No matter the weather, the time of day or even in the midst of a global pandemic, emergency medical service providers in Centre County answer the call to help those in need. But, because of funding issues beyond their control, local EMS groups are struggling, leaving some to wonder what would happen if things don’t change.
“What happens when you dial 911 and nobody shows up? That is where we are heading,” Centre LifeLink EMS Chief Kent Knable said.
The funding crunch has caused staffing issues around the area and Knable now worries how Centre LifeLink will be able to respond to calls other EMS providers would normally handle, but no longer have the means to be able to do so.
DOWNHILL SLIDE
Over the past decade or so, funding for EMS has faced “a downhill slide” due to the way the services are being reimbursed by insurance companies and lack of other outside funding, Bellefonte EMS Chief Scott Rhoat said.
“It is one big revolving circle, but it comes back to reasonable reimbursement for services or a funding stream to pay for services,” Rhoat said. “Because of lack of funding, it is difficult to have the resources available to operate the emergency service agencies on a daily basis.”
After EMS crews respond to a call, only 50 percent of the money billed out is paid by insurance companies, said Knable.
“That is just how medical insurance works. I am not sure why that is, but I heard one of our board members say the other day, ‘I would like to go to Wal-Mart and get $100 worth of products and tell the cashier I am only going to give them $50,” Knable said.
Medical assistance programs like Medicare and Medicaid, Rhoat said, are the “two worst offenders that have contributed to the funding dilemma, because neither one of them pay the actual cost of providing the service.”
Medicare will pay 60% of the cost of service while Medicaid will pay roughly 25 to 30%. He said the gap comes because the programs will only pay for the time spent with a patient, and not include the overhead costs that come from being prepared to respond at any time.
“They don’t care that you have a building, or that you have to have a phone, or you have to have insurance, or you have an electric bill, or that you are paying staff sitting waiting for that 911 call,” Rhoat said. “They don’t care about that; that is local governments’ problems.”
The number of calls EMS receive from patients with Medicare and Medicaid varies per community, but at Bellefonte EMS, roughly 70 percent of the calls received are from people with one of the two as their insurance — which is typical for Centre County.
Many EMS providers — such as Bellefonte — have asked local municipalities they serve to provide some funds to keep EMS services up and running in their areas. Rhoat said some municipalities have been eager to jump on board, while others have been less enthusiastic.
Centre LifeLink has not had to go this route yet, Knable said, but the agency is starting to look at other ways it can find revenue, because “if we continue to do what we are doing, we are going to continue to stay where we are at.”
IMPACT OF THE PANDEMIC
COVID-19 has also had an impact on the finances of local EMS. During the beginning of the pandemic, when people were staying home, there were less calls coming in for emergencies, especially in rural areas, but EMS still had to be ready to respond in case of an emergency.
“Fewer calls mean less revenue, but I am still paying staff 24 hours a day,” Rhoat said.
Call volume in Bellefonte remained low from March 2020 until October 2021, with some weeks dropping to 20 to 50% below pre-pandemic levels.
During that time, Centre LifeLink was “going day-to-day, trying to meet all of our bills and pay the staff and put fuel in the vehicles,” Knable said. “Now, it has boomeranged around and we are busier than ever.”
The same thing was seen by Moshannon Valley EMS co-manager Wes Cartwright. In 2022, MVEMS has already had 80 more calls compared to the first five weeks of 2021.
“There was a time when COVID came out that nobody would call 911. We were down a lot,” said Cartwright. “Now, every time someone gets a cough they are calling 911. So, it went from one extreme to another.”
But, as the number of calls increase, staffing remains a struggle due to the inability of EMS providers to pay a competitive wage, once again, due to the lack of funding.
“To get people to work in the EMS field full time is tough when you don’t have a competitive pay,” Cartwright said.
“Right now, we have paid staff that are making $3 or $4 an hour below what convenience stores are paying,” said Rhoat. “It is not because we don’t want to pay our staff better, but in fact financially, we can’t afford to pay them any better because of what we are being reimbursed.”
On top of that, EMS are working on the front lines during a pandemic.
“Our staff are constantly in contact with COVID patients and eventually it just breaks down and they get it too,” Cartwright said.
All this leads to more hours and more stress for staff, who are underpaid and working with the fear of contracting COVID.
“We are running on the line with staffing … we are stretched right to the limit,” Cartwright said.
Centre LifeLink benefits from having Penn State students that volunteer to get contact hours for medical and nursing school, and to give back to the community. Knable said staffing had never been an issue for the service until recently. Not having EMT classes during the pandemic was an issue, as well.
“It usually has been pretty easy to find paid paramedics, but recently there is nobody out there wanting to do what we do,” Knable said. “We are trying to make the pay as high as we can, but with reimbursements the way they are, increases in pay is just robbing one account to pay another account. At some point we are not going to have the money to even buy an ambulance.”
LOW MAN ON THE TOTEM POLE
Despite all this, throughout the pandemic, EMS have continued to answer the call. They were bolstered in many cases by generous donations of PPE from the community and received some help from the federal government.
Recently, the state passed House Bill 253, which appropriates $225 million to support “Pennsylvania’s heroic health care workforce.” This included $100 million to be distributed to all acute care, critical access and children’s hospitals licensed by the Department of Health on a per-bed basis. The funding will be used strictly for recruitment and retention payments to direct care staff. EMS was not included in that bill.
Rhoat said he would never take the money away from hospital staff who have worked hard through the pandemic, but “when they look at is front line health care workers. There is nobody more front line than EMS. Between the emergency department and EMS, we are the medical safety net for much of the community … So we would have hoped when you talk about the health care industry, EMS is considered part of the health care industry.”
Cartwright said, “basically we are the low man on the totem pole. By the time they start at the top and get down to EMS, the funds are gone. We have gotten some financial support from the government, but EMS is kind of on the short end of the stick.”
On Thursday, Gov. Tom Wolf signed Senate Bill 739, which specifically is tailored to help EMS through a $25 million COVID-19 Recovery grant program to offset impacts caused by the pandemic.
With roughly 1,000 licensed EMS agencies in the state, that comes out to around $25,000 each, if the money is divided equally.
“That is sizable and helpful, but it also depends on what you are allowed to spend it on,” Rhoat said.
HELPING HAND
Knable said there are a lot of ways people can support local EMS.
“It doesn’t have to be in the back of an ambulance. We are looking for people that can do administrative duties. We are looking for people who can do construction. We have buildings that need repaired every once in a while,” Knable said.
In Moshannon Valley, Cartwright said they are working on ways to recruit and retain EMS workers.
“We are trying to start at the high school level,” he said, “trying to get younger people involved in it.”
A big way that anyone can help, according to Knable, is taking part in the membership drives that are mutually beneficial for the EMS station and community members. Members pay a small fee to support the station and in turn, the EMS will not bill them for any fees not covered by insurance.
“It supports us and they don’t have to worry about being billed if they have an emergency at all,” Knable said.
Rhoat said it is important for the community to get involved because while healthy people may not worry about needing ambulance, “it may happen to a family member or a loved one, that you hope someone comes when you call 911.
“You can buy house insurance and car insurance that will replace your house if it catches fire or will replace your car if you wreck it. However, if EMS doesn’t show up, who is going to replace that family member, because insurance can’t replace that person.”
This story appears in the Feb. 10-16 edition of the Centre County Gazette.
