EMS services — Doing good job, but need help

The issues facing EMS departments in rural Minnesota and the future of the current models were the topics of a roundtable discussion last week in Dodge Center.

John Fox, the assistant ambulance director in Dodge Center, was joined on the panel by Minnesota Ambulance Association (MAA) President Michael Juntunen and Mark Jones of the MN Rural Health Association. Kate Raddatz was the moderator of the session. MAA hosted the session.

Locally, the issue of ambulance service has been a topic of discussion over the last few months as officials have struggled to find ways to keep the services viable.

Dodge Center Ambulance serves Dodge Center, Kasson, Mantorville, and Claremont along with several townships. Both West Concord and Hayfield have their own EMS services but have also struggled with the same issues facing Dodge Center.

At last week’s meeting, which was attended by EMS officials from throughout the area, the talk centered around two of the major issues — keeping sufficient staffing levels and financial stability.

There are two factors involved, Fox said, the work force and funding and the two are intertwined.

In Dodge County, like most rural areas, the EMS positions are staffed by volunteers although in some departments individuals do receive a nominal payment often a couple of dollars per call. Despite being a volunteer position, the job requires extensive training to be certified, ongoing training and the number of hours involved in answering calls can be overwhelming with volunteers often reaching the point they feel they must continue on as there is no one else to do the job, panelists agreed.

The type of calls they are answering have also changed over the years, he said. Today, they are seeing more calls for people with chronic health conditions, mental health issues, and substance abuse, compared to the car accidents, heart attacks, and injuries that were prevalent in the past.

“We are entry level health care,” Fox said.

Speaking of the volunteers, Juntunen said, “we’re asking them to go to school to be certified and then volunteer their time.” Many employers are also dealing with leaner workforces, he said, and are more reluctant to let employees leave their jobs during the day to answer a call.

Closely related to the staffing issues is the financial situation of the services.

Generally, Fox said, EMS services are “fee for services.” They answer a call and the bill for their work is submitted to the patient’s insurance companies. The payment received in rural areas is especially challenging because there are fewer calls for services which means less money coming in and because rural areas have more older residents more of the calls are reimbursed by Medicare which does not pay enough to cover the costs.

The model for billing the ambulance services has not changed in years and is still based primarily on a transportation model — the patient is picked up and taken to a hospital for medical care. With the changes in the types of calls EMS services now get, and the increased training the volunteer has received, they can do more than merely transport the patient and should be reimbursed according to those skill levels.

Medicare, Jones said, still looks at EMS as a transportation service, not a health care service.

As rural services look at how they can continue to provide a needed service, panelists said, they are looking at different ways of operating and funding.

The last Minnesota Legislative session did provide some help with $30 million EMS funding approved. That figure, however, was one-time funding and although, Jones said, it was “absolutely needed,” it did not serve the long-term issues.

Fox said the priority at the federal level needs to be changing the Medicare reimbursement model.

Despite the problems faced, panelists said EMS is doing a good job.

“Our services are still doing an outstanding job, Fox said, but we need some help.”