Mich. ambulance service, FD debate best EMS transport option before levy vote
MMR’s Vice President of Operations Eric Snidersich said the current system in Traverse City is very effective when compared to fire-based transport
By Jordan Travis and Elizaeth Rewer
TRAVERSE CITY, Mich. — It’s not unusual for two ambulances to respond to an emergency call in Traverse City.
City firefighter paramedics currently respond to every medical call in the city, to the tune of thousands per year. Mobile Medical Response, a Saginaw-based nonprofit that operates in 18 counties, sends a crew and transports patients to the hospital when needed.
That could change if city voters agree on Nov. 7 to lift a state-imposed cap on Traverse City’s operating millage for 20 years. If approved, the city could levy up to 1 mill over the Headlee Amendment-imposed cap on its operating millage, which is currently at 11.7688.
Bumping that up to 12.7688 would bring in an extra $1,173,500 in 2024.
Mobile Medical Response is currently the city’s primary transport agency, meaning its ambulances handle any transports unless none are available. City commissioners approved an agreement with the company in December where the company doesn’t charge the city, but it bills patients.
Should Traverse City Fire Department take over as the primary transport agency, residents would pay a higher operating millage, but any resident who needs an ambulance ride wouldn’t pay a bill for it.
Department Chief Jim Tuller said his department would use what’s called “tiered billing,” where city residents who are transported by ambulance would only be responsible for what their insurance covers. The fire department would waive the rest.
Nonresidents would be billed for the full cost of services. The fire department currently doesn’t bill for its services unless it transports a patient.
The millage — estimated to cost taxpayers who own a home with a $128,500 taxable value an extra $10.71 per month — would allow the department to hire nine more firefighter paramedics and an Emergency Medical Services captain, plus buy a second and third ambulance.
Tuller previously has pointed to several reasons for making these changes, including their shorter response times: The average response time for the department over 10,495 medical calls from Dec. 1, 2018, to July 24, 2023, is 3 minutes, 56 seconds.
Becoming the primary transport agency also would create continuity of care, department Capt. Steve Ball said.
With city firefighter paramedics often first on the scene, they would continue caring for patients during transport until they hand them off at the hospital.
With an aging population and many thousands of tourists visiting Traverse City each year, the need for an ambulance service that can provide advanced life support will continue to grow, Tuller said.
The startup costs would be steep, Tuller acknowledged: Total expenses in the first year could top $1.8 million, including buying ambulances, more equipment and paying salaries and benefits.
“Yep, the first-year startup is pretty scary, but that will result in Traverse City, the citizens, owning their own EMS transport agency and serving the citizens of Traverse City with the best care possible,” he told commissioners at a July 24 study session. “We can stabilize them, we can transport, we can get to Munson, we can get them to more definitive care in short order.”
MMR’s Vice President of Operations Eric Snidersich disagrees.
The current system in place is “very effective,” Snidersich said, and most of the bill for their service is covered by the patient’s insurance carrier.
The way the system works now, TCFD, as the first responder, begins lifesaving measures until MMR arrives on the scene, he said.
“Community responders, first-responder agencies like Traverse City Fire, who reside right in the middle of the city, are there to first-respond,” Snidersich said. “It’s in their name. They’re supposed to get there first. They provide the transfer of care and they take over while they’re waiting for the transport unit, which should be a minute or two behind.”
Then responders work together to get the patient into an MMR ambulance for transport to Munson Medical Center.
According to Snidersich, this method clinically provides the best outcomes for the patients. And their access to early CPR and defibrillation both make a difference in survival rates for the most life-threatening calls.
This system is exactly what’s already in place between MMR and Traverse City first-responders.
“So, from our perspective, we have a well-built system within Traverse City with good survival rates and excellent people,” Snidersich said. “We feel that we are the best option for the people because the only people that pay right now for our services are the people that use it.”
All of the paramedics who work for MMR here are based locally in the community, with some of them living within the city limits, said Amy Fairchild, MMR’s operations manager for Grand Traverse, Antrim and Crawford counties.
In addition to their contract with the city, MMR also has contracts with Acme, Garfield and Whitewater townships.
“So if Traverse City has more calls going on, we bring those extra resources in,” Snidersich said. “That actually increases the care.”
In total, MMR data shows they have 15 paramedics and 36 Emergency Medical Technicians for the area.
That same data set showed that, between July 1, 2022, and June 30, 2023, MMR responded to 2,238 calls and provided 1,680 transports to the hospital.
“It really is an efficient system the way it works right now,” Snidersich said. “And that’s the point we would like to make.”
Ball said that having Traverse City Fire Department take over as primary transport agency would be more reliable.
MMR doesn’t have an ambulance available about 5 percent of the time, he noted, which meant that TCFD transported some patients to the hospital instead. The fire department provided that service about 135 times in 2022 and is on track to exceed this in 2023, he said.
There also have been times when a city firefighter paramedic had to ride along with MMR because the crew that was available didn’t include a paramedic, said Jacob Steichen, a city firefighter paramedic and president of union Traverse City Firefighters Local 646.
According to Fairchild, that only happens a handful of times each year with “very critical” patients who may require more care during transport in the back of the ambulance.
If MMR runs what they call “Bravo trucks” which only have EMTs on them, Fairchild said the TCFD paramedics will jump in and help out. That has happened twice so far this year, with both calls taking place outside city limits, she said.
Not all city commissioners are convinced of the need for this change.
Commissioner Tim Werner cast one of two votes against placing the millage request on the ballot, and previously asked for arguments to support the fire department taking over as the primary transport agency.
Patient outcomes should be the motivating factor, and he said he heard nothing to suggest the current arrangement is bad for patient outcomes.
Mayor Pro Tem Amy Shamroe served on an ad hoc committee that examined TCFD becoming the city’s primary transport agency, including the results of a study by TriData.
Shamroe is in favor of the proposal, although she acknowledged it’s up to individual voters to decide what they believe is best and what their budgets can handle.
Many communities around Traverse City have fire department-based EMS services, while the city’s “half-in, half-out” arrangement doesn’t make much sense, Shamroe said.
“Our fire department has already been handling calls; they’re there often before MMR is on scene, and that’s something that I think the community takes for granted,” she said. “If we were to say that we don’t want to get full into transport, the next step would be to logically look at, then, why do we carry paramedics?”
Shamroe said arguments that passing the proposal would raise taxes for a service the city already gets overlook the fact that city taxpayers already support the fire department, and firefighter paramedics are already doing half the work on medical calls.
Plus, the city wouldn’t need to levy a full mill if it gets grants or billing incomes prove to be higher than anticipated.
Tom Mair, who’s challenging Shamroe for mayor in the Nov. 7 election, said he also supports the proposal. For one, it would restore a portion of what the city previously levied — that operating millage was approved for up to 15 mills.
For another, Mair echoed Shamroe’s criticism of the current setup, calling it “absurd” that someone in Slabtown might call 911, have a fire department ambulance show up from the Front Street station, but have to wait for another ambulance dispatched from Veterans Drive to get a ride to the hospital.
The issue matters to Mair on a personal level, since his wife, Susan Odgers, has needed the ambulance before. “Because Susan has used the ambulance before, it’s really important to us as a family to get the best service we can get.”
Former Munson Medical Center president and city resident Ralph Cerny said the current system should stay as it is.
“I’m concerned about what a 1-mill increase is all about — and why it’s necessary to do this,” Cerny said. “The private sector has provided a high-quality ambulance service to the citizens of this area, including the city of Traverse City, for a long time.”
No clear, outlined reasons support why the city needs to make this change, he said.
“There is no data that the city fire people have presented — other than response times,” Cerny said. “And response times, I believe, are not a good measure of healthcare quality.”
If voters approve the Nov. 7 ballot question, Tuller said it would take one to two years for the fire department to make the transition. That’s due, in part, to the lead times required to buy new ambulances, as well as the time needed to make the new hires.
He’s confident, though, that the department could meet the demand for increased staffing.
Becoming a primary transport agency would make TCFD a more attractive place to work, Tuller said. “There’s personnel that would like to be involved at that level, that would like to work at that level and provide for their community at that level.”