John Diedrich and Kevin Crowe, Milwaukee Journal Sentinel
By getting hospitals to reform their operations and stop turning away ambulances, Milwaukee County put itself at the forefront of a push to ensure patients get the best, fastest care.
But experts warn voluntary agreements like the one in Milwaukee and other cities can be fragile and easily discarded, in part because there is little regulatory oversight to ensure hospitals follow them.
The approach also leads to a peculiar patchwork, where hospitals in neighboring counties continue to turn away ambulances, even though other facilities within the same health care system have stopped doing so.
In fact, new figures show diversions by some hospitals in the Milwaukee area — particularly those belonging to Ascension Wisconsin — have crept up this year, despite the ban local hospitals agreed to three years ago.
"Informal agreements are great, but at some point they don't work," said Brien Barnewolt, an emergency room doctor at Tufts Medical Center in Boston. "That's the benefit of having statewide regulation — everyone is held to the same standard whether they are large academic medical centers or small rural hospitals."
Barnewolt was a member of the committee that in 2009 ended diversions in Massachusetts, which remains the only state with such a ban.
Read more: https://www.jsonline.com/story/news/investigations/reports/2019/12/13/milwaukee-hospitals-ambulance-diversion-plan-lacks-strong-oversight/2634059001/
Above emphasis is mine.