A private ambulance company that the city of Milwaukee says isn't keeping up with 911 calls on Milwaukee's northwest side has given notice that it plans to stop working with the city.
The notice from Midwest Medical Transport Co. it comes as the Milwaukee Fire Department, which handles the most critical calls, is under increasing pressure to respond to lower-level medical incidents that the city's system says should be handled by private ambulance providers.
“I run the last line of defense for Milwaukeeans when something is beyond their control, that's what we do here,” said Deputy Fire Chief Aaron Lipski. “And frankly, the people we represent are largely already the most underserved, most challenged communities in the state, and to leave them in the lurch is something I probably shouldn't take personally, but I do.”
The city's entire emergency medical response system is at a crossroads, he said.
The Fire Department currently responds to about 1,000 lower-level calls a month, Lipsky said.
That can make Fire Department paramedics unavailable to respond to top-level calls or force a first-responder fire truck or ladder truck to wait with the patient for long periods of time, he told the Public Safety and Public Health Committee Council last week.
The biggest impact, he said, is on the person who calls 911 because they want to go to the hospital after breaking their leg or cutting their arm.
The wait can be long because, although a fire engine may be on the scene, the department has limited transport capability to the hospital. Private companies would traditionally provide transport for lower level calls.
For a variety of reasons, Lipski said, it has become much less profitable to participate in the 911 system as a private provider.
In an April 12 letter to Lipski, Midwest Medical CEO Jeff Shullaw wrote that the company intended to terminate its agreement with the city and would be willing to complete that process as soon as April 30.
The Omaha, Nebraska-based company did not respond Friday to requests for an interview.
Midwest Medical attorney Brian Randall, who is based in Milwaukee, told the Ambulance Service Board earlier this month that staffing and funding are a challenge.
“On behalf of Midwest Medical, the decision was made that it is in everyone's best interest to issue the notice of intent and let the city focus on corrective actions that could improve the system as a whole,” he said.
The intention, he said, was not to leave the city in the lurch. There is a 180-day “get-out period”, he said, but the company could leave the deal earlier “if and when necessary”.
Ambulance Clerk: The system is down
At one time, there were four private companies that took less serious calls in Milwaukee, each assigned to its own area of the city. Midwest Medical's exit would reduce that number to two.
Paratech Ambulance Service essentially bought a smaller ambulance company and then was bought by Midwest Medical late last year, said Ald. Mark Borkowski, who also chairs the Ambulance Service Council.
It became clear early this year, he said, that Midwest Medical was unable to handle the workload.
“Clearly, they either had no idea what they were getting into or they basically didn't like what they found, but it put the city in a huge bind,” he told the Milwaukee Journal Sentinel.
Of the three private ambulance companies in the city, Midwest Medical was unable to handle the largest percentage of calls, and most calls were transferred to the Fire Department, according to Fire Department data.
The percentage of calls to which the company has not been able to respond is increasing, reaching 65.5% in February, according to the Fire Department.
Curtis Ambulance Service, another of the three private companies, was at 33.5% in February, while Bell Ambulance was at 1.2%.
The goal is to keep that rate under 4 percent, Assistant Fire Chief Joshua Parish told the Ambulance Service Board earlier this month.
“A rate only tells half the story, where call volume tells a much bigger story,” said Parish, chief of the Fire Department's Office of EMS, Training and Education.
The Fire Department has also handled the largest number of calls from the area of the city that Midwest Medical is responsible for responding to. That number reached 877 calls in February compared to 246 in the Curtis area and 19 in the Bell area of the city.
Lipsky told the Journal Sentinel that more of the lower-level calls go back to the Fire Department because private ambulance companies as a whole don't put enough ambulances on the road.
That's, he said, because it's expensive to train emergency medical technicians and ambulance personnel, and testing and vaccination efforts for COVID-19 have attracted workers who ride in ambulances.
At a deeper level, he said, low Medicaid reimbursement rates present financial challenges for ambulance services.
That issue was the subject of a letter sent by Bell Ambulance Vice President and CEO Wayne Jurecki, in which he wrote that “the City of Milwaukee's EMS system in its current form is broken.”
The cost of providing emergency medical services has increased significantly, while reimbursement from the government and third-party payers has remained the same or decreased, he wrote.
Last year, financial challenges increased due to higher costs related to the coronavirus pandemic, he said.
“Bell's size and available resources have allowed us to absorb the losses that come with providing service to the EMS system, but we simply find it untenable to continue to subsidize the EMS system,” Jurecki wrote.
His requests for the city included implementing a $125 response fee for each EMS system response the provider performs.
The fee “would help stabilize the viability of providers and help stabilize the unfair EMS system,” he wrote.
Contact Alison Dirr at 414-224-2383 or adirr@jrn.com. Follow her on Twitter @AlisonDirr.
