Rural EMS services struggling due to rising costs

Paramedics and emergency medical technicians have made it their job to assist people on some of the worst days of their lives. However, due to rising costs and new managed care organizations (MCOs), running an EMS and ambulance department in a rural community is getting harder and harder.

Richard Young, owner of Washington County Ambulance, a privately owned and operated company that has a contract with Washington County, said financial woes are a big part of the problem.

'Before, when somebody was on Medicaid, or Title 19, the state paid the ambulance services. Once they went to the MCOs, they changed the law,” he said.

Before the change, Medicare paid for 80 percent of the fee and the private insurance company paid the other 20 percent. Now with MCOs in effect, they are not required to pay the ambulance service that extra 20 percent.

'That's quite a bit of money so far, for us. That didn't affect only EMS, that affected hospitals (and) doctors when they changed that law,” he said.

To run the service for a full year, their budget is $1.1 million. Last year, there was more than $330,000 in fees the company was not able to collect due to MCOs. In 2016, there was about $200,000 they were unable to collect, which means the number is rising every year.

Jacob Dodds, Interim EMS Director for the Henry County Health Center (HCHC) in Mt. Pleasant, said often EMS services are treated as an after-thought by the state.

'Unlike police and fire, EMS is not an essential service so the state legislature does not dictate that any entity provide ambulance service,” he said. 'People recognize that there needs to be ambulance service but don't often realize the cost associated with it.”

HCHC is a critical access hospital and does not receive reimbursement for their ambulance service. The expenses draw down the reimbursements and create a negative impact on the overall budget. MCOs are a separate issue that also affect the budget. On average, HCHC is reimbursed for 16 percent of their costs to deliver care.

This affects the budget in that it makes it harder for the service to purchase new equipment when their income is cut and the reimbursement rate from the state of Iowa has not changed since 1987.

'If you think about what it cost to run an ambulance service in 1987, which I was doing, compared to what it costs today in 2019, it's not even close,” Young said. 'An ambulance back then in ‘87 was probably $40,000 ... now the same ambulance is $275,000.”

The other main issue both see is the shortage of paramedics and staff. Young said there are 30 ambulance services across the state and all are looking for qualified people.

He said one reason he suspects they have such a tough time finding people is because of the hours. In Washington, crews work in pairs of two and perform 24-hour shifts two days a week. Between full-time and part-time, they have 28 staff members which is down from where they have been, he said.

Dodds agreed, adding the hours, rough environment and pay are three big reasons he believes paramedics are difficult to maintain. On average, paramedics make between $15 and $22 an hour, making it more of a 'job seekers market,” he said.

'I've been in EMS for 18 years now and when I went through school, we had full classes of people coming out. There never seemed to be a shortage of providers, but it's just not a profession people are choosing anymore,” he said.

The Washington County Ambulance Service takes about 2,000 calls a year. Their response time varies depending on where the call comes from. In the city, the national standard is 8.5 minutes and in a rural area 15.5 minutes. Young said they struggle to reach that rural standard for places like Rubio and Wellman because they are so far away from the ambulance headquarters.

The county is looking at possibly putting another structure on the north side of the county to help reach places like this faster, but Young said this could be cost prohibited.

'Once you move up there you have to get a building and staff,” he said. 'I figured up, just to start a rig in the north end of the county, I think you're getting close to $500,000 to get going.”

The money would go toward wages, insurance, the ambulance itself, equipment and continuing education for the staff.

HCHC paramedics run on an average call time of about 12 minutes and take about 2,500 calls per year. Their full roster of 28 perform shifts in increments of 24 hours or 16 hours. The 16 hour shifts are on call and over night shifts, which can be taxing on the body if they have to get up in the middle of the night and go from sleeping to fully functioning, Dodds said.

The Jefferson County Health Center in Fairfield has a contract with Midwest Ambulance Service of Iowa, Inc. A representative for them could not be reached.