AMBULANCE SERVICE BOARD

200 E. Wells Street City of Milwaukee Milwaukee, Wisconsin 53202 Meeting Minutes AMBULANCE SERVICE BOARD Ald. Mark Borkowski, Chair Marlaina Jackson, Dr. Andrew Calvert, Jeff Fleming, Dr. M. Riccardo Colella, Dr. Robert Riepenhoff, Dr. Benjamin Weston, and Kyle Mirehouse Staff Assistant, Joanna Polanco, 286-2366, Fax: 286-3456, jpolan@milwaukee.gov Legislative Liaison, Gunner Raasch, 414-286-3467, Gunner.Raasch@milwaukee.gov Monday, April 12, 2021 9:00 AM VIRTUAL 1. Call to Order 9:06AM 2. Roll Call Individuals present: Bell Ambulance - Atty. Josh Gimbel and Chris Anderson Curtis Ambulance - Jim Baker and Stan Robakowski Midwest Medical Transport - Atty. Brian Randall, Jeff Shullaw and Ed Matteson Milwaukee Fire Department - Chief Aaron Lipski and Chief Joshua Parish Milwaukee Health Department Designee - Marlaina Jackson City Attorney's Office - Tyrone St Junior and Andrea Fowler Legislative Reference Bureau - Luke Knapp Present 7 - Calvert, Colella, Borkowski, Riepenhoff, Fleming, Weston and Mirehouse 3. Approval of minutes of the November 18, 2020 and December 7, 2020. Moved by Dr. Colella, seconded by Mr. Fleming to approve the minutes of November 18, and December 7, 2020. There were no objections. 4. 2021 Rate proposal. Chief Lipski and Parish presented a proposed annual ambulance rate adjustment. Chapter 75 assigns the responsibility to the fire department to annually adjust the rates for ambulance transport according to the relevant measures from the Consumer Price City of Milwaukee Page 1 AMBULANCE SERVICE BOARD Meeting Minutes April 12, 2021 Index (CPI). The Legislative Reference Bureau (LRB), provides the medical care portion of the CPI for Chicago‐Naperville‐Elgin and for Minneapolis‐St. Paul‐Bloomington. At the time of the previous rate change in May of 2020, the indexes were 519.194 and 570.270 respectively for an average of 544.732. The average medical care CPI for January 2021 is 562.212 for a net change of 1.03%. Pursuant to Chapter 75, the Milwaukee Fire Department respectfully requests that the Ambulance Service Board submit to the Common Council 2021 ambulance rates for service that reflect a 1% increase, and that the current average January 2021 index of 562.2 be reflected in the record for reference in the following year. Moved by Mr. Fleming, seconded by Dr. Colella to approve the proposed annual ambulance rate adjustments. There were no objections. 5. Update on 2020 ordinance changes Asst. Chief Parish presented the proposed amendment for Chapter 75. The Milwaukee Fire Department (MFD) maintains a holistic view of the Milwaukee EMS system and provider of last resort for patients requiring basic life support transport. To this end, we propose the following amendment to Chapter 75 to remedy recurrent and chronic issues within the system. Amend 75-15-19. VIOLATIONS. • Add reimbursement at a set rate and requirement of a performance bond or similar security • Reimburse at the MFD turnback rate in 17-15-17 Add to 17-15-17 CHARGES FOR PATIENT SERVICES DELIVERED BY THE FIRE DEPARTMENT: • Set an unacceptable threshold for UTH at 84th percentile of the last 12 months of reports. • Reimbursement would be triggered by a provider having two-consecutive months above the UTH rate. • Reimbursement at rate of 75-15-14 c-1 ($740 – 2020 rate). For context, the current 84th percentile for the previous 12 months of reporting is an Unable to Handle (UTH), or turnback percentage that exceeds 31.9% based on current volume. Moved by Dr. Colella, seconded by Dr. Calvert (with updated language) to approve proposed amendments to Chapter 75. There is no objections Chief Parish gave an update of the progress, of implemented last year's ordinance changes. 6. Private Provider Report Asst. Chief Parish shared the Call Volume report with a summary of the call volume that each private provider receives on a monthly basis. Anything that is highlighted, red appears outside of the standard. The Turn back standard is when a provider is unable to handle, the given calls City of Milwaukee Page 2 AMBULANCE SERVICE BOARD Meeting Minutes April 12, 2021 assigned primarily in their area. The Milwaukee Fire Department would handle those calls with ALS ambulance. Dr. Colella expressed the impact of this dramatic burden to the system, is concerning, for two reasons; one is, not having the private ambulance services be able to cover the low acuity calls takes all of the advanced life support paramedic out of the queue to be able to be ready for the most critical calls and the surrounding areas, because the reliance on mutual aid. Ald Borkowski request, Dr. Colella moved to share this report with the Public Safety and Health, Dr. Calvert seconded. 7. 201522 Communication relative to the status update on private ambulance service for the first three months of 2021. By Asst Chief Parish a. system current status In June of 2020, the current system changed the service area maps to redistribute the Areas of service since Paratech was absorbed by Medacare. The redrawing of the map did not change the total bucket of runs that providers were responsible for; Bell and Curtis each absorbed more area for their now call volume and internally, there were some issues related to the utilization of BLS emergency transport that needed to be revisit. Trauma issues likely caused the substantial spike in July, August, September of last yea. Likely the results of a lot of car accidents. There were times when a request for emergency transports from the BLS companies was made. The low acuity incidents are due to a big source of providers unable to handle the responses in their primary area. In working with medical direction, it was identified a substantial subset of low acuity calls, department looked into the call volume to see what the actual wait time was for some of these calls. b. Remediation attempt to address private provider response This first remediation, essentially says that when the system is busy, for these low acuity calls, the provider can actually reach out with a phone call in the interim to the patients, to let them know that the system is busy, those phone calls would take place sequentially every 10 minutes. MFD met with the private providers in February scheduled to go live on March 2021 with the goal of doing that for at least a month, giving everybody a couple of months to report out. It built a pretty substantial quality control mechanism incorporating medical direction. asked all the private providers to try reducing staff and moderate. c. Low acuity incidents - January 2021 d. Proposed remediation - April 2021 Is designed to aid in the routing and retention of individuals, the BLS ambulance service, by using some of the statistical tools, and the existing rate for the transport of a BLS patient with a ALS resource. To provides a funding source to enable the Milwaukee Fire Department Training Center to train new EMTs, to be hire by the private City of Milwaukee Page 3 AMBULANCE SERVICE BOARD Meeting Minutes April 12, 2021 providers at the completion of training. Ald. Borkowski read a letter sent to MFD Chief, Lipski from Midwest Medical Company, LLC - Notice of intent to terminate their private service agreement with the City. Chief Lipski stated that currently the City has very few options; Curtis and Bell have picked up the slack. Atty. St. Junior said that the process can take as long as 6-months or as long as the City needs to re-organize services. Atty. Fowler warned the committee for a possible closed session discussion at a later meeting to discuss the particular of enforcing or implementing the contract. A future meeting of this body could be scheduled as early as June 2021. Mr. Baker from Curtis said that the numbers in February were not good due to staffing and funding issues. Overall call volume is too high because there are not enough vehicles to fit the demand. Mr. Jurecki from Bell is willing to assist the City in the transition period. however they do have staffing shortages. Atty. Randall representing Midwest Medical is willing to comply with the extent of the contract and possibly amend some of the expectations of such to collaborate with the transition. Dr. Weston, seconded by Mr. Fleming moved to accept proposed remediation plan. There were no objections. 8. Announcements Ms. Jackson gave kudos for MHD efforts in these trying times. Dr. Weston congratuled Ms. Jackson strong advocate in the MHD Dr. Colella Medical College of Wisconsin and Froederet Hospital - May 16-22 National EMS Week Mr. Fleming - Mayor's Communication Director Bell Ambulance willing to continue collaborating with the City. Mr. Baker willing to continue collaborating with the City. Atty. Randall willing to be active participant with the City Atty. in the transitioning process of Midwest Medical Transport Company, LLC. Mr. Baker mentioned summer events and Midwest notice of intent to terminate their contract; should they provide any special event plan. Chief Lipski said that in regards to the Brewer's event. Chief Parish stated that in deed, Midwest medical DOES have to submit a special events plan. Asst City Atty. St Junior said that much of this discussion needs to take place at a City of Milwaukee Page 4 AMBULANCE SERVICE BOARD Meeting Minutes April 12, 2021 separate meeting and possibly notice for closed session. 9. Adjournment at 11:01 AM Joanna Polanco Staff Assistant In the event that Common Council members who are not members of this committee attend this meeting, this meeting may also simultaneously constitute a meeting of the Common Council or any of the following committees: Community and Economic Development, Finance and Personnel, Judiciary and Legislation, Licenses, Public Safety and Health, Public Works, Zoning, Neighborhoods & Development, and/or Steering and Rules. Whether a simultaneous meeting is occurring depends on whether the presence of one or more of the Common Council member results in a quorum of the Common Council or any of the above committees, and, if there is a quorum of another committee, whether any agenda items listed above involve matters within that committee’s realm of authority. In the event that a simultaneous meeting is occurring, no action other than information gathering will be taken at the simultaneous meeting. 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