An EMS Week Plea in Pennsylvania: It's 'Way Past Crippling'

The Meadville Tribune, Pa.

As part of National Emergency Medical Services Week, local EMS officials gathered with county commissioners and executives from various local counties on Monday to speak on the state of the industry in western Pennsylvania.

Unfortunately, it's not a bright one.

"We're way past crippling," said David Basnak, president and executive director of EmergyCare in Erie.

In a presentation lasting just short of two hours at Pampered Palate Catering and Conference Center in Saegertown, Basnak and Superior Ambulance EMS Chief Doug Dick spoke on the troubles and tribulations to the gathered county officials. Representatives from Crawford, Erie, Mercer, Venango, Clarion, Forest and Warren counties were present, including Commissioners Eric Henry and Christopher Soff from Crawford County.

Much like many businesses in the wake of the COVID-19 pandemic, EMS agencies are facing difficulties in finding workers, with Basnak calling the staffing issue for the industry "an epidemic in itself." However, he said these issues stretch back longer than COVID, though the pandemic has compounded the crisis.

"I'm not going to stand up here and tell you this is all COVID-19's fault, because this isn't COVID-19's fault," he said. "This was starting to falter long before COVID came into the picture. However, the pandemic has certainly sped things up quite a bit."

Namely, as some retail businesses have raised the amount of money new employees are paid as a way to attract more workers, EMS agencies have found themselves unable to keep up.

Basnak said emergency medical technicians (EMT) typically start at around $13 an hour, less than or equivalent to the starting wages of many retail or fast-food businesses.

This has led to a decline in workers accelerated by their ability to get better pay elsewhere. A chart presented by Dick showed the number of EMTs in his area dropping from 2,259 in 2013-14, to 1,852 in 2016-17, to 1,755 in 2020-21. Paramedics also dropped during that time frame, going from 573 in 2013-14 to 367 in 2020-21.

However, EMS agencies have found themselves in a precarious situation as it relates to funding, with Basnak stating that around 87 percent of ambulance calls result in either not earning their money back or even receiving nothing at all.

Basnak said based off of EmergyCare data, around 25 percent of ambulance calls result in no payment to the company. This could be for an ambulance getting called out to the scene of a fire where no one gets injured, for example.

Medical insurance also does not always pay out to an ambulance service. While EMS agencies are required to respond to calls they receive, Basnak said many insurance agencies won't pay out if transportation to the hospital was not medically necessary or if no transportation occurs at all, which he said happens on around 25 to 30 percent of ambulance requests.

Medicaid reimbursement also often falls short — such as only reimbursing mileage after the first 20 miles an ambulance drives — while Basnak said Medicare reimbursements are about "50/50" on whether they provide enough to break even.

These issues are further compounded by the rising cost of equipment, such as face masks, gloves, stretchers or new ambulances. In the case of gloves, Basnak said that cost has risen a little more than 300 percent since 2019, going from $10.02 to $40.14 for a box.

In addition to payment models for services not meeting expenses, Dick said EMS agencies do not receive much in the way of support from the municipalities they cover.

While there is municipal code in Pennsylvania allowing for municipalities to have an annual tax of not more than one-half mill to support ambulance services, Dick said most municipalities do not adopt the code.

"I cover 23 municipalities," he said. "Not one of my municipalities has a half-mill tax, but I can tell you three-fourths of them have a three-mill fire tax, which is the max they can have."

In addition, while areas with a Local Service Tax are required to use at least 25 percent of that funding source for emergency services, Dick said most of those go toward municipal fire or police departments.

Dick and Basnak acknowledged that county government itself does not fund EMS agencies, but pushed for the commissioners and executives to seek potential reforms and fixes, whether it's on the municipal, state or even federal level.

They mentioned Pennsylvania House Bill 2434 which changes how Medicaid reimburses ambulance services in the state or looking at joint municipal and county funding options. Dick pointed to Pike County in Pennsylvania, which he said provides match payments to EMS agencies to accompany support that municipalities lend.

"I'm hopeful that the county commissioners from the counties that were represented here today become our cheerleaders and rally behind us because we need everybody's help," Dick said.

Basnak said it was important to have events and conversations like the one on Monday, as he said trying to do so remotely through phone calls and emails is "impossible to accomplish what we need to accomplish here."