Detroit is remaking itself from the ground up

By Cate Long
March 20, 2013

You have seen the headlines from Detroit; how Michigan Governor Rick Snyder appointed an emergency manager, Kevin Orr, to take over the functional management of the city, how the water and sewer system is moving to a regional rather than municipal system and how 6,700 abandoned homes have been demolished. Big things are happening in the Motor City.

My attention was recently caught by a small story in the Detroit News that talked about efforts by the city’s emergency medical services to examine how their services are being used. Aside from education, EMS is one of the most expensive services that municipalities provide to citizens. In the case of Detroit, some citizens were under the impression that the EMS was some sort of a concierge service. From the Detroit News:

“A lot of times they’ll call the 911 system because they don’t know who else to call,” Detroit EMS Lt. Anthony Wade said. “They’ll say, ‘I’m sick, and I can’t see my doctor this week, so I’ll just call 911 to take me to the hospital.’”

Detroit has an annual EMS call volume of 135,000 in a city of 706,000. This is an unbearable load on a department that is stretched for resources. Those calls are expensive. Detroit News again:

But those [emergency] calls come at a high cost — to the caller and the city. The average basic life support transport costs $450 per trip while advance life support runs, for instances such as heart attacks, cost $800 each. Over the past 10 years, however, EMS has been able to collect payments only from 32 percent to 35 percent of the calls — mostly through insurance, officials said. EMS, meanwhile, is obligated to transport patients regardless of their insurance status.

So the city is providing 65-68 percent of this service for free. It’s easy to call for service when there is little to no cost to you. The calls were concentrated by location, according to the story:

After a survey last year found that nine of the top 15 addresses for EMS calls were senior citizen high-rises, EMS officials decided to become more proactive in preventing medical emergencies by holding health seminars at each of these locations this year.

It’s not surprising that senior citizens need a lot of support, although EMS may not be the most cost effective or humane way of providing it. The story revealed other areas with high call volumes:

The six-month survey also found Detroit’s three casinos — MGM, Greektown and MotorCity — were among the top four addresses with more than 180 calls each. Other addresses in the list included homeless shelters and the Rosa Parks Transit Center.

EMS, one of Detroit’s most expensive services, is carrying the burden of what is now a very thin social safety net. The EMS department decided that a new approach was needed:

“This is the defining moment for the city’s health care system and EMS,” James said. “With the city’s fiscal challenges, we can’t continue to do stuff like we used to. You can’t just fix the problem with more people and more units. That has not worked successfully for the city.”

“There has to be a better way to fix the city’s emergency response system, and I think the key to that is education.”

EMS hosted its first two programs at Midtown’s Bicentennial Towers on Alexandrine Street in January and Cambridge Towers on Evergreen on the city’s northwest side last month. The two locations combined for more than 300 calls in the six-month stretch that was surveyed. EMS plans to hold the next seminar in April at Village Center Apartments on Pallister in the New Center area.

At each program, EMS brought a couple of paramedics to conduct health screenings while other health care organizations, including Detroit Area Agency on Aging and Warriors on Wheels, informed the seniors on non-emergency health services.

I have written previously about privatizing EMS services in bankrupt San Bernardino. Every city has different needs and resources and it’s important for them to investigate what the best changes would be. Detroit is undergoing big structural changes. Every community can learn from what is happening there.

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