Emergency medical service agencies throughout county are struggling with myriad issues, including funding and staffing
Emergency medical service providers nationwide are in crisis: struggling with funding, the rising costs of doing business and finding qualified workers to provide vital services.
Ambulance services are dealing with these issues in a variety of ways, like using data to run more efficiently, supporting community health programs and finding alternate sources of revenue.
Jeff Kelly, chief of Cranberry Township EMS, said municipalities are required by law to designate an EMS provider for residents. But the requirements for funding that service are vague. That leaves many EMS agencies to find their own way forward.
In Butler County, Butler Ambulance Service is the largest EMS provider, with three stations covering 10 municipalities.
Cranberry EMS, which serves three municipalities, is the second largest.
Butler County is served by 11 EMS providers overall. That may seem like a lot, but there used to be many more 20 years ago — a reduction that is the result of the hardships facing many organizations in recent years.
<h3>Funding</h3>While costs and call volumes are increasing, the funding for ambulance services is not, said Ted Fessides, Cranberry EMS deputy chief of administration.EMS agencies primarily get money from insurance reimbursements. That can be a patient's health insurance, auto insurance or workers' compensation insurance, Kelly said.In many cases those reimbursements have remained flat or are decreasing, Fessides said.Medicare and Medicaid have set reimbursement rates for ambulance services, said Alicia Haas, billing manager with Butler Ambulance Service. Medicaid pays between $120 and $200 per trip, depending on the level of service. Medicare pays around $425.Butler Ambulance Service's payer mix is about 45 percent Medicare, 30 percent Medicaid, 20 percent commercial insurance and 5 percent private pay.Cranberry's payer mix is 47 percent Medicare, 32 percent commercial insurance, 8 percent Medicaid, 8 percent self pay and 5 percent auto insurance, workers' compensation and other.The problem for ambulance services is that their operating costs vastly outpace those government reimbursement rates.The average cost for a person transported in an emergency situation ranges from $675 to $1,000 for Butler Ambulance Service. For Cranberry Township EMS, their base rate is $949 for emergencies plus $13.05 per mile. At the top end, the bill for an ambulance ride can reach about $1,265.Ambulance services must accept what is paid by Medicare and Medicaid, Haas said. For people with commercial insurance — like UPMC, Highmark or Aetna — if the reimbursement amount from the insurance does not cover the entire bill, the patient is then billed directly for the remainder.If the patient doesn't pay, the bill is then sent to a collection agency.Commercial insurance companies give varying reimbursements. If EMS agencies contract with them, they will be paid — but at a fixed rate that is still lower than the cost for the trip.“In doing that, you accept a lower rate for emergency calls so that you can get the nonemergency calls,” said Denny Bacher, president of Butler Ambulance Service.If the services don't contract with the insurance companies, they may get paid the full amount, but they'll have to jump through hoops to get the money, Kelly said.For a patient who does not have insurance or who has not yet met their plan's deductible cap, the ambulance service has to get the money directly from the patient.EMS officials understand how quickly medical costs can pile up from an emergency trip, and how some patients face choices — like between putting food on the table and paying their ambulance bill.“These things add up and when it's all said and done, they may have $10,000 worth of bills,” Haas said. “When they do use an ambulance, they are often incurring other medical expenses. Sometimes the reimbursement is low, but we understand that and work with patients.”Haas said they offer payment plans. The key is to communicate with the ambulance service before the bill is sent to collections, she said.Kelly echoed that sentiment.“We just ask that they work with us and we're willing to work with them,” she said.Bacher said the Ambulance Association of Pennsylvania continually works with legislators to try to get reimbursement rates increased — mostly with Medicare and Medicaid — but it's an ongoing battle.Additionally, EMS agencies don't get paid through insurance unless they transport a person. Fessides said about 70 percent of the agency's calls result in transporting patients. The others are false calls, fire calls or situations where emergency responders treat someone on scene.Kelly said Cranberry EMS has a treat-no-transport fee of $172, but it's typically the patient's responsibility to pay that out-of-pocket.Butler Ambulance doesn't have such a fee.
<h3>Staffing</h3>Due to the multitude of funding issues, agencies cannot afford to pay their emergency medical technicians (EMTs) and paramedics enough to entice workers into the job or keep them there long term.“We're not able to pay them a living wage,” Kelly said.Bacher said Butler Ambulance is one of the higher paying services in the county, but they still have trouble filling vacant positions.“Especially at the EMT level, where our staff starts at $11 an hour, they can find a less stressful job at $10 an hour,” he said.At Cranberry, EMTs make on average $13.79 an hour while paramedics average $18.79 per hour. While they can't control wages, Cranberry EMS focuses on making sure the work culture is positive to keep employee morale high, Kelly said.“Our people are our biggest resource,” Kelly said.Butler and Cranberry both emphasize good benefits packages, which includes health insurance, paid time off and other perks.Many EMS agencies used to be fully staffed by volunteers, which is how Portersville Muddy Creek EMS began in 1989, said Kathy Neiper, a paramedic and founding member of Portersville EMS.She became the agency's first paid paramedic in 2003 and ran most of the calls. They now have seven paid paramedics, two paid EMTs and 10 active volunteer EMTs.Portersville EMS covers Portersville Borough, Muddy Creek Township and parts of Lawrence County and has two ambulances. It tries to cover the area around the clock. But sometimes staffing issues mean they have to scratch calls and have mutual aid agencies cover for them.“It's hard. We all feel awful about it,” she said.
