Is the cost of readiness too steep? EMS services seek balance amid rising costs and little relief
If ambulance services can’t cover their costs, they can’t cover the emergency needs of Butler County — and it’s becoming increasingly difficult to be ready for an emergency, according to the leaders of several Butler County-based ambulance services.
Expenses like workers’ compensation, vehicle insurance and health care for employees continue to climb by 20% to 25% year-over-year, but the primary form of reimbursement is only inching in the same direction.
Jay Grinnell, chief of Harmony EMS and a Jackson Township supervisor, said EMS agencies are working with close to the same revenue they received seven years ago on top of rising costs.
Butler Ambulance Service operations supervisor Nathan Bacher said over the past year, reimbursements from Medicare only rose 1.32%. Private insurance, Medicaid and patients themselves foot some of the bills, too, but Medicare is the most common form of reimbursement, he said.
“You don’t have to be a mathematician to figure out that doesn’t add up, and it’s not sustainable that way,” Bacher said.
Butler Ambulance Service spends more than $3,000 per day to maintain 24/7 ambulance access for 16 Butler County municipalities, excluding insurance costs for vehicles and employees.
The amount the service spends per day accounts for staffing six to seven ambulances during the day, two to four ambulances at night and the equipment required in each ambulance.
The ambulances themselves are also more expensive. Bacher said the service purchased an ambulance two years ago for $125,000, and that same ambulance today is $155,000, without factoring in repairs and service it may need over time.
Bacher said the vehicles are replaced about every five years or 200,000 miles.
“If you can stay into the positive, you’re winning right now,” Bacher added.
They’re winning, but just barely.
Emergency medical services have often been the overlooked component of emergency services, and most EMS leaders believe there’s a lack of public education about the cost of running an ambulance service.
“The word ‘for profit’ in the ambulance service is an oxymoron. There is no profit,” Grinnell said.
EMS care before the 1960s relied on law enforcement and funeral staff being trained in basic first aid to recognize acute medical conditions, according to the National EMS Museum. That was until 1967 when Dr. Peter Safar and Freedom House Enterprises, a nonprofit formed from a government grant, trained the first paramedics to ride in ambulances.
Freedom House Ambulance Service’s all-Black paramedics saved 200 lives by responding to 6,000 calls and transporting 4,500 patients in its first year. It would shutter in 1975 due to a lack of funding.
Paramedics with the nonprofit were paid, but at lower rates than their police and fire counterparts employed by the City of Pittsburgh.
As a nonprofit, Freedom House Ambulance Service was funded by a government grant, which enabled it to provide its services free.
Bacher said the idea of providing free coverage for municipalities has been passed down through generations of EMS, but economic realities mean it’s time to change.
“It costs something to have somebody be ready to respond at any minute every day, 24 hours a day, seven days a week, holidays, it doesn’t matter,” Bacher said.
Grinnell began volunteering as an ambulance driver in 1985. It was before the 911 system was born, when customers had to call lists of providers and see who was available.
“The days of volunteers are gone,” Grinnell said. “It’s just too much work and too much knowledge to expect volunteers to do it anymore.”
Harmony EMS and Harmony Fire Company split from each other around 1990, he said. Grinnell hired the company’s first paid paramedic in 1993.
“At that point, the fire departments owned the ambulances,” Grinnell said, adding most were staffed with EMTs only.
The Marion Township Volunteer Fire Company discontinued its ambulance service around 1994, according to Doug Dick, chief of Superior Ambulance Service and president of the Marion Township fire company.
He said Butler Hospital took over operations for a time before they went out of service and Superior Ambulance Service began covering the area in 1996.
Unionville Volunteer Fire Company discontinued its ambulance service around 1997, said Chief Mike Pflugh. The Butler Hospital ambulance service moved in afterward until it went out of business the same year and Butler Ambulance Service moved in.
Slippery Rock Volunteer Fire Company and Rescue Team is the only one in the area that managed to keep both fire and EMS services running since the rescue team was founded in 1975. But it’s done so at great difficulty.
In 2018, ambulance services in Chicora and Petrolia merged to become Karns City Regional Ambulance Service.
Then, a 2019 EMS Task Force Report from the County Commissioners Association of Pennsylvania analyzed the issues and highlighted potential county-level responses.
One of the issues commonly cited in the industry is the low pay.
The low pay base makes EMS services a jumping-off point into the health care field. Butler Ambulance Service has seen highs and lows from that.
“EMS is low-hanging fruit, I think, for people in health care, because they can get an EMT class in a couple months and then they can start having patient contacts,” Bacher said.
Bacher said he’s had physician assistant students work for two to three years at the ambulance service to gain experience before shifting to nursing programs that require more experience.
“There are agencies out there that I’m aware of that have kind of a combination of volunteer plus paid staffing,” Dick said. “A lot of the volunteers, a lot of those people, are drivers.”
Amid the blaring sound of sirens, many have stepped aside to take a look at the issue, but today, EMS providers in Butler County say they are barely hanging on.
“It’s EMS on life support,” Dick said. “They’re doing everything under their power and thinking outside the box of how to make ends meet to keep the doors open.”
