New York State appears to be stepping up to get a grasp on the EMS crisis and plotting a potential course for what’s next.
Across the nation, EMS is in crisis. Response times are longer. More workers are leaving the field than entering it, with mental health and burnout to blame. Costs are up and funding is dwindling. Pay is on par with fast food restaurants (although many rural areas depend largely on volunteers). The public, in general, doesn’t realize EMS is not funded the same way as the local police but still counts on municipalities to ensure services are in place should they need them.
It’s a national problem that many say is due to an approach established 50 years ago that no longer works. Back then, emergency services were paid by an individual’s insurance. Today, Medicare only reimburses for transportation. So, if EMS goes to a home and resolves an issue without having to transport a patient to the hospital, there’s no federal reimbursement.
In January, the New York Association of Counties (NYSAC) acknowledged counties are being asked to help shore up resources, but local laws and other issues are exasperating the challenge. Still, NYSAC presented proposals and legislation to address the issue. (By the end of the legislative session, one bill made it through both chambers, awaiting the Governor’s signature. It calls for ambulance services to be reimbursed by Medicaid when treatment in place is administered and/or when transportation is provided to a health care setting other than a general hospital.)
In March, New York State Comptroller Thomas P DiNapoli issued a report on “The Growing Role of Counties in Emergency Medical Services.” It discusses the variety of ways EMS is provided and funded in New York, and how a lack of data makes it difficult to assess what’s needed. It also points to counties playing a more active role in assessing and supplementing EMS services, as well as the need for greater State involvement.
According to the report, there were 989 agencies providing EMS in New York, with almost 64% classified as corporations and the majority being non-profit. The remaining 36% were owned by local governments, including 162 owned by fire districts.
Less than 20% rely solely on paid staff; about 50% rely solely on volunteers; and the balance work with a combination of the two. However, when it comes to city and county EMS agencies, most have paid staff like private for-profit EMS agencies. Some EMS staff also serve as firefighters.
In New York, patients are treated and transported regardless of ability to pay or coverage. Many agencies cover expenses by billing for services. At times, property taxes and other sources help with funding, as does fundraising by volunteer fire departments.
The report refers to the State Emergency Medical Services Council’s State EMS Sustainability Technical Advisory Group pointing out that most reimbursement is for transportation services, not medical services. Inadequate federal reimbursement rates and uncompensated care are issues. They also highlight a surge in county involvement with backup or mutual aid to meet residents’ needs.
The report concludes, “The current circumstances call for direct State involvement to support the efforts of counties and other local governments to turn fragmented and ad hoc responses into comprehensive solutions. While Regional EMS Councils and local government providers should conduct regular needs assessments, solutions need to start at the State level and include better statewide data collection, management and analysis to help EMS agencies identify where services are falling short and provide options for improving response times and outcomes. Better centralized guidance from the State about funding sources can help local officials make more informed decisions about how to pay for these services.”
It sounds like there’s more to come. As your municipality continues standing up to the many challenges associated with meeting residents’ needs, you can count on RBT CPAs for accounting, audit, tax, and advisory services. Why not give RBT CPAs a call to see how we can be Remarkably Better Together!
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