Its a new year and time for an EMS NEW YEAR'S RESOLUTION.


Now, say that 3 times and DO IT as many times as it takes to get their attention !!!

Its sad to say but we all have to be politicians and ambassadors for EMS in this ever changing world of ours. With a record number of local, state and federal budgets in the red these days, one would think that EMS has no chance of getting their attention unless you are a bank, auto mfg. co. or other large business that has high priced lobbyists. I always thought it was fruitless and never really contacted my elected officials until several years ago when we formed a Recruitment, Retention & Reimbursement Committee within our County EMS Council. Our committee has studied RR&R to death and it seems to come down to Money, "the Root of all Evil". I'm not talking about lots of money for expensive and fancy equipment, I'm talking about money enough JUST to survive and keep the EMS garage doors open. In a recent publication, I read that approx. 85% of RR&R programs cost money, according to a FEMA document. With that in mind, how do we develop programs to RECRUIT more members and RETAIN them if we don't have the extra money to develop the programs within our companies and depts? By "more money", I don't mean "extra"  money, I mean "Enough" money through REIMBURSEMENTS of our usual services from Medicare and Medicaid? In 2007, the Govt. Accountability Office (GAO) did a study of all ambulance service fees in the USA. Their report states that Medicare pays 6% LESS THAN COST TO OPERATE from the fees that we get from Medicare. That study was done 4 years ago. In Pa., Medical Assistance pays about 56% BELOW cost to operate. Pa. Law states that any MVA and Workman's Comp. EMS calls are to be paid at 13% & 10% respectively above Medicare approved rates. It doesn't take a rocket scientist to figure out that Medicare, Medicaid, MVAs and WC calls pretty much make up the majority of our 3rd party payors. With the majority of our "paying calls" being BELOW our cost to operate, just how long can your EMS service survive before being forced to close your doors for good? Did I mention that there is also case law in Pa. that prohibits rescue billing? Think the case is Safety Auto Ins. Co. vs McKean Cty. Rescue.

Expenses have risen dramatically for EMS since 2007. Fuel, Electricity, Insurance, Vehicles, Supplies & Equipment, plus all the other incidentals such as Minimum wage (for paid staff), repairs, parts and other services necessary for maintainence, training etc. What about computers, programs, billing services etc. just to be in compliance?

It used to be that EMS made a little profit and helped out their associated fire depts. with injections of cash. Today, EMS seems to be sponging off their fire depts. just to keep their services going. Now EMS & Fire Depts. are BOTH going down the tubes.

So, whats the matter? Well, in any other business, when a supplier gets charged higher prices from their manufacturers or suppliers, they just raise their prices to the consumer. Thats an easy solution for businesses but NOT for EMS in Pa. Federal law regulates the prices we get paid for our services to Sr. citizens. Pennsylvania law regulates the prices we get paid for welfare pts., victims of motor vehicle accidents and workman's comp calls. Ok, lets just charge more to the private patients to make up our losses from state and federal govts. reimbursements. Hmm, If you can't afford to buy health insurance and if you make too much money to be on Medicaid, hows that going to work out for you? From experience I can tell you "NOT VERY WELL". 

If we are not getting enough to meet our expenses, who's making out then? Lets see, maybe #1 on our list should be the insurance companies for health, workman's comp. and auto insurance. Do you see any insurance company working for peanuts? Would their executives, not to mention their employees work for cost or less than cost? Just look at the big buildings, salaries, benefits and lobbyists they can afford. Now compare an insurance company to EMS. Thats one hell of a desparity. They are allowed by law to charge high premiums and make record profits but EMS has its hands tied by state and federal laws to work for nothing or less than nothing. Get the Picture???

How can it be? We save lives and care for the sick and injured and insurance companies just shuffle paperwork and make a killing. Why do our governments allow this to continue? We're back to my NEW YEARS RESOLUTION for 2011.

How can we change this so EMS can survive and maybe someday "PROSPER" ? Your first step is to personally speak with your local, state and federal elected officials. Invite them to a meeting and "SHOW" them how tough it is financially to make ends meet. Tell them you are not looking for a handout or free money. You are asking them to see for themselves what you do and how much it costs and then explain to them that if they don't do something to help raise Medicare & Medicaid fees and revise and update antiquated laws governing our fees for MVAs, Workman's comp. etc., we may not be around when they or their families need EMS in an Emergency. You might also include that laws need to be changed to allow for Rescue billing. Does anyone actually think Santa brings new rescue trucks and the Easter Bunny gives hydraulic rescue tools for the holidays? Sorry for the sarcastic humor but had to let it fly.

Additional ways to help EMS. Support state and national EMS organizations by joining and participating. In Pa., the Amb. Assn. of Pa. has been our voice on a local level for all EMS agencies whether paid, vol., hospital, municipal etc. Last year they (and member organizations)  instituted a law suit against some large health insurance companies that were paying the patient instead of the EMS service. About 75% of the money paid to patients by these insurance companies never made it to EMS. What a concept! The insurance companies did say that if an EMS dept. would sign a contract with them (at fees just a little over Medicare) that they would pay EMS direct. Can you smell that? Moving right along, on a national level, Advocates for EMS and the American Ambulance Assn. are great organizations that work for us on the federal level. Without their lobbying efforts, we wouldn't be getting a small Medicare raise (still not enough) in 2011  and would probably see a 2% decrease instead. AAA and Advocates are our voice in Washington for sure, whether your organization is a member or not. Call, write and/or join them. Support their efforts and become active if you are able.

Before I forget it, I want to mention that approx. 2 yrs ago, Pa. Gov. Rendell signed a bill which gave the responsibility for EMS to the local municipalities. No big deal, right? It is a big deal NOW because the local elected officials in small communities have no clue about EMS for the most part and they are responsible to provide for it in their communities. Thats easy, we'll just keep on using our local volunteer services. When the local volunteer EMS agency needs funds to keep their heads above water, some local municipalities say its not in the budget or that they don't have any spare money. When mention is made that there is a 3 mill EMS tax (Pa state law) some officials quiver at the thought of adding that small tax on their constituents who are already suffering because of the poor economy. Besides, if the locals add an EMS tax, they may not get reelected next term. WHAT A SYSTEM !!! Ask your local officials to bring up these concerns at their "Statewide" Borough & Township Assn. meetings. If the word spreads throughout these state Assns., they can also contact state and federal elected officials. The more important people in our governments that know what problems EMS is facing today, the better chance we have of some corrective action.

So, whose responsibility is it to fix a dying EMS system? Let the feds. handle it!! Let the state handle it. Let the locals handle it. Let people die or wait forever to get an ambulance because of downsizing, slow response times, or whatever. None of these are acceptable answers to the problems you or your EMS agencies are facing.   

I hate to say it but you and your depts. are going to have to get together and make some noise locally, statewide and to your national elected officials. When you do, make sure you have "facts" which are able to be substantiated (documented proof). Support your local, state and national EMS organizations and tell them what your problems are.

When you bring your problems to an elected official about EMS, bring with you some solutions. Work WITH them on solving your problems, Don't just DUMP it on their desks. Its actually alot easier than you may think. Suggest HOW they can help your EMS agency. Ask them to become involved in state or federal EMS caucases. Suggest to them that public safety and health depends on adequate funding and reimbursements for EMS. Remind them that Local EMS, Rescue & Fire Depts. are our "FIRST LINE OF DEFENSE" for natural and manmade disasters. We spend billions of dollars overseas to fight terrorists AND we need to spend a little bit at home to insure adequate equipment & personnel for the safety and health of our citizens. Know how much the feds. have budgeted for EMS in Homeland Security? Less than 10% !!! Today, the threat of terroristic attacks on the homefront is more evident than ever. While many think foreign forces are all we have to worry about, think again. "Homegrown" terrorists are trying their best to do as much damage and kill as many Americans as they can. While our Homeland Security Dept. and law enforcement does all they can to prevent an attack, there are bound to be incidents which require mitigation following a successful attack. Guess who gets to respond and do the mitigation? Who is going to respond if we can't recruit & retain qualified members. Thats a scary thought !!!

Presentation and appearance means alot, especially when dealing with elected officials. If you arrive for an appointment, present a neat, clean appearance and have your act together. Agency uniforms are impressive, especially when they are in good repair and neatly pressed. Speak slowly and keep it simple, unless he/she wants more detailed information. Pick the representative from your company with some business and/or management experience to be your lead speaker. Leave a good impression on the elected official and show them your best professionalism. Followup several days later after your meeting with a nicely written thank you note written on company letterhead. Followup occasionally with the official's office to check on progress. Remember, these are YOUR elected officials and they work for you and YOUR community. You just may be the only person/people who will be able to capture that official's attention about the problems we face in EMS today. Don't forget to be polite !!! While the old saying that "the squeeky wheel always gets the grease" may be true, its probably more true if you use finesse and act professional rather than complaining, be demanding or acting out your emotions.

In conclusion, I would like to wish you well in 2011. If I may be of any further assistance in reference to the above, please feel free to contact me and/or use this document to assist your EMS agency/Dept. in interacting with your elected officials.

Its up to you and me to spread the word and solve the problems in EMS today. We may have a better chance of success now since the Nov. 2010 elections resulted in many changes in state and federal government officials. Lets all work to put EMS on the their agendas for 2011 and beyond. Spread the word to neighboring companies, depts.and EMS agencies and tell them what you are doing. Ask them to do the same. The more people who contact elected officials, the better.    


Happy New Year,


John W. Magyar, Chmn.

Recruitment, Retention & Reimbursement Committee

Lycoming County EMS Council (Pa)





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