Chief Ludwig (yes, Gary Ludwig) shared an article from Canada on his Facebook page the other day I am totally in agreement with, and it seems to be in place in other places with varying degrees of success.
CBC News in Canada reported that the Winnipeg Fire Paramedic Services will begin charging hospitals $117 per hour that the crews are held over 90 minutes. This will progressively trend down to 30 minutes over several months.
I like the idea, but it’s not new. Winnipeg is borrowing it from British Columbia, and in the United States has several examples including Pinellas County, FL. It was suggested here in Memphis back in 2007 as part of an efficiency study as a way to reduce ambulance wait times and increase the availability of ambulances. We are a few ambulances shy of meeting another recommendation, doubling EMS units available which has been met with marginal success. The question is will it work?
I think it will see marginal success. While the hospital will meet it’s goals in order to avoid the charge, there may be some that will just let the total add up, then there will be a lawsuit for the money, which will be locked up in court forever, meanwhile no actual problem will be solved. In the meantime, we’re still stacked 6 or 8 deep in emergency rooms while the hospital gets a free bed and a babysitting crew.
We see extended waits on most days here, while a 25 bed ED built for a workload of the last century attempts to find ways to adapt to a 21st century urban workload. Most hospitals have embraced the idea that bigger hospitals are needed, which is true, but we should be far more active in preventing the need for transports instead of accepting them.
We should also be advocating for changes to the Medicare system and finding a way to bill for non-transport “treat-and-release.” I would almost say that if we treat and release we should bill for equipment used and the unit time spent, but there is a chance of a slippery slope unless there is proper quality improvement and appropriate follow-up.
Our time is very valuable. A reduction in available ambulances increases response times, which drives up the chance of delayed interventions at a critical moment. This happens in real time, waiting ambulances cause transport delays which require fire companies to respond to more medical calls and wait longer on scene, which increases fire response times, the results could be most tragic.
If you think that response times don’t matter, ask Detroit…