Local emergency medical service companies are facing an “impending crisis.”
That crisis, according to Scott Rhoat, Bellefonte EMS executive director and chief, is fueled by financial and personnel challenges, such as flat-lining insurance reimbursements, lack of qualified workers and inability to pay a living wage.
“EMS is perpetually stressed, and it’s getting worse,” he said.
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The amount local EMS organizations are reimbursed from insurance companies isn’t nearly enough to cover the actual cost of operating, Rhoat said.
“Unfortunately, Medicare and Medicaid, I’ll say, are the two worst offenders,” he said.
The amount EMS companies are reimbursed by Medicare and Medicaid can vary based on several factors — whether the area is rural, transportation mileage and the level of service provided, according to information provided by the Pennsylvania Department of Health.
“We’re not looking to make a profit so to speak,” Rhoat said. “We’re not looking to gouge government, but when they’re not carrying their fair share and they’re not paying what it actually costs us to provide the service, that makes it very, very difficult for anybody to expect or to get reliable EMS services at some point in the future.”
The reimbursement only covers the time with the patient, not any of the overhead costs or cost of readiness, Rhoat said.
The reimbursement issue affects all EMS companies, said Scott Rawson, executive director of Centre LifeLink EMS.
The state health department is “committed to working to ensure that EMS agencies are properly reimbursed,” according to information provided by DOH.
In 2014, there were 53,173 people working in EMS in the commonwealth. In 2016, that number decreased to 45,960, according to DOH.
Pennsylvania, like many other states, has also seen a “large drop” in the number of volunteers working in emergency services, according to DOH.
Historically, ambulance services in Centre County had been a volunteer-based model, like fire service, Rhoat said.
EMS in the county transitioned to being augmented by career paid staff about 20 years ago, he said. Part of that was due to the ambulance call volume.
Rhoat said there’s no way to have enough volunteers alone to provide reliable, timely response to 911 emergencies.
Volunteerism is “pretty much nonexistent,” said David Corle Sr., Port Matilda EMS captain.
At Centre LifeLink, there are 60 paid employees and 40 volunteers, Rawson said. That number is enough, if it can be maintained.
The issue for LifeLink is that they know many of their volunteers come and go because they’re Penn State students who will want to move on in their career after school, he said.
Recruitment retention is always an issue, Rhoat said. Not very many people are signing up for the emergency medical technician class, whether it’s because of the time commitment (more than 200 hours of class time) or the price tag (almost $1,000).
Fawn Guignet started working in emergency medical service as a way to get patient care hours to go on a medical school application, but she said she realized that she enjoyed working in the field and didn’t know if it would be as fulfilling to work in a hospital where all the resources are right there.
Guignet’s worked in EMS for almost eight years — now working part time with Bellefonte EMS and part time as a monitor surveillance clerk at Mount Nittany Health.
But between those two part-time jobs, she could have to work 50 or 60 hours a week to make ends meet, she said.
It’s common for EMTs to have to work more than one job just to make a sustainable income, Rhoat said.
As a career, the wages are typically poor, he said. At Bellefonte, for example, EMTs start at $9.57 an hour, and that’s the best the organization can afford.
Guignet has considered leaving EMS and has taken her hours way down at points.
“I feel like EMS is something that it is either in your blood or it’s not,” she said. “Every time I try to walk away from it, I miss it.”
‘Something has to give’
Every EMS agency in Centre County is stressed on finances or personnel, and there are several that are struggling and “riding a knife edge,” Rhoat said.
Currently, Port Matilda EMS has a 6 a.m. to 6 p.m. shift and then goes out of service, Corle said.
“Believe me, we don’t like it,” Corle said. “We actually hate it.”
That’ll change starting in September when the company will have a live-in employee to cover most of the nights, he said.
It’d be helpful if the municipalities stepped up with funding, Corle said.
He said the company doesn’t want it to be the case that people will miss the EMS coverage as it’s going, saying they want to be there for the community.
“We’re very quickly coming to the point where something has to give,” Rhoat said. “We either have to cut services, or we need to have additional income.”