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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