Most commissioners said at a study session Monday that they're not interested in continuing with a status quo where Traverse City Fire Department responds to medical calls and Mobile Medical Response transports the patient to the hospital if needed.
There are plenty of options to consider, and while the city enters into contract negotiations with Mobile Medical Response after the company merged with previous provider Northflight EMS, city staff will consider possibilities ranging from billing for first responder services to taking over as the city's primary EMS transporter.
The latter would be a huge undertaking, one for which the city could seek taxpayers' support through a millage — the city already levies one for its police and fire pensions, city Manager Marty Colburn said.
Most commissioners agreed there's work to do regardless of which way the city goes next, including steps that could be taken right away like adding dividers to fire station sleeping quarters to accommodate female employees.
"I think the fire stations are well past the need for updating," Commissioner Brian McGillivary said. "Some of them don't even have up-to-date fire suppression systems in our fire houses."
Dr. Harold Cohen, a senior analyst with TriData, went over the company's study of the current arrangement and laid out various considerations for improving services, like keeping better track of response times, and implementing automatic vehicle tracking. Others were more involved, like staffing and equipment requirements if the city does opt to become the primary EMS transport provider.
That upgrade would be costly, according to the study. The city fire department would need two more ambulances, at up to $250,000 each and needing replacing after several years — fire Chief Jim Tuller previously said they can last five to seven years, depending on run volumes, and the study states eight.
The biggest cost would be growing the fire department's ranks by six to 11 personnel, which could cost from $755,000 to $1,548,000, according to the study. Then, the department would have to modify both its stations to accommodate the larger crews.
Charging for services would recoup some of those costs, but EMS services rarely turn a profit, according to the study. The city could anticipate $484,000 each year in revenues from transport, and $338,000 in revenues for first responder service without transport — the city potentially could opt to charge Mobile Medical Response for these services without moving to become a primary EMS transporter.
"Very rarely can 911 service EMS turn a profit, and most of the larger private services who do this 911 service do it because they also do the non-emergency work where the money is," Cohen said.
Cohen recommended the city contract out any billing services, as its labor-intensive and mistakes could have serious consequences, including fraud allegations from the Centers for Medicare & Medicaid Services.
The city could also consider several options in going ahead with Mobile Medical Response, including either enforcing or removing current contract clauses that requires certain response times, charging for first responder services the city provides that don't involve transport and ensuring there's a contingency plan should the company fail.
Cohen said he believed fire department personnel has the talent and will to handle whatever the city asks of them. Department members expressed a willingness to become the city's primary EMS transporter, something Cohen doesn't see in other cities.
Commissioners were supportive of investigating the city's options, including a phased approach to becoming the primary EMS transporter. Roger Putman said he hoped the city would consider that not everyone has insurance and can afford to pay for first responder services, and that the pandemic may have long-term effects that could make upgrading services a longer, more difficult process.
Jacob Steichen with Traverse City Firefighters Local 646 said some of the proposed fixes in the report would help with current issues caused by increased EMS demands on the department and a firefighter/paramedic roster that has shrunk over the years. More personnel and another ambulance would help relieve the strain, and the Federal Emergency Management Agency has grants that could help.
Commissioner Ashlea Walter said she wasn't happy to learn of some of the issues the report identified with current EMS services — Cohen identified a nearly five-minute average lag time between TCFD and Northflight EMS responses, for one. She was glad the city has six months to renegotiate its contract with the company's successor, and hoped city staff could look into funding for service upgrades as well.
"I know there's not much money out there at the state and federal level right now but it's always possible to look into other funding mechanisms to support such an important essential service," she said.
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