By Anthony Hennen | The Center Square
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This story is a follow-up to coverage The Center Square previously offered on the fractured nature of emergency services across Pennsylvania. To read that story, click here.
(The Center Square) – The financial status quo of providing emergency services has gone under, with the reimbursements made to ambulance services not covering the cost of operating the vehicles.
Officials argue the EMS system isn’t sustainable anymore, putting the medical safety net at risk.
At a House Republican Policy Committee hearing on Wednesday, the issues plaguing the EMS system were urgent, but not new.
“The EMS system in the commonwealth is broken,” said Donald DeReamus, the legislative committee chair for the Ambulance Association of Pennsylvania and a paramedic. “The annual turnover rate nationally and in the commonwealth is 30%; we cannot retain workers.”
Worker retention has been challenging because people can find less stress — and better pay — elsewhere, DeReamus said. In northwest Pennsylvania, EMS officials have had instances where paramedics could get higher pay working for Sheetz, as The Center Square previously reported.
“The costs to provide services are substantially more than the reimbursement paid, resulting in a deficit for every call,” DeRaemus said. “For every 911 dispatch an ambulance company takes, the cost to put the ambulance out there — the equipment in the truck, and all the administrative, fuel, maintenance — the cost to provide that service, you get about $100-$200 less in reimbursement when you actually bill for that call. Our business model is broken.”
State legislators have proposed expanding the authority of townships to levy taxes to support EMS services, as The Center Square previously reported, but a local approach may not be enough.
“We need to look at the possibility of developing a statewide fee schedule for ambulance service,” DeRaemus said. He noted consistent fees for all insurers, as well as ending the prohibition of co-pays for ambulances, could make ambulance services more financially sustainable.
“The failure in all our reimbursement is: everything is tied to Medicare. And Medicare is below the cost of providing service,” DeRaemus said.
Streamlining services could help to lower costs. Direct responsibility for emergency services falls on municipalities and townships, rather than counties. Widening that responsibility to the county level, as is done in other states such as Maryland, could provide benefits.
The County Commissioners Association of Pennsylvania has supported such a change, testifying in a 2020 Senate committee hearing that “granting significant flexibility on service, structure, funding, and related matters to be able to match local needs and circumstances” could help.
More contact with the EMS system would also be beneficial, at least for lawmakers.
“If you gain anything from this hearing today, reach out to your local EMS service to find out where they’re at,” DeRaemus said. “This is an urban, rural, and entire commonwealth issue.”