Emergency Medical Services, like other first response fields, have been facing a number of new challenges since the onset of the COVID-19 pandemic. But looming staffing shortages, thought to be nearly a decade away from critical levels, have skyrocketed in the past 18-months, leaving EMS providers scrambling to keep up with demand. On top of the worker shortage, funding issues have made the current economic model unsustainable for many agencies. So what is the solution? We spoke with CPSM’s own Matt Zavadsky, a 42-year veteran of the EMS world and current Chief Strategic Integration Officer for MedStar Mobile Healthcare, to discuss the current state of EMS and how agencies need to adapt and prioritize their first-responders.
What are the top areas of concern for public agencies when it comes to healthcare and emergency services today?
There are a couple things at play. First is the workforce. The EMS field, like the rest of healthcare, is facing critical staffing shortages. There were issues with recruiting and maintaining workers even before the pandemic, in large part due to pay, but what would have taken 10 years to become a critical problem has instead done so in a matter of a 10 months.
Second, the entire EMS economic model needs to be overhauled, and it has for some time. The simple explanation is that, in the current system, the cost of service is more than we are able to get reimbursed for. In most states, EMS is not considered an essential service, so the County can choose how much, if at all, it supports EMS services. Some states have realized its importance and have included EMS as an essential service, but many state associations don’t want it classified as essential service because of the tax dollars.
In terms of the labor shortage, why are fewer people interested in EMT work?
A fifth of healthcare workers have resigned in the last year, and many are leaving the field altogether either because it’s too dangerous, too demanding, or a combination of both. But another huge factor is the pay. At the end of the day, if a person can make the same salary in a low-stress, low-demand job, why would they put themselves at risk in the current climate? Someone fresh out of college can work at a restaurant or EMS for the same salary.
Additionally, hospitals are also suffering from staffing shortages, and paramedics are great nurse alternatives. They can assess the patient, administer medication, handle airway management, etc. When a hospital can pay $75/hour vs. the $35-$40/hour they were making as a paramedic, EMS providers just can’t compete.
The other factor is fear. The risk to healthcare workers is real. Hundreds of EMS workers and thousands of healthcare workers as a whole have died from COVID-19. And many paramedics and EMTs have decided it’s not worth it for the money.
Based on what you’re saying it sounds like we have a critical shortage of workers on the cusp of another pandemic wave. What will happen if this isn’t addressed nationwide?
We could get to a point where someone could call 911 and there won’t be an ambulance available to respond. That’s the scary truth. In the past, the average response time was 9 minutes. That won’t be the case any more.
So what can be done?
There are some pilot programs rolling out that are taking more data-driven approaches. For example, standard practice used to be to put a paramedic on every ambulance. But after looking at data, we can see only 40% of calls need advanced life support care that a paramedic can provide. The other 60% of calls don’t need a paramedic. Since EMTs are easier to find than paramedics, we’re looking to increase efficiency by staffing ambulances based on this data.
Call response time is another place we can adjust without causing any negative impact on outcomes. Most people are willing to wait 15 minutes for an ambulance, regardless of the necessity of the situation. Over time, we have created an unrealistic expectation, and we just can’t afford those kinds of response rates for headaches and stubbed toes any more. We need to change those response time standards.
What were agencies attempting to address the labor shortage before the pandemic, if anything?
Eighteen months ago this was a backburner issue. The pandemic took what we thought would happen in 10 years, and accelerated to 10 months. So most agencies didn’t think they needed to address it yet.
One more recent project for a county in upstate New York is a good example of how agencies can reevaluate once these issues start affecting their workforce. In this particular agency, their volunteer workforce had been dwindling for some time but as soon as the pandemic hit, their volunteer ranks tanked. Most of the volunteers were older and too at risk for coronavirus to continue volunteering.
It was then CPSM’s job to come up with the least costly way to bring in a safety net ambulance provider.
This is something that all agencies should be doing. You need to plan and have a safety net system to ensure there is going to be an ambulance there to respond to calls. It costs money but you have to do it. If volunteers can muster it up, then great, but you need the backup.
The pandemic has obviously come with new risks and issues. Almost two-years in, how have you seen other agencies adapt to these challenges? What has been successful?
The agencies who have been the least affected have recognized the need to be nimble. They can change the delivery model, they can work with and be honest with the community because they are trusted. These agencies can take a more radical approach of, ‘maybe we don’t need to send ambulances for certain types of calls.’
Because really, some calls don’t need an ambulance. Some car crashes, no one is hurt enough to go to hospital. It saves resources and it saves the would-be patients money, time, and the headache of the emergency room. If we can have a resource to evaluate and ensure everyone is OK to go, perhaps even help to get them a ride without an ambulance, it would be much more efficient all around.
There’s so much money spent on these unnecessary ER visits which backs up ER waiting rooms and costs money. Now that the pandemic has accelerated this acceptance of navigating patients away from ERs to urgent care offices or other doctor’s offices, there’s no reason to make an ambulance wait outside a crowded ER for hours for a broken finger.
We’ve seen a rise in telehealth options recently for obvious reasons. How do you see this helping the EMS situation?
Telehealth has helped dramatically. Medicare is the largest payer of EMS so once they opened up to allow telehealth, it opened up a huge number of opportunities. Now, EMS workers with patients can call a doctor and get them assessed then and there.
How does an agency begin to understand where changes are needed?
It takes data analytics, an outside view, and a group of professionals who live and breathe innovations and transformation every day. That’s the value of bringing in CPSM. We can provide a fresh set of eyes with unmatched experience as well as a data analytics team, and people who can ask the tough questions.
You need to look at data, protocols, procedures, what is your reimbursement structure, what’s your billing system, etc. it’s about balancing costs with quality. What kind of agency do you want to be?
What is your response to agencies that say they can’t afford these changes?
You might not be able to afford to keep doing it the way they are doing. CPSM will give you options and show you the costs of all of it. It’s an upfront cost that will save you longer term and set you up for efficiency and success.