township hire their own ALS staff.
For the consultants, partnering with Bois Forte’s Vermilion Clinic to hire paramedics is the preferred option. This would involve hiring three full-time-equivalent personnel, who could work at the Vermilion Clinic but also be available to respond to 911 calls as well as conduct home-based medical care. But this would also involve housing the paramedics working outside of regular daytime hours. The paramedics would work through the existing ambulance services.
Based on 2022 call volume, the Tower service had an average of 1.2 emergency calls per day, and Cook had .53 calls per day.
Contracting with Virginia Fire Department could include having that department provide one paramedic in a rapid response vehicle, such as an SUV, who would respond to ALS type incidents in the township and also in both ambulance service areas. Another option is contracting with another ALS provider to provide a paramedic based in the area.
The report also discusses the issue of skill diminishment with this option.
“Since the call volume for the area is relatively low,” it states, “there is a concern that the ALS personnel’s skills could diminish over time due to lack of utilizing their ALS skills on a regular basis, as their only experience would be limited to the area’s 911 calls.” The study says this can be alleviated by the contracting entity rotating their staff on a monthly basis.
The fourth option is to have Greenwood hire their own staff, the equivalent of one paramedic a day, and provide a rapid response vehicle as well as housing. This paramedic would work with the existing ambulance services.
“A joint partnership with the Bois Forte Band of Chippewa Clinic-Vermilion is definitely a win-win-win situation,” the study concludes. “The township of Greenwood would receive a faster response to emergency medical calls, with an ALS provider; or the Virginia Fire Department would receive income for their ALS relocation of personnel stationed in the Greenwood area; or the Tower and Cook Area ambulance services would be able to utilize ALS personnel on their ambulances.” The bonus to the two local ambulance services would be the ability to bill at the ALS rate if ALS skills are required on the call.
Some of the estimates of the cost of maintaining 24/7 paramedics on call were based on an hourly wage of $21.63 if the paramedic was a township employee; the township has previously noted this is not a living wage or commensurate with the level of training required.
The study showed several options for staffing with paramedics not hired by the township, on either a 12-hour shift or 24-hour shift schedule (where overtime would need to be paid). The study estimated these costs per paramedic ranged from about $63,000 and up, without adding in benefits.
The study was also updated with the recent data about the Certificates of Excellence received by the Tower, Cook, and Orr ambulance service. It notes that the Tower Area Ambulance Service obtained a performance rate of 80-percent or higher in seven of the nine areas (one was not relevant), including calls for strokes, blood glucose, chest pain, pediatric calls, respiratory calls, and trauma.
The town board will be discussing the study at their next regular meeting on Tuesday, April 11.


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