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Home > Topics > EMS Management
November 02, 2010
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EMS News in Focus
by Arthur Hsieh

Smoke and mirrors (aka EMS politics)

By Arthur Hsieh

Editor's note: In response to the article "Voters will decide ambulance fee issue in Md.," our editorial advisor Art Hsieh gives his take on the inside politics surrounding the issue.

Perfect for election day: In Montgomery County, Md. voters are being asked to decide on a measure to allow its combination (career-volunteer) fire-rescue services to bill health insurance companies for its EMS services.

When I first viewed the article, I wondered why anyone would oppose receiving for health insurance monies that have already been set aside for ambulance transport? I mean, who would I rather have it, my local EMS provider or my health insurance company?

It turns out that the volunteer side of the department is opposed to the measure since it would raise a barrier to the public to call 911, and it would decrease their ability to raise money during annual fundraising campaigns. I found this to be curious, so took a look at some of the arguments to support the opposing view.

Barrier to 911 service
On the website www.stopambulancefee.org, a study of a nearby EMS service showed a decrease in call volume in the years after that county allowed billing to occur. On the surface, it might look like there might have been a trend. But measured in tenths of a percent when looking at changes from year to year? Is it statistically significant?

Did the visits to county emergency departments change as well? And were there any interviews or studies done to find out whether in fact people felt less likely to call 911? Did the overall age of the population fall during those years, resulting in a generally healthier population?

Now, there may be answers to these questions, and I'd love to see them as it would make me more likely to listen to those opposed to the measure. On the other hand, if there isn't, why try to hang your argument on a meaningless statistic?

Reduction in fundraising ability
In checking the measure's language, and in some of the background material, I didn't see that the revenue would be dedicated to the "career side" of the county's fire rescue services.

I imagine that the offset would be evenly distributed to departments, based on some formula that is related to need and call volume. It doesn't appear that county residents would ever see a bill for service, so I'm not sure how that would impact donations.

I wonder if studies were done in nearby counties to see how their fundraising rates compare whether or not they bill health insurance companies.

Now mind you, I'm not weighing in on this measure. I used to live in the county, and have limited experience with both the career and volunteer side of its fire-rescue services.

My bigger point is, like in most of politics, make sure you use sound, reasonable arguments for why you support or oppose a measure. To keep things the way they are, just because it ain't broke — well, given today's economic hard times and the flux of health care, it IS broke.

Trying to provide high quality care and prompt response to medical emergencies costs money, whether it's a tax, an assessment, or a bill to a health insurance company or patient.

Yes, I believe that EMS has a public safety function; certainly the American public believes that it should receive emergency medical care and transport to an emergency department when needed. Should it be treated as a public safety function, in terms of funding? Sure. But it's not. Why, I have no good answer. In the reality of today's world, let's figure out how to do our business well.

About the author

EMS1 Editor in Chief Art Hsieh, MA, NREMT-P currently teaches at the Public Safety Training Center, Santa Rosa Junior College in the Emergency Care Program. In the profession since 1982, Art has worked as a line medic and chief officer in the private, third service and fire-based EMS. He has directed both primary and EMS continuing education programs. Art is a published textbook author, has presented at conferences nationwide, and continues to provide patient care at a rural hospital-based ALS system. Contact Art at Art.Hsieh@ems1.com.
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