Could you have your heart attack tomorrow, we’re busy today!
What would you do if you dialed 9-1-1 and got a recording saying: “We’re sorry due to budgetary restraints we are unable to save your life today”?
That could be a very real scenario in Pennsylvania unless strong and dramatic action is taken to address a crisis in funding facing emergency medical providers throughout the state – at least those still in business. While attention has been focused on the medical malpractice insurance crisis, 67 ambulance organizations have quietly closed their doors in Pennsylvania over the past year.
In the wake of the September 11, 2001 terrorist attacks the spotlight rightly fell on the critical role played by fire and police departments. The federal government and many states, including Pennsylvania, took steps to improve investment in these services as part of the effort to improve homeland security. Somehow, emergency medical services – the companies that run the ambulances that respond to your 9-1-1 call – got left behind. According to South Central Emergency Management Services, only $3 million of $25 million appropriated in the state for emergency services in 2003 will go to EMS providers.
Funding for emergency medical services (EMS) is a problem that has been brewing since the 1970s and is now rapidly approaching the crisis point. Piles of new regulations have made it more difficult for individuals to qualify for EMS crews. As a result, fewer and fewer people can invest the time and money in the training required to serve on an EMS crew on a volunteer basis. This trend toward paid crews has dramatically increased the cost of providing emergency medical care.
There was a time when most emergency medical responders were affiliated with your local volunteer fire department. Now, 70% of the more than 950 ambulance companies operating in Pennsylvania are independent organizations not officially affiliated with any fire department. As a result, most of the money approved for distribution to emergency services in the wake of the terrorist attacks never made it into the coffers of EMS organizations.
The Federal government has contributed to EMS funding woes by failing to increase reimbursements since 1989 for Medicare and Medicaid patients, those low income and elderly individuals who make frequent use of emergency medical services. Of course, the cost of providing service has increased dramatically over the past 15 years, leaving EMS companies scrambling to cover costs.
Add to all this the increased cost of real estate for housing ambulance companies, skyrocketing equipment costs, and the out of sight increases in medical malpractice and other insurance, and you have the making of a major financial meltdown.
To make matters worse, EMS organizations tend to be forgotten by government at all levels. Most logically support for ambulance companies would come from municipal governments. And in fact, cities, boroughs, and townships do tend to be the most supportive level of government. However, their financial commitments fall woefully short of what is needed, and often is far less than that provided to firefighters.
With the trend in emergency medical services strongly toward consolidation, counties are being looked at as a part of the solution. Since counties already operate 9-1-1 emergency management systems they are the logical level of government to be major players in a new paradigm for providing emergency medical services. But, counties are already suffering from a decrease in funding as revenue from taxes on land telephone lines drops as more and more people switch to un-taxed cellular phones.
No tax reform is on the horizon from Harrisburg, so counties are left with no way other than to raise property taxes to cover the growing costs of such services. The largest portion of a property owners’ tax bill goes to fund government education, so most property owners are experiencing big property tax increases from their school district and can ill-afford higher county taxes.
The big problem lies at the state and federal levels. It is the state and federal governments that have burdened local EMS providers with regulations and mandates to the point they have become financially insolvent. At the same time, state and federal reimbursements and grant programs have not kept pace with the rising costs of providing emergency medical service. The state, meanwhile, has handcuffed county and local officials by failing to pass any sort of meaningful tax reform to allow local governments to deal with the problem on their own.
It all gets back to the central mission of government. Governments at all levels have gotten off track in implementing a wide range of programs and services aimed at pleasing politically noisy constituencies while failing to adequately fund those activities that truly belong in the public realm. Defense and public safety are the core functions of government – and in Pennsylvania at least, government is failing to adequately address the needs of the emergency medical services community.
Something needs to be done and soon – before there is nobody left to answer the call when a medical emergency strikes.