Morning Call
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Allentown, Penn. — When Dan Jessup had a heart attack several years ago, a 911 call got an ambulance to his Dublin apartment in a few minutes.
He wonders if he’d get that prompt service now that Dublin Regional EMS, the ambulance squad that for years was a stone’s throw from his apartment complex, has gone out of business. The nearest ambulance station is now about a 12-minute drive away.
“Time element-wise, that’s a concern,” said Jessup, 73.
It’s the type of concern that’s becoming more common in the Lehigh Valley region and across the state as financially strapped nonprofit EMS companies close their doors, take ambulances off the road and lay off workers.
Many companies say they are finding it increasingly difficult to survive in a state where nearly 1,000 licensed organizations treat 1.6 million patients annually, according to the state health department.
Since March, three organizations in the region -- Dublin Regional and Perkasie Community ambulances in Bucks County and Williams Township Emergency Squad in Northampton County -- have either closed or announced plans to close. Others say they’re in danger of closing if towns or residents don’t start pumping more money into their operations.
Over the past seven years, at least 11 squads in the region have reported financial problems that forced them to cut staff or hours and ask for more funding.
Officials in some municipalities, including Upper Saucon and Lower Milford townships and Coopersburg, have been discussing ambulance squad mergers or have commissioned studies to explore consolidated services.
Barry Albertson, director of Suburban Emergency Medical Services, which serves Monroe and Northampton counties, said the problems already have caused longer response times and increased mortality rates in communities across the state.
The problem comes down to money, said Albertson, who is also the head of the Ambulance Association of Pennsylvania. He said it’s going to take law changes to turn things around, which could mean residents will see a bump in tax bills in years to come.
Ambulance company leaders say they’re not getting enough tax dollars from municipalities, which spend millions annually on fire and police departments. State laws don’t obligate municipalities to provide the service.
“We’re the forgotten third service,” Albertson said. “There are four things we talk about: Recognition, recruitment and retention [of personnel] and reimbursement. Everyone has one of those four problems, if they don’t have all four.”
Years ago, when ambulance squads first formed, they were all-volunteer groups tied to fire companies and were always lumped with the fire side of emergency services. Today, with more of a need for around-the-clock service and more training and schooling required, most ambulance companies have a paid staff and are becoming independent of firefighting organizations.
And for years, ambulance officials say they’ve been shortchanged by customers who use ambulance rides as a free payday. A number of ambulance leaders, who acknowledge that a number of high-profile embezzlements and thefts from squads haven’t helped their cause, say medical insurance reimbursement checks, which are sent to patients and are supposed to be forwarded to the ambulance services, never reach the squads.
“When I ran [with an ambulance] in the 1970s, it was an old scenario that right before the major holidays, you would have people fake a heart attack situation and called for an ambulance,” said state Rep. Tim Solobay a Washington County Democrat who has also worked as an emergency medical technician. “The person gets a $1,000 check from the insurance company and never pays the ambulance bill. Merry Christmas.”
Pressing issue
The ambulance crisis has not been lost on elected officials.
U.S. Rep. Patrick Murphy, D-Bucks, has organized a hearing Friday at Delaware Valley College in Doylestown Township to hear testimony on the problems in Bucks County, where companies in rural areas don’t have the volume of emergency calls they need to cover their operational costs.
“I see this as a national issue,” said Gary Pearson, a supervisor in Tinicum Township, and president of Upper Bucks Regional EMS, which recently asked the towns it serves for more money to keep it open. “I don’t know of any state that requires EMS [funding] like it requires fire and police [funding].”
“The free ride isn’t there because you don’t have volunteers anymore,” said Betty Graver, executive director of the Pennridge Chamber of Commerce and one of the directors on a new board looking to reopen a Perkasie-based ambulance service.
Paramedics and medical technicians say the solution to their problems is simple. They want law changes that would put more onus on local governments to fund ambulance companies.
In its top recommendation following an in-depth study of emergency services in Pennsylvania, a state Senate Commission in 2004 called for a change in the state borough and municipal codes and Pennsylvania manual to include “emergency medical services” as part of the list of services municipalities are required to provide. Up until now those codes have included only fire and police services.
“It comes down to one word in a document,” said Cathy Schlager, an emergency medical technician who serves on Central Bucks Ambulance and Rescue’s board of directors.
Solobay, chairman of the state House Subcommittee on Security and Emergency Response, said there has been interest in bills proposing those changes in the law, but “we just have to get working on them.”
Ambulance groups also want to see a law requiring insurance companies to directly reimburse ambulance companies, rather than their insured customers.
No easy fix
Both sound like simple solutions, but they have been anything but.
The Pennsylvania State Association of Boroughs and the Pennsylvania Association of Township Supervisors both say they recognize a need to better help ambulance organizations, but they have to look out for their taxpayers, too.
“We want to find a way to help [ambulance squads] without having our hands forced [by legislation],” said Courtney Accurti, spokeswoman for the state boroughs group. “Our [municipal] budgets are just as tied as theirs.”
The insurance industry has lobbied against legislative bills that would require them to pay ambulance services directly, not because it objects to the direct payment, but because of other provisions in those bills that insurers claim will drive up insurance premiums for everyone.
Samuel R. Marshall, president of the Insurance Federation of Pennsylvania, said the nonprofits could easily get reimbursed directly if they have their patients fill out and sign a standard “assignment of benefit” form that are routinely used at doctors’ offices. Those forms allow medical providers to collect insurance payments directly.
One of the main problems with the bills proposed in Harrisburg, Marshall said, is that they could force insurance carriers to pay ambulance companies for emergency calls regardless of whether the service was provided in an emergency.
“We all agree we need ambulance services,” Marshall said. “But no insurance policy covers ambulance services when there’s not an emergency.
“If John Doe incorrectly used an ambulance and the ambulance was properly dispatched to pick him up, who pays for that? The solution is that they probably need greater ability to collect from John Doe. And we may need some better public funding for ambulance [companies].”
Historically, ambulance companies have relied heavily on donations, annual subscription-paying members and reimbursements from insurance companies. Some, but not all, receive tax dollars from the towns they serve. Ambulance workers say much of the public is under the wrong impression that their squads are taxpayer-funded municipal services and, therefore, don’t donate.
Albertson said they’re only getting a fraction of what firefighters and police receive.
“Even statewide, there’s $25 million of grant money out there through [the state] fire commissioner’s office. EMS is getting only about $3 million,” he said.
Albertson and others predict many ambulance groups will be merging under a single management group to reduce costs.
The funding problems are likely to come up at the Murphy’s hearing.
Joe Schmider, the director of the state Health Department’s Emergency Medical Services Bureau, said it’s the taxpaying public that ultimately will decide the level of service it gets.
“Is 10 minutes OK [for a response time]? Is 2 minutes?” Schmider asked. “It’s going to take community involvement to make that determination.”