The two years of discussion between the City of Platteville and Southwest Health over Platteville EMS may end with a Common Council vote tonight.
But even if the council votes for the agreement to shift control of Platteville EMS to Southwest Health, Platteville is more than a year away from having paramedic-level EMS services.
In the proposal the council is scheduled to vote upon in its meeting at 7 p.m., Southwest Health would upgrade EMS service to paramedic level, with a combination of paramedics and EMTs staffing the service, within two years of approval. Southwest Health would build a new ambulance garage by the end of 2016, and take possession of Platteville EMS ambulances and equipment.
Under the terms of the proposed agreement through 2034, the city and the seven towns in the EMS district will pay Southwest Health $100,000 in 2016, and then 75 percent of operating costs — up to $150,000 in 2017, and from $130,000 to $150,000 per year between 2018 and 2024. The city and the seven towns will pay based on the current formula that apportions costs for Platteville EMS to its participating municipalities.
Annual reimbursement could increase annually by the Consumer Price Index from 2025 to 2034 at Southwest Health’s discretion, according ti the contract.
Southwest Health estimates in the contract that paramedic service would cost about $200,000 per year, including construction and ambulance replacement costs.
“If the costs are what we predicted, the hospital will lose $50,000 on this” each year, said Southwest Health CEO Dan Rohrbach, who added there are “opportunities to possibly drive that cost down,” including grants.
Information on the proposal, including the proposed agreement between the city and Southwest Health and Frequently Asked Questions, can be found at www.platteville.org/?post=18447.
Rohrbach said the cost per call to patients “doesn’t necessarily change” with an upgrade to EMS service.
Platteville EMS administrator Brian Allen said basic EMS service calls cost $650 for district residents and $850 for non-residents. Another $100 is charged for advanced EMS calls, which Allen said total about 25 percent of Platteville EMS calls.
“The fee schedule, there’s no intention to change that,” said Allen. “The same crew is going to respond. Advanced skill is there if needed,” but charges are based on which medical services are performed, he said.
The city held an information session on the proposal Thursday evening, during which Rohrbach said the cost of up to $150,000 per year totaled only $8.81 per resident of the EMS district. Rohrbach said the cost compared favorably to spending up to $2.2 million over 20 years to finance construction of an EMS garage, as well as spending $200,000 every five years for an ambulance.
When asked why Southwest Health was interested in getting into EMS service given the money the hospital would lose, Rohrbach said the hospital loses money on other services, including Epione Pavilion in Cuba City. “But we still do that service because it’s needed,” he said.
Rohrbach formerly worked with hospitals in Minnesota that provide EMS service. That model is much less common in Wisconsin, which has only nine communities with hospital-provided EMS, including Divine Savior Hospital in Portage and Sacred Heart Hospital in Eau Claire.
Rohrbach said the ambulances would be a “mobile billboard,” adding, “We want to become more of a regional presence as the service continues to grow.”
Rohrbach said Southwest Health already calls Dubuque and Madison private ambulance services in case transfers with advanced care are needed, about 200 times a year.
Southwest Health was apparently the only health care provider the city negotiated with over EMS services. Paramount Ambulance in Dubuque and Tri-State Ambulance in La Crosse operate paramedic services.
“When we recognized that call volume was going up every year … we did approach Paramount at that time, and at that time they didn’t feel it would work for them,” said Common Council president Eileen Nickels. “The other thing was that Paramount wasn’t interested in building a building” in Platteville.
City Attorney Brian McGraw said the city was not required to bid out EMS services to other potential providers.
In addition to the City of Platteville, Platteville EMS provides service by annual contract for all or part of the towns of Platteville, Belmont, Elk Grove, Ellenboro, Harrison, Lima and Smelser. The city and the towns would have to approve Southwest Health’s taking over EMS services, or if not find a new EMS provider.
City Attorney Brian McGraw said May 12 that the towns “seemed to view it positively” in initial discussions. McGraw said the agreement “puts the hospital in the position of serving customers, and customers include the city and participating townships.”
Platteville EMS serves about 17,000 people, with the City of Platteville totaling 77 percent of the EMS district and the Town of Platteville 10 percent. About 85 percent of Platteville EMS’ calls are within the city boundaries.
The annual costs to the EMS district municipalities of up to $150,000 were reduced from initial projections of $200,000 to $250,000 per year when the subject first came up in 2013.
The discussion was spurred in part by the need for a new EMS facility to replace the EMS garage on Furnace Street under the city’s old water tower. The city had included $500,000 in a previous Capital Improvement Plan for a new EMS garage, but later construction costs were estimated at up to $1.5 million. The city also planned to spend $250,000 for a new ambulance in the near future; the city has $150,000 to $160,000 in a ambulance replacement fund.
The EMS garage discussion took place at the same time as discussions about expanding the fire station, possibly including ambulance parking, or building a new fire station.
State law requires every municipality to either provide emergency medical service, or contract with a provider for EMS service. In addition to providing basic first aid, EMT–Basic services can provide aspirin, albuterol, Atrovent for asthma or Chronic Obstructive Pulmonary Disease, epinephrine and glucagon to increase blood glucose levels.
Platteville EMS is classified as an EMT–Intermediate Technician service, which is able to provide IVs and more medications than an EMT–Basic service, including nitroglycerin for chest pain, Narcan for narcotic overdoses, and 50-percent dextrose for diabetics.
According to the Wisconsin EMS Association, EMT–Basics are certified after 140 hours of training. EMT–Intermediate Technicians require another 100 hours of training. EMT–Intermediates require another 335 hours of training, and Advanced EMTs require an additional 170 hours of training beyond that.
Paramedics require 1,000 hours of training to get a license. Paramedics can administer 40 or more medications, and perform some procedures, including sedating a patient to insert a breathing tube.
Platteville EMS currently has 26 EMTs, including three paramedics, after two recent resignations. In 2014 Platteville EMS had 1,165 calls — an average of three per day — but 2015 call volume so far projects to an 11 percent increase over the year.
The closest paramedic services in Wisconsin are several Madison-area EMS services and Tri-State Ambulance in La Crosse. Paramount Ambulance in Dubuque is also a paramedic service.
Southwest Wisconsin EMS services
EMT–Intermediate Technician: Barneveld, Dickeyville, Dodgeville, Highland, Lancaster, Mineral Point, Platteville, Potosi.
EMT–Basic: Arena, Argyle, Avoca, Belmont, Blanchardville, Blue River, Boscobel, Cassville, Cuba City, Fennimore, Hazel Green, Montfort, Muscoda, Rural Medical (Darlington), Shullsburg, West Grant (Bloomington).
First responders: Bagley, Benton, Cobb, Gratiot, Hollandale, Jamestown, Linden, Livingston–Clifton, Rewey, Ridgeway, South Wayne, Woodman.
SOURCE: Wisconsin Department of Health Services