By TED MEBUST for AllOstego.com
The New York State Emergency Medical Services Council’s “2023 EMS Agenda for Future,” released last month, inspected challenges involved in supplying EMS delivery by creating topic-specific subgroups to study agencies, education, government, support, operations, hospitals and staffing.
The Center for Public Safety Management’s recent “EMS Services Delivery Report” did the same by analyzing data from the computer-aided dispatch system at Otsego County’ Emergency 911 center. Among the many challenges examined by these studies, the two main issues identified—which are not isolated to New York State—are the existing systems of funding and changing communities.
Funding EMS services in Otsego County, as of right now, is accomplished by aid from the New York State legislature, the County Board of Representatives and ambulance transport fees. Though the burden looms largely on taxpayers, programs like Medicare and Medicaid, and with independent commercial insurers, ensure the costs are covered by applying prices indexed on the level of care provided. However, agencies within Otsego County provide services without any knowledge of their patients’ coverage or ability to pay. Additionally, there’s little consistency among agencies in applying service fees to patients. Therefore, as the CPSM report noted, “inadequate reimbursement from government and insurers for services provided” poses a major threat to existing agencies.
As the American Rescue Plan Act aid wanes, the Otsego County Public Safety and Legal Affairs Committee relies heavily on the CPSM report for options to maintain the county ambulatory service. Along with his analysis and 12 major recommendations on how to improve the service, project leader Matt Zavadsky proposed multiple courses of action for revenue streams, including possible contracts with area hospitals and developing community partnerships. As it now stands—taking into account the negative growth rate the report applied to the county given the downward trend of Otsego County’s population size over the last decade—the CPSM report projected that “the County’s ALS ambulance division will run an average deficit of $639,847.00 over the next four years.”
The New York State report recommended that “creating statutory changes that establish and define EMS as an essential service in New York State and mandating that the services’ beneficial stakeholders pay their fair share of the costs of funding it” will be necessary for a sustainable EMS system. Once this designation is in place, the state plans to develop grant programs to provide relief directly to regional EMS providers and encourage relationships between them and hospitals to secure contracts for services provided.
While both reports highlighted funding systems as a main point of observation, they also recognized the declining rates of volunteerism in communities throughout the state.
“In New York, the overwhelming loss of EMS personnel across all ambulance agencies resulted in approximately 30 Volunteer Ambulance Corps closing their doors and other departments losing valuable, well-trained personnel,” stated the report, which also noted that less than half of all certified providers in the state provided EMS care after 2020 and rates of volunteerism plummeted.
One barrier for volunteers or paid EMS providers is the educational level necessary to operate much of the increasingly advanced medical equipment found onboard ambulances. Additional requirements for recertification and certification of advanced life-support levels have been introduced as the scope of the EMS profession has expanded, and many existing volunteers simply do not have the time or funds to commit the extra hours necessary to satisfy such prerequisites. These certifications require coursework that often takes months to complete.
While communities fail to produce newer generations of volunteers, and paid crews continue to leave the EMS profession, the state’s report recommended that EMS coverage reliability standards will be necessary for agencies to provide certain levels of care to their specific region. By 2024, agencies will be required to respond to 80 percent of dispatched calls without the aid of another agency. This standard will increase each subsequent year.
“We have no volunteer agencies meeting that standard right now,” said Robert O’Brien, Otsego County 911 director. “The future is paid EMS.”
The CPSM report maintained that social and community-related challenges were among the most detrimental to issues of ambulance delivery in Otsego County. These challenges included less emphasis on the social aspects of volunteering, aging communities, the “me generation”—which places personal needs over service requirements—and a loss of community feeling. These conclusions were drawn from meetings and surveys with existing volunteer EMS agencies throughout the county.
Despite all the associated challenges to recruitment, the New York State report recommended committing $5 million to creating a campaign to promote volunteerism throughout the state.
While funding issues and changing communities represent barriers to providing EMS services to patients across the county, and these reports have pointed out flaws in the current system, remaining volunteers continue their commitment to helping those in need.
This is part two of a three-part series on Otsego County EMS. Next week’s edition will examine the perspective of volunteer EMS providers in relation to the current state of services. Read more on: www.allostego.com