Local ambulance leaders discuss rural ambulance challenges

Dodge Center Ambulance Director John Fox and West Concord Ambulance Director Adam La Plount sat in a conference room in St. Paul, as ambulance leaders from across the state, discussed the growing challenges plaguing EMS services as part of its statewide roundtable series.
Rising costs, a lack of volunteers, a need for increased pay, and decades long battles with Medicare to pay the true cost of the bill, were all discussed.
For Fox and La Plount, it was nothing new. It’s something their communities have been struggling with for years.
Increasing Revenue
One of the questions raised during the roundtable discussion was whether or not funding based on call volume works the same for rural services as it does for metro areas.
It’s something Fox has spoken about before.
In order for an ambulance to “really do OK” the ambulance needs to be close to 2,000 runs a year, while Dodge Center does upwards of 1,200 a year.
Becca Huebsch, is the Perham Area EMS Director almost 300 miles away from Dodge Center.
She also agrees with Fox’s assessment.
“In my opinion, no it does not,” Huebsch said.
The reality is, call volumes won’t be as plentiful as they are in places like the Twin Cities.
“I think call volume increases will help if we can find ways to provide more revenue generating services that will certainly help our bottom line,” Huebsch said. “But at the end of the day rural area EMS is never going to be able to run as many calls as say a Mayo Ambulance or a Fairview Ambulance just because our population is different and our larger geographic areas we cover.”
She explained, oftentimes for rural ambulances, it takes longer to run one single call, which doesn’t necessarily mean more money coming in.
“Those time differences very much do add up,” Hubesch said.
Hubesch also explained that it’s likely they will always require some type of subsidy, something the Dodge Center Ambulance is currently exploring, through either a Taxing District, or a Joints Power Board, which would allow for income to come in through taxes, just like a school district, or even a library.
“So much of the service we provide is in readiness, and being available for whatever happens, we’re part of every single industry’s emergency plans but none of those industries are currently supporting EMS and it’s important we’re there 24/7, we’re required to respond whether we’re being subsidized but call volume is not our way out,” Hubesch said.
Lookingfor relief
Just like the Dodge Center Ambulance, other ambulances have looked to the communities part of its Primary Service Area, for some relief to help keep the ambulance going.
Minnesota Ambulance Association President Michael Juntunen explained that the City of Nashwauk had put out a RFP to sell its ambulance service.
“They’re happy with the ambulance service they have, they got a good staffing model, they weren’t having trouble recruiting but the cost to run that ambulance was growing expediently every year,” he said.
Juntunen said Nashwauk went to the other municipalities in their ambulance service and asked if they would help offset the cost.
“But there is nothing that mandates them to have to do so and they didn’t because they didn’t want to have to raise their tax burden,” he said.
No one was interested in purchasing it, so now Nashwauk continues to have to pick up the tab for the “lion’s share” of it.
“It just shows there’s a lot of stress happening throughout the industry and we should have a better way to sustain that,” Juntunen said.
Other factors increase costs
Randy Strohmeyer, the Lake County Ambulance executive director, said the big issue they face is bringing people back home or to a facility after they take them to the hospital.
Unlike in the metro, there’s no ride sharing, taxis, or public transit, in rural areas.
“There’s no family, there’s no Uber, so there is a real need to take them back home,” Strohmeyer said.
He said receiving funding for those rides could be a benefit.
“Being able to be funded for some of those return trips, if there was a way to do that, that would really help to offset some costs,” he said.
Could Legislature help?
A question raised during the roundtable, was what does the legislature currently do to help with some of the pressing issues facing EMS entities.
“I wish I could rattle off a long list of things that the state does to support rural ambulances but I just can’t,” Eric Simonson said.
He said for many years “people just assumed the system worked, you call 911 someone shows up,” but said the issues are just being brought to light in the last few years.
A major issue Fox and other officials have pointed to is the fact Medicare and Medicaid don’t pay the full cost of the bills for patients, causing funding shortages.
Simonson said the ask for the legislature will be to help with funding stop gaps, until when or if, there are changes to federal reimbursements.
“I would say in the absence of federal support, the state of Minnesota absolutely has a responsibility to step in and keep these agencies operational, because that’s essentially what we’re going to ask them to do,” he said.
Workforce
Staffing is a major challenge for rural ambulances, including West Concord, which has for more than a year, relied on Dodge Center Ambulance for daytime coverage, due to two long-time volunteers retiring.
Fox said, volunteer hours, his rank in file put in each day, is a “hidden revenue.”
Last year, the department received about 14,000 in volunteer hours.
“That alone is the only reason we’re surviving,” Fox said.
Fox also recognizes the reality; each year the state has been losing more providers than it is bringing in, and the vast majority leaving are under 30.
“You can’t sustain a profession if you can’t bring young people into it,” Fox said.
Burnout is a real thing Juntunen said at the roundtable discussion.
“Burnout is definitely an issue, low pay, long hours, and a lot of educational requirements on top of it haven’t done us well,” he said.
Over the years, different types of calls have also changed, for example, the need for EMS to wear body armor at times.
“The violence against EMS is different than it was 20 years ago, ”Juntunen said.
But even for ambulances who have the full-time only staff, there is a need to work second and even third jobs to survive.
Huebsch said it’s something her department is dealing with, the mental toll at times, it has on first responders.
“We’re forgetting the continuous exposure that they’re having (from) the lack of breaks that they’re having, and the truth is EMS professionals are underpaid compared to the healthcare industry overall,” Huebsch said.