Hudson Common Council members and representatives from its EMS partners gathered Thursday, Dec. 13 to hear proposals for EMS services from four entities - Lakes Region EMS, Lakeview EMS, North Memorial Health and St. Croix EMS.

During discussions, Lakeview Hospital President Ted Wegleitner told the city the EMS service will begin taking all transfers out of Hudson Hospital, which is connected to Lakeview under the umbrella of Health Partners, on Jan. 1. St. Croix EMS was previously the first called for all Hudson Hospital transfers.

"We think it's the best for our community and our EMS program to do it that way," Wegleitner said.

Transfers are a large part of revenue for most EMS services, and was a question posed to every presenter Thursday.

Lakes Region

Lakes Region would provide a two-ambulance service based in the city of Hudson, and offer employment to all current St. Croix EMS employees if selected as the city's EMS service, Operations Director Ben Wasmund told the council.

Lakes Region is a nonprofit provider based out of Minnesota, serving areas in Chisago County in Minnesota and St. Croix Falls and Milltown in Wisconsin.

Lakes Region is based on working with small agencies that are passionate about EMS, but weren't able to survive on their own, Wasmund said.

"Partnerships with our communities are utmost importance," Wasmund said.

Costs for the proposed service would be $15 per capita for the city and its two partners, town of Troy and village of North Hudson. The original proposal, made before town of Hudson left its EMS contract with the city, was for $10 per capita.

Without transfers from Hudson Hospital, Wasmund said the service would not be able to operate in Hudson.

Wasmund said the service's intention is to try to reduce, and possibly eliminate, per capita as it further develops. It has not done so yet in other services areas, he said.

Lakes Regions uses a paramedic and EMT model. It would employ eight full-time paramedics and eight full-time EMTs to staff its two ambulances, as well as casual part-time EMTs who would be required to work 48 hours a month. Paramedics and EMTs would be at the station during shifts rather than on-call.

Lakes Regions does not see staffing as a challenge, Wasmund said. The service has never been staffed under 100 percent, he said.

The first year of service in Hudson would be led by the organization's existing leadership, with hopes to hire a manager later on, Wasmund said.

Wasmund said Lakes Region would help still utilize the community's existing first responders, and help the group become its own entity.

While Lakes Region uses dynamic deployment, where ambulances shift between communities when one truck goes out on a call, in its other coverage areas, Wasmund said it would not use that model in Hudson.

"The distance is too great," he said.

Instead two ambulances would be housed full time in Hudson. Wasmund said the proposal factored in funds to lease a space, as EMS may not continue to maintain the current public safety building after the new fire hall is built.

Wasmund said response times for the service are usually 10 minutes or less, with crews en route within two or three minutes.

Lakeview EMS

Lakeview EMS, now contracted to serve the town of Hudson, wants to provide a regional solution to EMS, the council and municipal representatives heard.

Wegleitner said the organization wants to continue the mission of improving the health and wellbeing of the community done through Hudson Hospital with EMS.

Lakeview EMS proposed servicing Hudson and the surrounding community with two ambulances stationed at Hudson Hospital 24/7, all year. This includes the one ambulance set to be stationed there for service to town of Hudson.

The city and its partners would not pay any per capita subsidy for service from Lakeview EMS.

Users would pay market-competitive rates, Lakeview Hospital Ancillary Services Vice President Nate Pulscher said. Uninsured patients receive an automatic 58 percent discount, and families that make under 200 percent of the poverty line have their bills waived.

Hudson Council Member Jim Webber those rates are significantly higher than current rates.

The ambulances would use the two-paramedic staffing model. Lakeview EMS Director Jon Muller said the model assures the service can provide the highest level of care on every call. It also provides high-retention of employees who have a lifetime career model, he said.

The model means Lakeview EMS does not employ EMTs, a concern that was raised last year when the city first considered transferring the service to Lakeview. Wegleitner said the hospital would be open to having a conversation about how to integrate existing full-time paramedics and EMTs into the service.

Lakeview EMS would employ the dynamic deployment model it currently uses in its operations. This means if both Hudson-based ambulances went out on a call, Lakeview would shift coverage and move one of its Minnesota ambulances into the area. Likewise, if all ambulances in its other service areas are out on call, a Hudson-based ambulance would then shift to cover that area.

Lakeview EMS has a policy that the ambulance is en route on a call in 90 seconds or less, Muller said. Average response time to date in 2018 is six minutes in all current service areas.

Lakeview does not pay for first responders, Muller said, and instead utilizes either volunteer first responders or paid responders from a fire department in the area.

St. Croix County dispatch center expressed concern during last year's discussion about how Lakeview would be integrated into the dispatch calls. Muller said the service has spoken with the center and come up with an agreement on an operation plan.

North Memorial

North Memorial Ambulance Service proposed serving Hudson with two-ambulances in the area.

North Memorial is driven by values of accountability, inventiveness and relationships, Medical Transportation Vice President Pat Coyne said. Its EMS serves 2 million people in more than 10,000 square miles with 100-plus ambulances

Outstate Ambulance Director Rick Wagner said North Memorial services would be 911-service only. Revenue from transfers was not included in the proposal, as the service knew there was a question about who would receive transfers in the future.

The volume in the area is not enough to be self-sustaining, so the communities would pay a subsidy of $621,000 annually. The run volume numbers were based solely on city of Hudson and town of Troy calls, Wagner said, in case the village of North Hudson's request to leave the city EMS contract early was approved.

As a second option for financing the service, the city could pay a lower subsidy if it assumed some financial risk and guaranteed a negotiated margin so the service could recapitalize itself.

Wagner said North Memorial would anticipate a five to eight minute response time. It also implements a zero response time care, which employs emergency medical dispatchers who can walk a caller through initial instructions like applying pressure, giving chest compressions or assisting in a birth while the ambulance is being dispatched.

The service would have 10-12 full-time staff as well as part-time positions for the two ambulances. One ambulance would be on site 24/7, Coyne said, and the other would be on site for 16 hours and on call, within eight minutes, for eight hours.

Coyne said they would encourage all current St. Croix EMS employees to apply if North Memorial is selected, and most would be hired. In past similar transitions, Coyne said just about everybody has been hired.

A local manager would be hired for the service in the area.

An advisory board made up of representatives from the contracting communities would be created to meet with North Memorial frequently at first and then on a regular basis.

Coyne said North Memorial approached the proposal as a brand new EMS venture, factoring in the need to pay for a building as well as equipment and ambulances.

St. Croix EMS

The city's current EMS provider proposed three options for the community to continue to be serviced by the organization with the same staffing and response times, but at lower costs.

Jerry Clemens, who worked with Operations Supervisor Josh Olson on the proposal, said the service has more than 45 years experience in the area and its staff have developed a strong partnership with the community.

Currently EMS partners pay $17 per capita, a total of $474,394.

Proposed Option A would eliminate the subsidy paid by the partners, and increase non medicare run rates by 80 percent to an average cost of $950 paid by patient or insurance. This rate is still a third less than hospital service rates, Clemens said.

Option B would maintain the city of Hudson's subsidy at $226,000, and eliminate the subsidy from partner municipalities. This option would increase rates by 45 percent, less than half of hospital service rates, Clemens said.

Rates could be adjusted as needed quarterly based on actual call number.

Under both of these options, Olson said St. Croix EMS will continue to operate with its paramedic and EMT model. With this model, a paramedic responds to a call in a chase vehicle followed by EMTs with the ambulance.

St. Croix EMS would staff five full-time paramedics with 38 active EMTs and casual paramedics that are paid on call. It would also maintain the dive and rescue team.

Two paramedics and two EMTs will be on per day working 12 or 24 hour shifts.

St. Croix EMS response rates have an average of 5.12 minutes.

The proposals do not factor in a change of facilities, as that would be a council decision, Olson said.

The 2019 budget for St. Croix EMS does not plan for any Hudson Hospital transfers, Olson said, and the proposal does not include them either.

Option C provides a long-term plan to join the New Richmond EMS association, a intergovernmental co-op of 11 municipalities who are all owners of the service.

New Richmond EMS Director Matt Melby said it takes a 75 percent vote from the 13-person board for a new municipality to join the association. Melby said he can't speak for what the board would want, and some have expressed interest while others have expressed concern.

The association currently covers 220 square miles with a population around 23,000. Its board is responsible for financial decisions, and Melby reports to it.

If St. Croix EMS is approved to join, Melby said it would be beneficial to keep them based in Hudson as a second base to the association's existing New Richmond location.

A final decision would be up to the association, but Melby said it would likely operate two ambulances in Hudson, maybe dropping to one at times.

Member municipalities pay a subsidy based 50 percent on calls in their area and 50 percent on population. The per capita cost would be $9.88.

The rates for the association are less than St. Croix EMS's, Melby said. The service would have to match up under the association rate.

With the association St. Croix EMS would have automatic mutual aid. If two ambulances went out from one base, another would shift to cover it.

The structure of the service is similar to what St. Croix EMS has now, with five full-time paramedics and the rest casual, part-time, Melby said. The St. Croix EMS operations would have its own station chief, Melby said.

Council Member Randy Morrissette II asked if St. Croix EMS' operations would remain the same as they are now, with the buying power and stability of the association. Melby's answer was affirmative.

The group will meet again in the new year to discuss all of the proposals.