Monday, March 25, 2019

Ambulance companies are responding to some existential emergencies

Ambulance companies across New York are facing significant threats from the federal and state governments. It’s something that citizens should pay attention to because the availability -- if not the very existence -- of ambulance services could be compromised, putting entire communities at risk.

Let’s begin with a look at an experiment undertaken by the Trump Administration.

The Department of Health and Human Services (HHS) is launching a pilot program in select municipalities that looks to cut costs of Medicare by having responders determine if the patient can forgo a trip to the emergency room and be taken to a far less expensive doctor’s office or urgent care center.

It’s a well-intentioned idea as it mirrors what those under private insurance are encouraged to do by their insurers and employers and their own personal finances – everyone of us is charged to not go to ERs to save considerable money on premiums, deductibles, and copays. If an illness or injury is not limb- or life-threatening, you’re better served by skipping the trip to the hospital.

Despite the intentions of the HHS plan, there will be unintended consequences.

Here’s the kicker: With skin in the game due to those aforementioned costs as well as the hefty bill for an ambulance ride, the privately insured drive themselves or have someone drive them to a provider for non-emergent care. Under this fed’s proposed plan, Medicare users will be encouraged to have someone drive them to the doctor or an urgent care facility – that “someone” will be the local ambulance company. In this case, the ambulance becomes a glorified taxi service.

As more and more seniors hear of this program and it becomes regular practice (which is HHS’s goal) an entire generation of Americans will utilize first responders to take them to physicians and care centers for minor maladies and even appointments.

Such abuses are already happening.

Talk to any emergency medical technician or driver or pay close attention to recurring addresses on the police scanner. There are repeat offenders who once or twice a month feign a significant illness when calling 911 so an ambulance can drive them to the hospital for a pre-scheduled appointment or to treat a cold or headache. Some play ignorant about it while others openly admit to EMTs that’s what’s happening. You can do that without shame or guilt when Medicaid or Medicare is paying for that super-expensive shuttle service.

Realize that every time this happens, an ambulance is removed from serving its community for an hour to three at a time. In rural areas, where volunteer crews are small and spread thin, the town is put at great risk. If a real emergency occurs -- like a car accident, heart attack, or industrial or sports injury -- there’s no one to respond because they were forced into providing an unnecessary ride.

Now, if this happens quite regularly from abusers of the system, imagine what will happen when a system is in place that encourages a call to 911 for run-of-the-mill ailments. Understaffed ambulance crews will constantly be called into action for non-emergencies. They could be out of their districts many hours of the day. What this will do to public safety is pretty scary.

What’s also scary is Governor Cuomo’s budget proposal which would change the payment model for ambulance companies.

Currently, if they serve a patient who is on both Medicaid and Medicare, the ambulance company is reimbursed for the service by both government programs – 80 percent by Medicare, 20 percent by Medicaid. Cuomo would like the Medicaid reimbursement scratched entirely.

Volunteer ambulance companies will be hard hit. While lacking labor costs they still have to cover gas, vehicle and building maintenance, medical supplies, insurances, training, and investments in new equipment.

Paid services will take a more significant beating, one that puts them at risk of folding. Not only do they have all of those overhead costs, but they have to also pay their workers while providing competitive wages and benefits. It’s not an inexpensive undertaking.  

The United New York Ambulance Network (UNYAN) claims that paid, non-government emergency services will be denied $14 million annually.

Mind you, this is on top of the $31.4 million a year that they are already shorted by New York’s deficient Medicaid reimbursement policies.

So, when you ask why EMTs seem so underpaid relative to their responsibilities, the state’s underfunding is a major -- if not the -- reason why: The state is shortchanging them by $31.4 million now and if Cuomo’s proposal passes it will surpass $45 million. That’s not chump change.   

Many of UNYAN’s member organizations say that if the Legislature buys-in to this plan they will have to cut back on staffing and some companies in upstate – where there is an inordinately high population of senior and low-income residents -- might have to close altogether due to insurmountable funding gaps.

Underserved, or entirely unserved, communities are a very real possibility if Trump’s and Cuomo’s plans go through. If they do, pray to God you never need to dial 911.  

From the 25 March 2019 Greater Niagara Newspapers and Batavia Daily News

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