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Old 03-14-2011, 03:06 PM
 
Location: Milwaukee, WI
142 posts, read 278,879 times
Reputation: 127

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Quote:
Originally Posted by blast49 View Post
If MFD and the privates think the system they have is absolutely the best, I would suggest getting all the fact together, because I'm sure SOMEONE will come looking.

I believe I stated the system works very well and is cost effective. It combines a service-system that delivers EMS in a few minutes, along with ALS with a system that delivers private companies to transport.
Most larger cities are going to systems similar to what is utilized here. Denver, CO and Chicago, IL are two of them, with the difference being those cities using municipal based ambulance for every kind of transport.

We should always be evaluating the system and looking to improve service. My opinion is that this is happening for all aspects of service, from the communications center all the way thru transport.


Quote:
Originally Posted by blast49 View Post
Now your saying MFD EMS is "generating revenue?" Gotta be honest...I don't buy it. I'm reminded of Sheboygan Fire...taking over EMS then realizing that without doing the Interfacility transports and private calls that Orange Cross does, they LOSE money (increased operational cost) doing EMS. If you can show me where MFD is making enough "profit" to offset their costs, I'll give you a cookie.

You're talking two different items in your post. You're talking about generating revenue and turning a profit. I haven't gone back and looked but, unless I worded myself incorrectly I never stated that the MED rigs "turn" a profit.
As you have pointed out, it is nearly impossible to turn a profit by providing 9-1-1 based service. We know that and so do the privates. That's why they are very serious about the inter-facility transports. Those are the runs that pay the bills, so to speak. These types of calls are what keep the private companies in business, even tho the vast majority of that billing is medicare/medicaid or forward based. (those are all tax dollars) They also put a priority on their interfacility transports, whether they admit to it or not.

When the city/county bills for service they are only looking to help off set budget. The money is going to be spent to keep those rigs available for public use, regardless. The concept is that any revenue generated helps to offset that budget and provide some relief. I may not have detailed it well enough.
On a personal note, I don't agree with 9-1-1 based billing. No one cares because I'm not in charge, nor will I be anytime soon.
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Old 03-14-2011, 08:25 PM
 
26 posts, read 69,267 times
Reputation: 17
Your right, I did use both terms, it was accidental. It's obvious that your not going to "turn a profit" as you have the entire department to support financially...so to speak. I'm just saying that the operating costs of the entire department won't be overcome by billing.

But as far as "generating revenue"... OK, the department may bill for calls...whether you like it or not :-) My point is, I don't believe the paltry sum that the EMS division collects will even offset the cost of an individual EMS rig. If you collect on 80% of your patients...and that being VERY generous in Milwaukee, we'll say an ambulance will TRANSPORT an average of 12 patients...I believe that TOO is generous. So, 12 patients, collecting 80%, billing around $150, a transport. Comes to roughly $1440.00 collected from 1 ambulance....and thats a REALLY good day. The salary and benefits of a two man crew...assuming they make roughly $20.00 an hour (I'm pretty sure I'm shooting low) will come to a little over $1000.00 a day. Throw in cost of rig maintenance, fuel, insurance, etc.
My point is, just because your billing and collecting, doesn't mean much in terms of revenue if your not covering your own costs. Yes, you can call it "revenue" but in actuallity, the EMS division has to be hemmoraging money. The generated "revenue" may be OFFSETTING your costs slightly, but it seems to me your billing could come up...significantly. I know you won't agree, because it should be a "tax-payer" service...but lets be honest, how many of the folks are you transporting actually PAY property tax.

As greedy as you think they might be, perhaps MFD can take a page from the BELL playbook on this one. Bill patients accordingly, and keep a tight leash on your billing service.
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Old 03-14-2011, 10:38 PM
 
Location: Milwaukee, WI
142 posts, read 278,879 times
Reputation: 127
Quote:
Originally Posted by blast49 View Post
But as far as "generating revenue"... OK, the department may bill for calls...
I'm not an accountant; in fact, I do as little math as possible. The numbers I have read and heard from chief officers is in the several millions of dollars. Over the past several years there has been a huge emphasis on the accurate collection of insurance information. If you're really that interested you can contact the bureau of administration; it's tax money so the numbers are available to the public. (just no patient info)


Quote:
Originally Posted by blast49 View Post
My point is, just because your billing and collecting, doesn't mean much in terms of revenue if your not covering your own costs. Yes, you can call it "revenue" but in actuallity, the EMS division has to be hemmoraging money. The generated "revenue" may be OFFSETTING your costs slightly, but it seems to me your billing could come up...significantly. I know you won't agree, because it should be a "tax-payer" service...but lets be honest, how many of the folks are you transporting actually PAY property tax.
The department isn't here to turn a profit. It is here to provide a rapid, quality and efficient all hazards/emergency mitigation service. Outside of paramedic transport it does not bill for any service that I am aware of. Should it bill for auto accidents? Fires in the home? How about a subscription service above and beyond property tax? What about those who can't pay? How about visitors? Sometimes they use our service, yet they don't pay.
Are people less deserving or less entitled to care or service because they don't pay property taxes? I know that doesn't happen in the hospital setting.

Quote:
Originally Posted by blast49 View Post
As greedy as you think they might be, perhaps MFD can take a page from the BELL playbook on this one. Bill patients accordingly, and keep a tight leash on your billing service.
They're a profit driven company, it's what they do. I have seen people refuse to go to the hospital because they are more worried about the ambulance bill than their injury/illness. I have an ethical problem with that happening. If someone feels they need an ambulance to get to the hospital, who am I to judge? We are not definitive medical care, that's your job! This service is to make sure people are able to arrive to the ED alive. Whether they are drunk or sober, rich or poor, black or white or any combo you can imagine.
When someone is having what they perceive to be an emergency, I would rather them not worry about a bill or whether we accept visa.

For what it's worth, all billing info is turned over to a company that one of the privates in the system utilizes as well as other cities in this nation.
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Old 03-15-2011, 07:22 AM
 
Location: Brewers Hill
88 posts, read 178,397 times
Reputation: 132
Quote:
Originally Posted by Devitron5000 View Post
Scott Walker Wants To Remove Nearly All Collective Bargaining - Project Economy News Story - WISN Milwaukee (http://www.wisn.com/money/26833263/detail.html - broken link)

Please forgive me if this doesn't belong here. However,I think this is kind of interesting. Bank that funded Scott Walker, Now Closed -- Firefighters and others withdraw all deposits. // Current
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Old 03-17-2011, 03:44 PM
 
Location: Milwaukee
447 posts, read 1,528,892 times
Reputation: 260
Quote:
Originally Posted by TommyGavin View Post
The department isn't here to turn a profit. It is here to provide a rapid, quality and efficient all hazards/emergency mitigation service. Outside of paramedic transport it does not bill for any service that I am aware of. Should it bill for auto accidents? Fires in the home? How about a subscription service above and beyond property tax? What about those who can't pay? How about visitors? Sometimes they use our service, yet they don't pay.
Are people less deserving or less entitled to care or service because they don't pay property taxes? I know that doesn't happen in the hospital setting.

They're a profit driven company, it's what they do. I have seen people refuse to go to the hospital because they are more worried about the ambulance bill than their injury/illness. I have an ethical problem with that happening. If someone feels they need an ambulance to get to the hospital, who am I to judge? We are not definitive medical care, that's your job! This service is to make sure people are able to arrive to the ED alive. Whether they are drunk or sober, rich or poor, black or white or any combo you can imagine.
When someone is having what they perceive to be an emergency, I would rather them not worry about a bill or whether we accept visa.

For what it's worth, all billing info is turned over to a company that one of the privates in the system utilizes as well as other cities in this nation.
I would never in a million years want to depend on a private company as a first responder. You just can't compare the services that companies like Bell offer with any public first response unit.
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Old 03-21-2011, 12:14 AM
 
26 posts, read 69,267 times
Reputation: 17
Look, guys, I'm not here to bust your balls, though it may sound like it. The point I've been trying to make since the start, is that things can improve. In several aspects, financially, communications, oversight, etc.
I'm going to go on a limb here and sound like an ass...but if someone is cognitive enough to "worry" about the bill. Then, yes, they MAY not need an ambulance, or maybe they do, but if there mind is on money, then they aren't that worried about thier current health situation.
I also never said you were here to turn a profit, we both know thats not going to happen. My only point was, why isn't MFD, or the county meds...whoever bills for the ride, charging comparable rates to others in the metro Milwaukee area? Hell, in Ozaukee, the base rate for an ALS call is $475, in Waukesha, it's an average of $500. per ALS call, even Racine (so you can't play the "poor population card") charges $450 as a base rate. ...the measly $150 bucks that your telling me MFD charges is pretty slim...

Nuclear Art, - That arguement goes both ways, nearly a third of the United States has a private service as there first responder service. Take Appleton/Neenah/Menasha/Hortonville/New London/Grand Chute/Little Chute/Combined Locks/Brillion for example. The whole area is covered by Gold Cross Ambulance, which is a private company. Anyone who has worked in emergency services in the state has great respect for them. The do excellent work, and save the tax-payers millions. We could look at Orange Cross also. The Sheboygan Fire Department told the city that they could provide EMS better, and cheaper. Two years later, guess what... They spend more, for the SAME service, in fact, the fire department was not even able to improve Orange Cross' response time. So it goes to a public vote, keep EMS in the fire dept, or let it go back to Gold Cross....throw some FD Union money towards public campaigns, and it stays with the FD...go figure.
BUT, if you want to technical.
Bell may not have an ambulance every few blocks in the city...however, looking at the care given by their medics, and the training they have....I wouldn't spend to much time insulting them. I would personally enjoy seeing some comparitive tests handed out to MFD medics, and Bell/Paratech medics, I think the results would surprise you.
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Old 03-30-2011, 05:09 PM
 
Location: Baltimore
1,332 posts, read 3,521,595 times
Reputation: 654
Quote:
Originally Posted by blast49 View Post
Look, guys, I'm not here to bust your balls, though it may sound like it. The point I've been trying to make since the start, is that things can improve. In several aspects, financially, communications, oversight, etc.
I'm going to go on a limb here and sound like an ass...but if someone is cognitive enough to "worry" about the bill. Then, yes, they MAY not need an ambulance, or maybe they do, but if there mind is on money, then they aren't that worried about thier current health situation.
I also never said you were here to turn a profit, we both know thats not going to happen. My only point was, why isn't MFD, or the county meds...whoever bills for the ride, charging comparable rates to others in the metro Milwaukee area? Hell, in Ozaukee, the base rate for an ALS call is $475, in Waukesha, it's an average of $500. per ALS call, even Racine (so you can't play the "poor population card") charges $450 as a base rate. ...the measly $150 bucks that your telling me MFD charges is pretty slim...

Nuclear Art, - That arguement goes both ways, nearly a third of the United States has a private service as there first responder service. Take Appleton/Neenah/Menasha/Hortonville/New London/Grand Chute/Little Chute/Combined Locks/Brillion for example. The whole area is covered by Gold Cross Ambulance, which is a private company. Anyone who has worked in emergency services in the state has great respect for them. The do excellent work, and save the tax-payers millions. We could look at Orange Cross also. The Sheboygan Fire Department told the city that they could provide EMS better, and cheaper. Two years later, guess what... They spend more, for the SAME service, in fact, the fire department was not even able to improve Orange Cross' response time. So it goes to a public vote, keep EMS in the fire dept, or let it go back to Gold Cross....throw some FD Union money towards public campaigns, and it stays with the FD...go figure.
BUT, if you want to technical.
Bell may not have an ambulance every few blocks in the city...however, looking at the care given by their medics, and the training they have....I wouldn't spend to much time insulting them. I would personally enjoy seeing some comparitive tests handed out to MFD medics, and Bell/Paratech medics, I think the results would surprise you.
A test doesn't prove much. These guys for the most part are textbook medics. That doesn't make them good. Bell runs senior homes for the most part. They don't have that real experience that you can't get from your textbook.

I'm speaking from experience. I worked in a Milwaukee suburb as a firefighter/EMT. I now work in Washington, DC where I see shootings, stabbings, cardiac arrests, etc on a regular basis. The knowledge I had in the suburbs compared to here in the city running "real" emergencies isn't even comparable.
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Old 04-05-2011, 10:55 PM
 
26 posts, read 69,267 times
Reputation: 17
ffknight918, I see what your getting at, but it goes both ways. The experience of the trauma calls your speaking of, shootings, stabbings etc. is cookbook medicine. I can teach a monkey to run a trauma call.
What I expect to see in a GOOD Paramedic, is a medical detective. Someone who can take the signs and symptoms of what they see, and treat based on their working diagosis. "Senior Homes" as you call them, are the PERFECT place to get experience for that. Every patient in there is a medical trainwreck, and for the most part, what I've seen is pretty good care coming from those private services that everyone has issues with. I'm much more impressed seeing a CHFer come in getting CPAP or BiPAP with an in-line nebulizer, and/or Nitro-drip and accompanied by a couple of medics than can rattle of thier history, giving me their opinions and ideas, than I am with a couple guys bringing me the patient, still in severe respiratory distress with a oxygen mask, a poorly written report with little history to go on it, and the attitude "here he is, go ahead and fix 'em"
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Old 05-11-2011, 02:09 PM
 
26 posts, read 69,267 times
Reputation: 17
I saw the recent article in the Jounal about the Alderman who proposed a least "looking" at ways to cut costs, etc. What I found most remarkable were all of the comments that were posted. It's obvious that many were MFD personnel. First, I noticed that there weren't many good solid arguements, just a lot of insults and slander, and yes, there was some coming back from the other side, but most seemed to be coming from the MFD side. I found this very interesting. My view is, hey, if your as good as you say you are, truely "Simply the Best" than why are you so worried about competition? I found that many of the comments posted on the article may work against you, as many came off as immature. I'll be honest, this IS what I wanted to see, not neccessarily changing a single thing, but finally, someone else wants to LOOK at possibilities. What's wrong with that?
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Old 05-11-2011, 03:50 PM
 
Location: Milwaukee, WI
142 posts, read 278,879 times
Reputation: 127
Blast, give it a rest, please. You're only seeing what you want to see and trying to paint your opinion as fact, when you aren't even working in the system itself. You have a bias towards your side of the equation and seem bent on trying to compare a system that takes in 120,000 annual calls with systems that respond to ...5,000...maybe...

When you compare EMS in Milwaukee with of cities that are comparably sized, ie...Denver, CO, Seattle, WA, Boston, MA, Washington, DC, Baltimore, MD, etc...then you have a more apples to apples comparison. You can't compare what happens with Milwaukee to Appleton or even Racine. The fact is that the system in Milwaukee delivers a high quality EMS response, to your door step within four minutes of you picking up the phone.

You keep harping on the this and that...MFD said this or they said that...it's all hearsay from you. Who is it that posts on these forums? How do you know they are members of MFD? Are people required to present a fire department ID prior to posting? Sounds a lot like the "Axeman" issue you had earlier; you never did tell me how you knew they were MFD members and not suburban firefighters, btw...just saying... It sounds an awful lot like you have an axe to grind to me, tho.

Look at it like this; with the fire department responding to EMS alarms, you are getting full service. You get a vehicle that is able to handle virtually any type of incident there is in which you can imagine.
How about the "typical" car accident; caller reports a car accident and fire department responds. On arrival, it is learned that the vehicle occupants are pinned in. The truck company is able to initiate EMS care and go to work on cutting the car apart, all the while an appropriate transport vehicle is enroute.
Or, the "typical" man-down in the street is a pulse less non-breather, and due to the four minute response and extra hands, he walks out of the hospital. I could go on, and on, and on.

My opinion is to study whatever you want. However, you show your naivete about how things work in government. You can get a study to show whatever you want it to, and the study will cost whatever the city will pay. And, pay they will, and waste more and more money.

Do a little research on private EMS in urban settings. What happens when the private just up and shuts it's doors? Don't say it can't happen, either. It has, and the citizens of that community were left high and dry.

I don't get what the chip on your shoulder is. There is nothing I can say or show you that will change your mind; whatever. Study away and waste even more money if you want, it's just tax money, right? So much for your wanting to be a fiscal conservative.

Here's a hint; the department has been changing it's response matrix and how it does business all the time. Over the years the number of calls directly handed to the privates has been increased, as the department has been learning. It is a very good combination of public and private interaction to provide very important, safety-based services.

Then again, you only see what you want to see, right?
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