Guest commentary: EMS organizations in trouble

While you may not recognize my name, you may have recalled my public appearances with respect to public awareness during the onset of COVID-19. I’ve been involved in emergency medical services since the age of 16 and continue to provide services to my community to this very day; nearly 25 years. I have worked and/or managed EMS systems and delivery models for over a decade.

I write today to discuss a topic that hits home, my home… Including all the friends and colleagues I have been privileged to work with over this time.

Kutztown Area Transport Service, Inc. has announced its closure after nearly 40 years of service. KATS served Kutztown and portions of Greenwich, Maxatawny, and Richmond townships with prompt, professional, and tax-free service since its inception. Jeannette EMS, an ambulance provider in western Pennsylvania, suffered the same fate just a few months ago. I can promise you this: There wil be more.

EMS has been struggling to survive statewide for the better part of the last 20 years. Ever since the passage of the ambulance national fee schedule, agencies without a solid municipal backing have been struggling to make ends meet.

Payroll, the biggest chunk of an EMS organization’s budget, encompasses 50 to 70% of most organizations’ total recouped revenue, leaving 30% for everything else; utilities, fuel, insurance. This doesn’t factor in the rising costs of supplies and lifesaving equipment, vehicles and a reimbursement structure that does not provide sufficient funding to support service. Throw in recent inflation for good measure and the rising cost of gasoline, and you may get the gist of what I’m describing.

The national ambulance fee schedule is an abomination. EMS is the “red-headed stepchild” of the medical profession and first responders. Have you ever referred to an EMT or Paramedic as an “ambulance driver?” We do not take kindly to that term, as we have thousands of hours of emergency education that do not exclusively focus on transporting people from point A to point B. Would you like an Uber driver performing a chest decompression or surgical airway on you? I would think not.

Medicare and Medical Assistance, the two primary sources of EMS revenues, reimburse far less than the actual costs necessary to provide service, and they admit it. Nearly every time any ambulance leaves its station, the organization behind it is losing money providing the service.

Many organizations in this area are in a unique situation. Located in communities between the general area of four major hospital systems with at least 15-20 miles to the closest one, the ability to concentrate services in one central region is nearly impossible. Couple that with unreimbursed mileage to an incident and return from hospitals, and with some insurers, travel costs to the hospital go unfunded.

Oh, did I mention that the medication EMTs infused on the way, that splint they applied and that oxygen they administered weren’t paid for either? Do you think insurance should reimburse an ambulance less than what it cost to provide the service? I would tend not to think so.

It is unfortunate that today there are still many municipalities that make inequitable decisions about how they support local EMS service while still guaranteeing a response from agencies located elsewhere. EMS is required by law to provide service whenever and wherever we are requested to do so, regardless of distance, medical necessity, political boundary, a patient’s ability to pay or any other factor. The municipalities have been forced to supplant their EMS services from neighboring jurisdictions in legally mandated mutual aid assistance.

Please. Reach out to local and congressional leaders. This problem has been ignored too long. The Band-Aids provided are not providing enough care to the wound that has been left to hemorrhage for decades. It will take courageous leaders to make swift and decisive steps to finally make EMS not necessarily profitable but self-sufficient. Just like your police department and fire department. Otherwise, I guarantee, this will not be the last time you are reading about EMS closures in this region.

Salamone is director of operations for the Lower Alsace Volunteer Ambulance Association.