If you have been in the profession for a while, you know that low wages and poor benefits are partially caused by the lack of financial reimbursement EMS receives from large insurance carriers. Medicare and Medicaid have been continually reducing the amount of money provided for emergency medical services for decades. Private insurance carriers have followed suit.
Given the high cost of maintaining the health safety net that is EMS, this combination has forced both private and public EMS agencies to be creative in keeping their budgets in the black. This trickles down to the field providers, who aren’t compensated well enough to consider staying in the business for the long run.
EMS health care reform concerns
So, amidst the anger and frustration, the federal Congress has presented a health care reform bill that has the potential to drastically reduce financial reimbursement for EMS.
I recognize that this move might help pressure the overall health care system to spend more money on less expensive prevention and monitoring activities that have greater value. But draconian cuts to reimbursement have the potential to cause a seriously frayed safety net to tear apart.
It appears that many in our communities would agree. The American College of Emergency Physicians (ACEP) indicates that 75 percent of Americans polled believe that EMS – both field care emergency departments – should remain a top funding priority. It’s alarming to learn that as many as a third of the respondents have already delayed or avoided seeking emergency care due to financial fears.
No respect for emergency mental health services
Emergency mental health services are intimately related to EMS. Locally, the hospitals that I transport my patients to are inundated by patients experiencing a mental health emergency who literally have nowhere to go.
We end up on wall time, unable to transfer our patients to the emergency department. This in turn impacts our systems, reducing the number of available ambulances for emergency response. When we transfer mental health patients, it’s often over long distances, further limiting the EMS system.
While states like Vermont and New Hampshire are struggling to form a system to manage these patients, long-term fixes appear to be a continuing fantasy. This country’s inability to recognize behavioral health as a medical concern has resulted in near total loss of a mental health safety net. And yet the reform bill aims to cut mental health services even further.
It’s widely understood that this country has a bloated, inefficient and, in many ways, ineffective health care system. The Affordable Care Act made an initial set of steps in the direction of reform and refinement. The current bill aims to make wholesale cuts that endanger entire communities, not just those with insurance.
As both providers and consumers of health care, it’s imperative that we fight to keep EMS within the system.
