Our ambulance services are drowning in red ink because of a lack of financial support

In Allegheny County, Pennsylvania, it costs about $550 to send a fully-stocked ambulance to a call for help.  Why?

• A brand-new EMPTY ambulance (no equipment, radios, stretcher, EMTs or paramedics, not even a single bandage costs roughly $300,000.

  • According to the 2021 Allegheny County and City of Pittsburgh Market Value Analysis, the average home sale price was about $154,000.

  • Even if an EMS agency can get 10 years of use out of 1 ambulance, they're still "buying 2 new houses" every 10 years.

    • Can you get 10 years of use out of your vehicles?

• Most EMS organizations have more than 1 ambulance.

  • For example, the City of Pittsburgh has 14 frontline ambulances.

• Every ambulance requires radios and a heart monitor as well as many other types of equipment for licensing.  Radios for dispatch and hospital communications cost around $7,000.  A heart monitor/defibrillator can run as much as a new Honda CR-V, Hyundai Sonata or Ford F-150.

• There's a shortage of EMTs and Paramedics to staff these ambulances.

  • Training can take from months to more than a year to complete.

  • Compared to their public safety counterparts, starting salaries are lower and the career ladder is limited.

  • According to the US Bureau of Labor Statistics, in 2021 the median pay for EMTs and Paramedics was $17.76 per hour.

    • A "Co-Driver" for the Department of Environmental Services in the City of Pittsburgh who drives a solid waste truck and collects refuse makes $22.19/hour during their six-month probationary period.

• Then there's the cost of gas/diesel fuel, vehicle and equipment maintenance; rent, lease, or mortgage expenses for their building(s); employee benefits; insurance; support staff; disposable supplies; office equipment, etc.

How bad is it, and what does that mean to you?

• Many ambulance services have closed because they cannot meet the ever-increasing expenses.

  • That means fewer ambulances available to respond to calls for help.

  • That can equate to longer distances to travel to provide that help by the services still in existence.

  • Longer distances to travel mean longer response times until help arrives after you call 911.

• The average EMS response time in Allegheny County is 16 minutes.

  • In a cardiac arrest, brain death starts in 4-6 minutes.

  • CPR alone rarely revives a patient, but it does buy time until electrical defibrillation becomes available.

  • After 3 minutes of CPR, the effectiveness of defibrillation decreases by 10% for each passing minute.

  • Even with good CPR, defibrillation at 8 minutes means the likelihood of survival is 50:50 - equal to flip of a coin - and it only decreases from there.

But ambulance services get reimbursed by government insurance programs like Medicare and Medicaid, why is this a crisis?

Reimbursements don't even come close to meeting true costs.

• Medicare and Medicaid have strict guidelines as to what constitutes a Basic Life Support (BLS) versus an Advanced Life Support (ALS) ambulance, and there are different pay rates for each.

  • BLS - basic medical equipment (e.g., splints, bandages) staffed with EMTs.

  • ALS - advanced medical equipment (e.g., IVs, heart monitor, cardiac medications) staffed with at least one paramedic.

• They also have strict guidelines for what constitutes an emergency transport versus a non-emergency transport.

  • Medicaid pays $325 per call for a BLS ambulance and $400 for ALS.

  • For BLS, Medicare pays:

    • $260.68 for a non-emergency.

    • $417.09 for an emergency.

  • For ALS, Medicare pays:

    • $312.81 for a non-emergency.

    • $495.25 for an emergency.

  • These rates apply EVEN IF THE ACTUAL COST IS 5 TIMES THAT!

• Most private insurance carriers base their reimbursement off these government rates, so they rarely cover the actual costs of a trip either.

• Reimbursement covers actual costs ONLY ABOUT 15-20% OF THE TIME!

  • How long would it be before you went looking for a new job if your employer only paid you for the full amount of the work you did, just 15-20% of the time?

• The ambulance cannot bill for services if a patient is NOT transported.

  • For example, if an ambulance is sent to a motor vehicle accident, but no one is injured or their injuries are minor and they decline to be transported to the hospital, insurance WON'T PAY ANYTHING!

• They also pay a mileage reimbursement rate, however...

  • The Medicaid mileage rate is $4.00 per loaded mile

  • "Loaded" means just the miles traveled while transporting a patient

    • There is no reimbursement for the miles driven to get to the patient, or for the miles driven from the receiving hospital back to the ambulance service's coverage area once the patient is at the hospital.

    • AND they only reimburse mileage if the patient is transported MORE THAN 20 MILES!

  • For example:

    • An ambulance backing up a neighboring service drives 16 miles to the patient.  They then drive 19 miles to deliver the patient to the closest hospital.  Now, it's a 25 mile drive back to their home coverage area.  That's 60 miles for one call, and not one single mile of it qualifies for mileage reimbursement.

What can you do to help?  It's your life and the lives of your loved-ones and neighbors that's on the line. Take an interest in EMS!

• Learn CPR and get trained in basic first-aid care.

• Get to know your local ambulance service.

  • Who are they?  What's their staffing like?

  • Who are their backup services that respond when none of their ambulances are available?

• Contact your local government leaders and ask them the following:

  • Who is the primary ambulance provider for our community, and what is their average response time to a call for help?

  • Who is our secondary/backup ambulance provider, and what is their average response time to our community?

  • What, if any, support do you provide to these EMS agencies?

• Contact your County, State, and Federal officials.

  • Demand fair reimbursement for services rendered by EMS agencies.

  • Demand that private insurance providers do the same.

  • Demand subsidies for the communities to shore up the EMS system as a whole, and for all who may need it.

Your survival in a critical emergency, may first depend on the survival of your ambulance service!