Emergency Medical Services have been described as being at the intersection of public health, health care, and public safety. We have also been described as a health care safety net because regardless of who you are, the nature of your need, the time of day, your location, or your ability to pay, EMS will respond and provide capable, compassionate, and professional care.
EMS is more than the EMS providers, a single service or combination of services, it is a system. One that also includes 9-1-1 emergency communication specialists, educators, medical directors, emergency physicians and nurses, and regional and state administrators.
It is a system that works in a manner that is often invisible to the patient, which is both good and problematic. It’s good because a patient does not need to be concerned with what’s happening behind the scenes. Upon arriving at the scene of an emergency, the EMS provider assesses the patient, collects pertinent medical information, and communicates that information to the local hospital. While the patient is being transported, the hospital is preparing to have specialists ready upon arrival. In some cases, a patient may bypass a local hospital and go directly to a trauma or cardiac specialty hospital.
But it’s problematic in that people are often unaware of how fragile and strained our system is. Callers who request an ambulance and get one may not realize that on an increasing basis, the ability to have such a response is in jeopardy. Last year, two Maine communities lost their long-standing ambulance service in large part because of inadequate payment rates, and many more ambulance services are precariously close to that same point.
At the heart of the payment issue is the fact that MaineCare, which pays for a significant portion of patients served, only pays 40-45 percent of the ambulance service’s cost of the service.
What does this mean statewide? It means that out of the gate, EMS services are losing well over $10 million dollars every year, which means municipalities, hospitals and businesses and their employees must fill this financial gap.
This is not a sustainable business model — and it should come as no surprise that this has an impact on equipment purchases, maintenance, wages, and provider and patient safety.
Fortunately, there is hope on the horizon.
Senate President Troy Jackson and key legislators from both parties have sponsored and supported LD 915, which establishes that MaineCare will pay 100 percent of the Medicare rate. This bill received unanimous support from the Health and Human Services Committee and now moves to votes in the House and Senate, then on to the Appropriations Committee.
In every legislative session there are more requests for funding than resources, but this is an issue that’s been largely ignored for over a decade. The need to address adequate reimbursement for ambulance services is critical and the time is now.
May 19-25 is National Emergency Medical Services Week, which was first proclaimed by President Gerald Ford in 1974, to celebrate EMS providers and the work that they do.
Throughout the state, there will be activities to both recognize EMS providers and increase public awareness about the opportunities and challenges of emergency medical services.
EMS Week is a time to learn about EMS, and the many ways it is more than red lights and sirens. It is about a system we rely upon that needs help. Let’s celebrate this week by responding to this call.
Robert “Butch” Russell is the president of the Maine Ambulance Association, a non-profit trade association representing ambulance services of all types and sizes. He is also the CEO of North East Mobile Health Services, a paramedic ambulance service with bases in Scarborough and Rockport.