By Karen Shuey
Reading Eagle
BERKS COUNTY, Pa. — Eight minutes is the most it takes, at least for now.
When an emergency call is made, seeking help for someone in urgent medical distress, responders across Berks County are able to arrive within eight minutes. That means it only takes eight minutes for someone suffering a heart attack or other life-threatening issue to get the help that may allow them to see another day.
But that crucially quick eight-minute span could be at risk.
Emergency services across the country are facing challenges, threatening response times, staffing and even survival.
Funding shortages are leading to financial strain, workforce shortages and insurance reimbursement shortages have highlighted the need for systemic reform.
The 13 EMS services in Berks — which by law must respond to emergencies and must transport a patient if they request service — have not been immune to those struggles.
Mount Penn officials invited representatives of the local EMS community and local lawmakers to sit down recently and discuss the challenges the industry is facing and brainstorm some solutions.
Attendees included U.S. Rep. Chrissy Houlahan, state Sen. Judy Schwank, state Rep. Jacklyn Rusnock and Berks County Chief Operations Officer Kevin Barnhardt.
Philip Salamone, director of operations for the Lower Alsace Ambulance Association, led the discussion.
“These are the people who keep showing up every single day to hold together a system that’s quietly unraveling,” he said of all the first responders in the room. “We need you to see what we see because we’re in trouble. We’re here, not to celebrate resilience, but to confront a very harsh truth: EMS in America is collapsing.”
Salamone said Berks has seen that firsthand, as long-standing ambulance services — with decades of proud history — close their doors simply because they can no longer afford to keep their service going. Unless something changes soon, he added, more will likely follow.
“The map of emergency coverage will continue to shrink, leaving communities waiting longer hoping that someone, anyone will answer the call from 911,” he said.
Salamone said the math no longer works. The federal Centers for Medicare and Medicaid Services still do not reimburse EMS services at a rate that allows these agencies to be self-sustaining.
“Our crews respond to thousands of calls that never end in hospital transport that still demand skill, time and resources,” he said, explaining that no-transport calls don’t qualify for reimbursement. “And for that, their service goes unpaid.”
And that’s not the only issue, Salamone said. Medicare, Medicaid and private insurers pay less than the actual cost of delivering services, federal payment laws go unenforced and insurance companies keep sending reimbursement checks to the patient instead of the agency that provided the care.
EMS services are also facing a labor shortage, Salamone said.
“We are bleeding out our workforce, training costs have ballooned out of reach and recruitment has slowed to a trickle,” he said. “And through all of this, EMS is still not recognized as an essential service in this country.
“We operate alongside firefighters and police officers facing the same threats of violence, disease, disaster, yet without the same protections, funding or respect.”
Salamone said that if nothing changes the future of EMS isn’t uncertain.
“It’s unsustainable,” he said. “We’re essential when it’s convenient and invisible when it’s not. It means fewer ambulances on the road, it means slower response times, it means people will die waiting for help to come.”
Better payment
Salamone explained that EMS is not viewed as part of the health care system.
When health care providers in a hospital provide a service, each service generates an entry in the patient’s record that will allow for billing. Health care organizations are able to bill for every service and each day that service is provided.
EMS, on the other hand, is only able to bill per transport. If a patient is not transported, then no bill can be generated.
Rather than being able to perform itemized billing for each medication or assessment provided, EMS providers get funding based on a reimbursement rate schedule controlled by the Centers for Medicare and Medicaid Services.
Salamone said the EMS community wants a higher rate to reflect the true cost of the medication and equipment being used in the lifesaving actions being performed. When asked by Houlahan what rate would be more appropriate, he said the same reimbursement schedule as an emergency room would be ideal.
“One of the big things that would fix the problem is if the federal government actually recognized EMS as a health care provider,” he told Houlahan.
He noted that ambulances have come a long way over the years as technology has allowed them to be outfitted with many of the things seen in an emergency room.
Another issue, Salamone said, is that many private insurers will reimburse the patient for services rather than the ambulance agency. He said some people will call the ambulance and then pocket the check.
There is legislation in the Pennsylvania General Assembly that would address this issue. It would require insurance carriers to reimburse ambulance companies for 911 services provided regardless of whether the EMS agency is part of the insurance carrier’s network.
Anthony Tucci, chief executive officer of the Western Berks Ambulance Association, said EMS agencies lose money on nearly every call. They don’t get paid for those who don’t go to the hospital and they don’t get fully reimbursed for those who do.
“We want to be treated like a health care provider because that’s what we are,” he said.
More funding
Tucci, a borough council member in Birdsboro, said municipalities need to step up as well, though he knows that’s a tough pill for many local officials to swallow when they are facing possible tax increases to pay for it. He believes the cost is worth it.
Tucci said the Western Berks Ambulance Association provides service for a wide swath of the county. Six municipalities contribute $45 per household to the agency.
But the municipalities around them pay nothing. So the communities that are paying are subsidizing service for the others. Tucci likened it to municipalities that have their own police coverage.
Berks Emergency Services Director Brian Gottschall said it’s not exactly the same thing. He said those municipalities that choose to rely on state police know their residents will probably have to wait longer for a response. But EMS often is a matter of life and death.
Gottschall said the state law needs to be updated when it comes to municipal responsibilities. The current law requires local governments to provide for “emergency services to the extent and in the way that they deem appropriate.”
“That’s ridiculous,” he said. “That means that if a municipality wants to have a bucket full of water hanging on a post in the town square and two Girl Scouts with a box of Band-Aids then they have achieved everything that they are required by law to achieve.”
Gottschall said he’s tried to explain the issue to municipal officials.
“We have done a lot, I literally don’t know how else to make clear to them how bad the problem is and what the next steps are going to be if there’s not an intervention,” he said.
Tucci said one thing lawmakers could do is uncouple EMS service from fire service when it comes to grant funding.
He noted that the federal Assistance to Firefighters Grant program provides financial assistance directly to eligible fire departments and nonaffiliated EMS organizations, but EMS only receives 3% of those grants. He said they need their own pot of money.
Funding through those grants helps pay for equipment, which is getting costlier. For example, Salamone said an ambulance cost $150,000 five years ago. This month they are getting two ambulances that cost $275,000 each.
What they need
Gottschall summed up what they are asking for.
At the federal level, EMS is looking for an increase in the reimbursement rate and recognition that EMS is a health care provider.
Houlahan thanked everyone for attending the meeting. She acknowledged that she “suffers from ignorance on these issues that are enormously complicated” and requested that they put together a wish list of items they would like her to address.
“You guys have given me a lot of things that I need to better understand and I would like you guys to give me a list of things that need to be done,” she said.
She said she will take that information and then research what bills have been introduced and how she could use what is already out there to craft a larger package of legislation that would be a vehicle for those reforms.
At the state level, EMS is looking for a change in insurance law that allows its services to be billed directly and an update of the language that requires municipalities to fund EMS providers.
Schwank conceded that they may have to wait for those changes and asked what she could do right now.
Tucci said the most immediate way to help would be to allocate a large infusion of cash to “stop the bleeding.”
“We need a tourniquet,” he said. “Reform takes time, we need help now.”
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