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Sunday, July 2, 2023

'In crisis': Allegheny County EMS chiefs sound alarm on budget shortfalls staff shortages - TribLIVE

If Chief Todd Plunkett placed a price tag on how much money Baldwin Emergency Medical Services loses every year due to low reimbursement rates from insurance providers, he thinks it’s anywhere between $250,000 to $400,000.

So Plunkett says he finds ways to stretch a dollar — riding an ambulance more miles or delaying new equipment purchases — without impacting patient care. But it’s not a perfect solution.

“EMS is not on the way to a crisis. EMS is in crisis right now,” he said. “If EMS services continue to struggle, reimbursements are not fixed and new funding sources are not found, EMS is going to bottom out eventually.”

Every year, thousands of people across Allegheny County rely on ambulance services from about 35 agencies. Whether it’s a car crash or stroke, it’s typically taken for granted that emergency medical technicians and paramedics will show up quickly to provide top-notch care. But EMS chiefs across the county warn that systemic issues could affect this core mission.

Apart from Pittsburgh EMS, which covers the city of Pittsburgh, the other agencies in Allegheny County serve communities of 7,000 residents up to 75,000. While the communities are different, chiefs repeated strikingly similar problems — staff shortages and budget shortfalls, ultimately caused by low reimbursement rates from Medicare, Medicaid and commercial insurance, as well as lack of funding from municipalities.

Financial support from municipalities

The Allegheny County EMS Chiefs Association conducted a survey last year to explore financial support from municipalities, according to Eric Schmidt, chairman of the organization and chief of Shaler Hampton EMS. Support, they found, varies widely. One agency received $1.2 million, while about 10 received nothing.

“Municipalities have become used to receiving EMS service for no cost, and it just can’t be that way anymore,” Schmidt said.

One of the agencies that receives no direct financial assistance is Valley Ambulance Authority, which covers Coraopolis Borough and Moon, Crescent and Neville townships, and has a joint operating agreement with Quaker Valley Ambulance Authority, serving 11 municipalities in the Sewickley area.

Brian Herskovitz, Valley Ambulance Authority deputy chief, said he thinks there needs to be a funding model that supports EMS, whether that’s from the state, county or local communities.

“Lack of funding means lack of resources. With a lack of resources that means less ambulances. Less staffing means less ambulances, longer waits for patients,” he said. “Across our commonwealth, agencies struggle with putting ambulances on the road, due to a lack of bodies, due to lack of funding.”

Schmidt said he’s seen firsthand the positive impact this financial support can have. He said each of the three municipalities Shaler Hampton EMS covers — Etna is the other one — supports the agency financially, including contributing to its operating fund or toward a capital plan that goes toward purchasing new ambulances, training equipment and more. In total, about 10% of the agency’s annual budget is covered by the municipalities.

“That 10% funding that we get from our communities is what makes a difference. It’s what allows us to compensate our people well, provide really good benefits,” Schmidt said, adding that more improvement is needed to attract quality people to the career.

Shaler Hampton won the 2023 Pennsylvania EMS Agency of the Year award and was able to offer its employees an across the board 15% pay raise last year.

Plunkett, the chief at Baldwin, agrees that support from communities makes a “gigantic difference” toward building a budget. He said the agency receives about $300,000 from the six boroughs it serves: Baldwin, Pleasant Hills, Brentwood, West Homestead, West Mifflin and Whitaker. According to Plunkett, having council members on the agency’s board of directors helps explain the support.

“They see the grants getting accepted, the grants getting denied,” he said. “They see the financial loss from insurance companies not paying us 100%. They see the cost of ambulances. They see the cost of equipment, the cost of employees.”

Some chiefs have gotten creative in trying to get this support. Jim Erb, EMS supervisor for Citizens Hose Ambulance Service, was elected as a commissioner in Harrison. This year, the township gave the agency a $50,000 stipend for emergency services.

“I wasn’t permitted to vote or to lobby, but I was able to educate the other commissioners, and the other commissioners have learned of the struggles from other places and other leaders and they knew that it is getting to be almost crisis mode,” Erb said.

Reimbursement from insurance

EMS agencies across the state have been impacted for a long time by reimbursement rates from Medicare, Medicaid and commercial insurance that don’t always cover the cost to provide emergency services. Plunkett said for a $1,000 bill, Baldwin EMS might get $500 or $600 from insurance companies.

Schmidt said the “cost of readiness” in emergency services is quite high. For example, he said Shaler Hampton EMS responded to about 5,000 calls last year, but transported only about 3,400 people to the hospital. That means the agency got no revenue from the 1,600 calls that didn’t require a transport.

“When somebody calls us at 2 o’clock this morning or 7 o’clock this morning or 2 o’clock this afternoon — or three people call us at the same time, or if we have an accident where there’s four people injured — we have to be able to respond to all those things at a moment’s notice and be beside them in eight minutes or less, all the time,” he said.

This year, Medicaid reimbursement rates increased. The reimbursement rate for each mile beyond the first 20 miles a patient with Medicaid rides in an ambulance rose from $2 per mile to $4 per mile. The rate for basic life support services also increased from $180 a trip to $325, along with the rate for advanced life support services which went from $300 to $400 a trip.

Meanwhile, bills are moving in both Pennsylvania chambers to expand Medicaid reimbursement. Senate Bill 555 would provide reimbursement on every mile someone is transported beyond the first five miles, while House Bill 479 would provide reimbursement on every mile someone is transported.

Paul Falavolito, chief of White Oak EMS, said while the increased Medicaid reimbursement rates have been “great,” it’s not enough.

Another issue, he said, is unpaid ambulance bills. White Oak EMS — which covers White Oak and Versailles boroughs, and South Versailles Township — accumulates around $300,000 worth of unpaid ambulance bills every year.

Many EMS agencies also run subscription programs to generate revenue from contributions by community members. These programs give people some sort of discount if they use an ambulance.

“EMS in my opinion is the worst business model,” Falavolito said. “It would be the equivalent of you and I walking into Giant Eagle, buying $100 worth of groceries and when they say ‘OK, your bill is 100,’ we say ‘You know what? Here’s 25. See you,’ and you walk out the door. And that’s somehow legally OK to be able to do that.”

‘Critical workforce shortage’

The Ambulance Association of Pennsylvania points to poor reimbursement as a contributor to staff shortages. They say agencies’ financial distress hinders wages, on top of other dangers that come with the job. According to the 2023 EMS National Survey, applications for paramedic and EMT positions are down an average of 13% compared with 2019, and turnover grew from 8% in 2019 to 11% in 2022.

“There have been some EMS agencies that have closed their doors because they can’t make it anymore. So if you’re not able to pay a decent wage, if you cannot get the staff, you are struggling with competing agencies that want the little staff that are out there,” said Heather Sharar, president of the Ambulance Association of Pennsylvania.

“When you have an EMS agency that closes its doors, then you’ve got the neighboring EMS agency that has to, by law, respond,” she added. “So then there’s a longer wait time, and that could impact the morbidity and mortality of the residents of the commonwealth.”

At White Oak EMS, EMTs earn between $14 to $17 per hour, depending on experience, while paramedics make between $20 and $25 per hour. Falavolito said they lost about half of their staff in 2020 during the covid-19 pandemic for a number of reasons, such as people wanting to take a different career path or the pay wasn’t high enough. He added that some people joined the field during that time, though, because they saw the inspiring stories of EMS.

“We saw a drastic decline in people that truly wanted to come into EMS and make it a career versus coming into EMS and having it be a stepping stone for continuing on to become a registered nurse or a physician’s assistant, or even an emergency room physician,” he said.

Falavolito doesn’t think there’s been a decline in patient care — yet. The impact, he said, has been on first responders who are working double or triple time to cover shifts.

“That’s going to increase the burnout ratio,” he said. “That’s going to potentially make these people think there’s got to be an easier, better job for me than the hours that I now have to work.”

Daniel Miller, executive director of SouthBridge EMS, said his agency, which covers Bridgeville, Cecil and South Fayette, pays starting EMTs $18.50 per hour and $22 per hour for paramedics. Miller said staffing “has been a challenge,” agreeing that often people use it as a “stepping stone” to other careers.

If funding support from insurance or townships don’t improve, Miller warns, response times will increase.

“We’re already seeing less advanced life support responding on every call where now you’re just getting basic life support,” Miller said. “I think that the quality of EMS is going to — it already has — but it’s going to continue to deteriorate if the funding is not put in the system to bolster it back up.”

Rebecca Johnson is a Tribune-Review contributing writer.

Rebecca Johnson is a contributing writer.

Categories: Chartiers Valley | Hampton Journal | Local | Sewickley Herald | Shaler Journal | South Hills Record | Valley News Dispatch

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