This story about Minnesota ambulance services constantly making adjustments does a pretty good job of describing the transforming landscape of EMS in the face of declining reimbursement. Whether volunteer, fire-based, contracted or third service, EMS providers have been adapting to the trends that are occurring at the intersection of public safety and health care for two decades.
I agree with virtually everything that was mentioned, especially the last comment:
“We are concerned because our costs don’t drop,’ [Edina City Manager Scott] Neal said. ‘We are not going to refuse assistance. You help first, and get paid second.”
It’s a perfect statement. EMS is in an unenviable, unrealistic position of having to provide services when called upon, yet receive little financial support to cover its costs. To be fair, we also have not demonstrated that the majority of our services benefit the patient in either the short or long run. The Centers for Medicare and Medicaid (CMS) has been increasingly scrutinizing all health care costs and cutting reimbursement for services that are deemed ineffective or inefficient.
And we’re a perfect target. Staffed 24/7/365, sent out on every type of call imaginable, on a population that is poorly covered by health insurance and can ill afford to pay for what is at times the most expensive cab ride in the world — we are set up to be wasteful.
That’s why things have to change, either in how we operate or the entire paradigm of emergency care. We’ve been working on the former — becoming leaner, adapting our mission, performing the research needed to validate our services (although much more needs to be done). And we’re starting to explore the latter — multiple community paramedic or mobile health care projects are evaluating what EMS providers can do to improve the health of their community populations.
Still, some of us are stubborn. Many administrations and labor groups still believe that somehow they are “entitled” to provide EMS in their community. Here’s a news flash: That ship sailed a long time ago. Community leaders are realizing that every penny counts, especially when it comes to public services.
Some organizations may enjoy the advantage of an apathetic community, but those situations are dwindling. At some point, they will have to face the music, and they will have to decide whether they should remain involved in providing EMS services or step aside and allow progress to occur.
