Stagnant reimbursement and rising operational costs plague EMS companies — just ask Zach Menter, president and CEO of Menter Ambulance in Fulton
By Deborah Jeanne Sergeant
As with other segments of healthcare, the emergency transportation sector has faced significant challenges in recent years.
The one that may impact healthcare consumers the most is the cost to operate emergency medical services.
It may seem like ambulance companies should be flourishing, as the cost of services has escalated.
However, the situation is much more complex.
Like any other business, overhead has substantially increased for ambulance service operators.
Zach Menter, president and CEO of Menter Ambulance in Fulton, said that his company’s fuel cost has experienced a significant increase.
“Our fuel bill is roughly up $6,000 to $7,000 a month, in addition to the cost to stock, repair and maintain the equipment. An ambulance has well over $100,000 pieces of equipment on it and on some cases, you’re giving drugs and using equipment,” Menter said.
Although the supply chain has improved since the end of the pandemic, obtaining stocking supplies and maintaining vehicles and equipment still takes longer than it used to pre-COVID-19. But it may cost more going with a supplier that can respond faster than another.
Staffing is also tough, as with any area in the medical sector. Menter said that although his staffing is stable, raising payrates to continue to attract workers has made the industry tougher.
Additionally, reimbursement has not kept pace with expenses. Menter said that with more people going on Medicaid and public assistance, the reimbursement rates go down.
“Unfortunately, Medicaid reimbursement rates are extremely low,” Menter said.
They won’t cover the cost of staffing, equipment maintenance, supplies and medication, he said.
“Other payors do better at covering those costs, like commercial insurances. But unfortunately, there’s a higher rate of Medicaid users in different demographics,” Menter said.
The volume of patients the ambulance company receives helps support the business model. However, sometimes the resources dispatched do not align with what the patient needs. Although Menter does not want people to hesitate to call 911, when people misuse the services, it squanders resources.
Sometimes people call emergency services for a routine matter because their area lacks a primary care provider or they are uninsured. Other times, people are unsure of what type of help they need.
“We get a lot of requests to calls that probably do not warrant EMS, like maybe someone is out of their medication,” Menter said. “We get called for things that might make more sense for someone to have an appointment with their primary care provider.”
“An overwhelming number” of mental health calls may be better handled with a professional in behavioral health, Menter added.
Although they need care and do receive transportation to the ER, that’s not the site where they will ultimately receive care.
Menter staffs 14 ambulances during the daytime and eight at night.
He said that not a lot of people realize that the cost of ambulance calls is not for just the specific ambulance arriving at the address of an emergency and providing care. It is also the expense of paying for the fleet and staff to be available at all times. Healthcare consumers pay for that readiness.
Staffing Woes
At American Medical Response of CNY in Syracuse, John Falgiatano, operations manager, said that staffing represents one of the biggest struggles for the industry.
Both recruiting and retaining employees is difficult, he said.
“It’s dollar-driven,” Falgiatano said. “Competitive wages, benefits package, educational opportunities, and those other incentives that you can offer them that will be ahead of most of the other agencies, like specialty care bonuses and overtime bonuses.”
All of these are expensive and drive up costs.
Like Menter, he said that Medicaid, Medicare and insurance don’t reimburse at a level that currently covers expenses and the ambulance services industry has been lobbying for better rates that keep up with costs.
“Fuel costs, equipment repairs and durable medical equipment have all gone up without reimbursement rates going up,” Falgiatano said. “It’s tough to equip and provide quality of care without raising rates.”
Onondaga County has launched Nurse Navigation, a program that uses nurses to triage 911 calls so people get advised about or dispatched the right resource, whether rideshare services, telehealth, crisis response, fire fighters, law enforcement, urgent care, primary care provider or EMS. This can help reduce misusing EMS and lower the number of calls that will have poor reimbursement rates.
“It will be a game changer to reduce the number of calls EMS is facing,” Falgiatano said. “Another component as an EMS agency, we’re trying very hard to triage calls to have the correct available response for the caller. Someone might not get an ambulance in seven minutes or less for things who aren’t high acuity.”
For example, someone experiencing chest pains would receive a faster response than someone who has had a severe cold for several days.
Another factor in timely response is the ability to move patients into the health system. This affects “offload time” of EMS personnel, as if a hospital bed is not yet available, they cannot remove the patient from the ambulance.
