MILWAUKEE — Milwaukee's private ambulance providers are facing a staffing dilemma, struggling to hire people to man the ambulances, and the effects are spilling over into the 911 system.
One private ambulance company, Paratech owned by Midwest Medical, is pulling out of the city's 911 agreement with the private providers, citing staffing issues as a factor in its decision.
"It's the staffing issue and the staffing goes back to reimbursement," said Bell Ambulance Director of Operations Chris Anderson. "It all ties together."
The leaders of the companies that will remain, as well as the Milwaukee Fire Department, told the I-Team that a big reason they can't recruit EMTs out of school is because of the way the companies are reimbursed to take patients insured by the state and federal government.
"A majority of the patients are covered by Medicare or Medicaid," said Curtis Ambulance CEO Jim Baker. "Medicare this year actually gently lowered our rate in the middle of a pandemic, and Medicaid has not had a significant increase in over 20 years."
A ride in an ambulance costs about $525, but Medicaid and Medicare don't pay that $525 back.
According to the reimbursement table from the Wisconsin Department of Health, provided to the I-Team by the Professional Ambulance Association of Wisconsin, Medicare reimburses the ambulance companies $365 a ride, a loss of $160 a call. Medicaid, or Badger Care, reimbursed by the state of Wisconsin, pays $185 a ride, a loss of $340 a ride.
"Our goal is for Medicaid to at least match the federal Medicare reimbursement levels," Anderson said. "If we can do that the system will be much healthier, the service model will be sustainable. It essentially will fix all of our biggest issues."
Private ambulances handle non-life-threatening 911 calls, leaving the Milwaukee Fire Department paramedics available for the most serious calls. The private companies say they need support to hire more EMTs to continue the level of service they provide.
"I think at some point in time someone has to wake up and go this isn't working," Baker said. "In the last year alone we've lost 4 ambulance services. So it's kind of a warning sign. You're not going to get sirens because there won't be any ambulances around."
The change would have to come from the Statehouse, and lawmakers are currently discussing the budget for the next two years.
"The real solution is fund Medicaid," said state Sen. Lena Taylor, D-Milwaukee. "The real solution is, give them a reimbursement that equals their costs for gas and for the maintenance of their vehicles. And to pay employees a living wage so that they can live."
Taylor and other Democrats have called for an expansion of Medicaid in the state of Wisconsin. It would release federal dollars the state could spend on the private ambulance reimbursement rate, among a list of other items.
Republicans that control the Legislature have been hesitant to expand Medicaid, worried federal dollars may run out over time.
State Rep. Amy Loudenbeck, R-Clinton, sits on the Joint Finance Committee, in charge of deliberating the state's two-year spending plan. She's also a former volunteer firefighter.
Loudenbeck says there could be a reimbursement adjustment without a full expansion.
"There should be a reasonable reimbursement so that they are not losing money on the Medicaid populations that they have to make up for on the property taxes," she said. "So I think the argument can be made that if the state wants to provide coverage for people under Badger Care that we should reimburse at a rate that covers that service or comes close to at least the Medicare rate for that covered service."
It's a potential solution, but it would take time.
"If the state of Wisconsin changes the Medicaid rate today, and let's say doubles it, you're not going to see an improvement in this for at least a year," Baker said. "Because you've got to get people through school, trained, and on board the ambulances. So it's a high-priority thing that these rates get adjusted."
Loudenbeck notes if the rate adjustment is not included in the budget, it is something lawmakers could consider fixing with separate legislation later this session.
The I-Team continues to investigate the private ambulance matter, including potential long-term solutions to the staffing issue. If you have a tip you want them to investigate, you can contact them at firstname.lastname@example.org or call 414-967-5556.