The ambulance crisis

It appears that state lawmakers are hearing the message about the need to fix the broken funding system for the state’s ambulance services, particularly those serving rural areas. The message could not have been clearer during last week’s legislative field hearing in Mt. Iron, during which dozens of EMS workers and city officials repeatedly told lawmakers who make up a new emergency services task force that ambulance services can no longer be financed solely on a fee for service basis as long as the state law limits funding options and federal reimbursements cover only a small fraction of the cost of maintaining round-the-clock emergency services.
Local mayors and other city officials made it clear, as well, that they can no longer afford to allow their city taxpayers to subsidize the cost of providing ambulance services to large, outlying service areas without operational funding from either counties or local townships that they serve. All agreed that EMS must be reclassified as an essential service, with mechanisms put in place to allow for a more equitable assessment of the costs of providing the service.
When a city levies its citizens to pay for the cost of a police or fire department, that service isn’t provided outside the city limits, except through a mutual aid agreement or a contract for service.
In the past, ambulance service largely paid for itself through the payments made by patients or their insurers for the care they received during medical emergencies. Those days are over for several reasons, including the fact that most services can no longer rely on volunteers for staffing. The wage costs of many area ambulance services have skyrocketed as it has become more difficult to attract volunteers and as the state has imposed more rigid rules for staffing.
At the same time, the cost of an ambulance and the equipment that goes with it has jumped sharply over the past several years, further adding to the financial strains.
Action at the federal level, to increase reimbursements for patients on Medicare and Medicaid, could make an enormous difference to rural services, which serve a patient load that is overwhelmingly dependent on these public insurers. But federal changes could take years to implement and many ambulance services won’t last that long.
The Legislature could make significant progress in the upcoming session by making it easier to create new taxing authority for those public entities operating ambulance services. They could also change the rules that apply to the service territories, allowing services to require paid contracts from any outlying communities they serve. As it stands today, ambulance services must cover their entire service area whether or not area taxpayers contribute a penny. That’s unreasonable, particularly in our area, where average incomes of residents in many cities that operate ambulances are far lower than the outlying communities they serve.
Ambulance services also need more flexibility when it comes to staffing. As several speakers at last week’s hearing noted, requiring two on-call personnel 24 hours a day, seven days a week, is incredibly burdensome for many services and raises their costs of operation considerably, since those individuals now need to be paid.
While some have suggested a restructuring to regionalize ambulance service is part of the solution, it’s not at all clear that will be a solution. The closest thing to a regional service in our area is in Virginia, and as Virginia Mayor Larry Cuffe noted at last week’s hearing, the city is facing annual ambulance deficits of $500,000-$750,000. If Virginia can’t operate a service profitably, with 4,500 runs annually, how would a regionalized service function with ambulances and personnel spread all across northern St. Louis County? There is no reality in which that is plausible today.
Comparisons to school consolidation are misplaced when it comes to ambulance service. School consolidation typically involves shuttering schools and busing students longer distances to larger schools. That’s the opposite of what we want when a medical emergency arises. We want an ambulance as close as possible. Besides, the savings from school consolidation are usually vastly oversold and the experience would likely be no different for ambulance services.
The crisis in EMS reflects the need for a new funding mechanism and greater flexibility in how services are staffed. Those changes are needed whether we realign coverage areas or not.
The good news is that it seems lawmakers have finally gotten the message, and we can thank Sen. Grant Hauschild and Rep. Dave Lislegard for helping to sound the alarm. They’ve said addressing the ambulance funding crisis will be top of the Legislature’s agenda in the coming months. We certainly hope they’re right.