NY county struggles with how to solve EMS dilemma
A drop in the number of volunteers has resulted in squads having to pay EMTs, but the pay rates and lack of fringe benefits have not kept shifts filled
By Don Lehman
WARREN COUNTY, N.Y. — In March 2014, dozens of Warren County leaders met and representatives of emergency medical services organizations from around the region came together to try to figure out how to improve EMS service that had suffered in parts of the county as squads struggled with manpower issues and slowed response to calls.
A drop in the number of volunteers has resulted in squads having to pay emergency medical technicians, but the pay rates and lack of fringe benefits have not kept shifts filled in many organizations in Warren County and other rural counties.
Five years later, some county officials are frustrated that a plan is still not in place to better serve the public. Research has been done, several possible solutions have been explored and numerous brainstorming sessions have been held with EMS experts from around the region and state.
Discussions this past week led to some progress. But with all of the proposed fixes requiring hundreds of thousands of dollars, if not more, county supervisors are still figuring out how to move forward as EMS costs continue to skyrocket in a number of towns in the county.
A gathering last week of the Warren County EMS Task Force, which is made up of elected officials and emergency services leaders, led to some steps being taken to move toward creating a team of county-paid emergency medical technicians who would work with existing rescue squads that need help.
That would help ensure the squads have the people needed to respond to calls, while not requiring the purchase of new ambulances. The task force favored the county Sheriff's Office overseeing it, as is done with a similar program in rural parts of Albany County. Warren County Administrator Ryan Moore is researching the pros and cons of that possible entity.
Chester Supervisor Craig Leggett, who chairs the task force, acknowledged the organization's progress has been slow, as there are myriad options to consider. There is no timetable for any county assistance program to be up and running.
It was still not known which towns will participate, what the costs would be or how money would be raised to pay for the additional services. Funds could come from town budgets, or special taxing districts to be set up, including multi-town districts. State grants could be sought as well, as Essex County did in revamping its EMS system amid similar issues to Warren County's.
Rescue squads that are not having manpower or response issues, such as the squad run by Glens Falls Fire Department and the busier ones in Queensbury, would not be required to sign on with the program. But the rural towns in the northern and western parts of the county that need help would be given the option to participate.
Also proposed was a plan to purchase vehicles dubbed "fly cars" that have some basic medical equipment and would allow county-funded EMTs to get to calls more quickly while rescue squads muster full crews for ambulances. That program could cost about $1 million a year if the county went with a 10-person team outlined in a county Office of Emergency Services report on the EMS options.
Leggett said nothing has been decided, but options have been whittled down.
"What we are looking at now is the county providing supplemental assistance to the squads in some form," Leggett said. "It's amorphous right now. Nothing has been finalized."
Brian LaFlure, the county's emergency services director, said the county program could "fill the holes" in squad schedules with EMTs vetted by the county, while leaving existing EMS resources in place.
Leaders of some squads have expressed concerns about keeping their organizations in business, as well as possible use of their equipment and buildings by non-members.
"There are a lot of issues involved," LaFlure said. "The final decision someone needs to make is do we want to move forward, or are we just going to keep throwing money at the squads?"
Many factors lead to response problems
Efforts to find a solution come amid complaints that numerous rescue squads have been unable to field crews to respond to calls, particularly during the day when volunteers who have conflicts with full-time jobs can't respond.
Medicaid reimbursement rates for patients who don't have insurance also don't cover the costs of many calls, and that has resulted in squad budgets rising dramatically in some towns as they have to pay for more staff.
The recent finance-related closure of Gloversville-based Ambulance Service of Fulton County, which provided service in parts of Fulton and Hamilton counties, areas that are as rural as much of Warren County, underscored the money issues that EMS squads are having. North Warren Emergency Squad closed for a period of time in 2012 amid management issues but has since re-organized and resumed operations, and North Queensbury Rescue Squad could not respond to "advanced life support" calls because of license issues attributed to manpower shortages in 2016.
The United New York Ambulance Network, a rescue squad advocacy group, warned last week that lacking Medicaid reimbursement is causing major financial problems. It said proposed elimination of additional funding could devastate the industry further and cause more squads to go out of business.
The organization said the state and federal reimbursements received for these calls are far below the cost of actually providing the emergency and non-emergency ambulance services.
The state Department of Health's recent "Medicaid Rate Adequacy Study Report" found that ambulances across the state are underpaid $31 million annually for Medicaid transports, according to the network.
But as the financial hit for taxpayers mounts to keep squads going, Warren County Sheriff Bud York is among those who are frustrated that the task force and county supervisors have not yet been able to settle on a plan to better help the public.
"I want to get this up and running," York said Wednesday. "We've wasted enough time on this."
LaFlure said there have been many obstacles to finding a solution, with money being just part of it.
One of the issues has been that the state doesn't classify emergency medical services as "essential," so municipalities aren't required to provide the service for residents, and ambulance services have difficulty getting grant funding. Fire and police protection, and even trash pickup, are considered essential services. There are bills pending in the state Legislature that would make EMS an essential service.
It's not as simple as having neighboring squads pick up calls for each other through a pre-arranged "mutual aid" plan, because that results in ambulances being taken from one area to help another, and potential issues when multiple calls occur at one time.
Billing of patients can cover some of the tab. Lake Luzerne Supervisor Gene Merlino, though, said he had concerns about towns where EMS is running well having to pay more in taxes to help others, saying "I don't want my people paying twice."
But existing fire protection taxing districts in towns could be used to collect funding for the squads, Warrensburg Supervisor Kevin Geraghty said. Rescue squads used to be connected to fire departments years ago, he pointed out.
Not everyone is on the same page
Leaders of a number of rescue squads have expressed concerns about a county-led program, believing they can work to improve themselves. Leggett said the North Warren Emergency Squad, which covers Chester and Horicon, has improved in recent years, as the county-led discussions about assistance have picked up.
But that improvement has come as the towns of Chester and Horicon have provided increasing amounts of money to the squad. Chester's funding rose from $75,000 in 2017 to $170,000 this year. Horicon's EMS stipend rose 30 percent for this year.
While squad budgets rise to fund paid staff members who are needed, how the county's program would impact staffing levels of agencies was a concern to some.
County-paid staffers would likely come from the roster of EMTs from the squads, as the better pay and benefits would entice them.
That may drive some squads out of business.
"Lake George EMS would cease to exist. The county employees would come in and they would take the keys and go to work," Lake George Emergency Squad President Chris Hawley said.
But Kevin Fusco, captain of Johnsburg Emergency Medical Services, pointed out that rescue squads continue to operate in Albany County where that county's Sheriff's Office supplemental program exists as well.
"There are still a lot of agencies there who transport patients," he said.
Hawley compared the situation of bringing in additional help for existing resources to that of communities that pay for extra police protection during busier times of the year.
Leggett said task force members will meet with members of rescue squads to keep them apprised of the plan's progress and hear their concerns. The task force plans to meet again April 1 at Warren County Municipal Center.
But as county leaders try to find a way to help improve EMS service, LaFlure said another emergency services manpower crisis is looming, as he warned that volunteer fire departments are going to be confronting the same issues down the road as well with volunteerism dwindling.