EMS Task Force continues to look for solutions locally to strengthen ambulance service

‘The creation of an ambulance district in order to implement a tax for service has been discussed, and is on the September meeting agenda, but unfortunately includes a long legal process to establish.’

Press Release, Orleans County EMS Task Force

ALBION – On October 26, 2021 the local elected officials in Orleans County were briefed on the crisis EMS agencies are facing not only in our county, but across all of New York State and throughout the Nation as a whole.

Following this, local officials requested that the county create and facilitate an EMS Task Force to identify issues ambulance services and fire departments in the county were facing and determine a course of action.

The EMS Task Force members included representatives from each town, village and fire department, as well as representatives from COVA, Kendall Ambulance, Monroe Ambulance and Medina Ambulance. Orleans County Legislators, Public Health Officials and the Orleans County Sheriff’s office were also included.

Prior to the EMS Task Force being established, the Orleans County Legislators worked with the Emergency Management Office to identify three major focus areas for the EMS Task Force to explore: augmenting the existing services with county municipal ambulances, contracting with the existing providers for service, and an EMS model similar to what is being used in the West side of the County.

The first meeting of the Orleans County EMS Task Force was held on Feb. 16, 2022. Although introductory, the meeting laid important ground work for future meetings. Each ambulance service provided an overview of their operation and an evaluation of their strengths, weaknesses, challenges they face and how they overcome them.

A history of EMS within Orleans County was provided so that all members of the Task Force had an understanding of the challenges currently faced.  One challenge highlighted, addressed the loss of six volunteer fire department operated ambulances or transport capable rescues in the past 15 years, with a seventh loss looming, as a result of less volunteer medics and rising operational costs.

Additionally, each ambulance agency within the county is different; what is legally allowed to do for one agency may not be allowed for another. Kendall Ambulance is all-volunteer non-profit, COVA is non-profit and combination of career and volunteer, Medina Fire Department Ambulance is a municipal agency, and Monroe Ambulance is a career for-profit agency.

Response metrics for the previous 4 years were distributed, showing increased requests for ambulances, increased response times, increased number of calls the responsible agency was unable to handle, and increased requests for mutual aid response.

‘Medicaid and Medicare are also an issue of great concern when it comes to funding.  Medicaid and Medicare reimburse at rates of 20-30% of what is actually billed by the transporting ambulance agency.’

For some agencies the increases were minimal and no cause for alarm, while for others the numbers were concerning. Each metric examined has an impact on each of the others; more requests for services means less ambulances available which leads to ambulances responding from greater distances, or relying on other ambulance services for mutual aid which causes shortages in other service areas.

As meetings progressed the three focus areas remained consistent, but the Task Force also began to evaluate additional factors impacting these focus areas.

Staffing shortages continue to be a challenge for volunteer and career agencies. One contributing factor is that EMS is not considered an essential service, and therefore not a part of the same retirement and benefit systems that law enforcement and firefighters are a part of.

As a result, EMS sees a large turnover of personnel as they ultimately seek jobs outside of EMS that offer those benefits. For both career and volunteer medics, there is a great deal of training required to become certified and additional education is required to keep certifications current. The financial investment of this training can be significant.

Many of the local volunteers happily donate their time to participate in available training and respond to a calls. However, as dedicated as volunteers are, outside obligations sometimes mean the local fire department is unable to have an Emergency Medical Technician (EMT) on every call within their response area. As a result the Task Force is looking at ways to better compensate career medics and how to recruit and retain both volunteers and career personnel.

Available funding is one of the ongoing issues for ambulance agencies. The EMS Task Force sought proposals to evaluate costs associated with providing EMS service, at varying levels, in the East and Center portions of the county and exploring the means to fund this service. The creation of an ambulance district in order to implement a tax for service has been discussed, and is on the September meeting agenda, but unfortunately includes a long legal process to establish.

Recruitment, training, continuing education and retention of both career and volunteer providers will remain focus areas for the EMS Task Force going forward.

Insurance reimbursement plays a significant role in an EMS agency’s bottom line. Although New York State Law requires insurance checks to be paid to the patient rather than the transporting EMS agency, this often times results in delayed payment or non-payment to the EMS agency. And although legislation has failed to pass committee on either the Senate or Assembly side for over a decade, our County Legislators and EMS Coordinator have continued to work with Senator Ortt, Assemblyman Hawley, Assemblyman Norris and the Senate Minority Office to get this legislation changed.

Medicaid and Medicare are also an issue of great concern when it comes to funding.  Medicaid and Medicare reimburse at rates of 20-30% of what is actually billed by the transporting ambulance agency.  Locally the impacts of this low reimbursement have impacted COVA significantly. The Villages of Orleans, Albion Correctional Facility and Orleans Correctional Facility all fall in COVA’s response area and most transports from these facilities are Medicaid or Medicare covered, these responses ultimately result in a loss.

As it stands now, estimated costs to provide services for EMS service in the Center and Eastern portions of the county are being obtained by the towns. If agreements are met between the towns and service providers in regard to ambulance coverage, this solves only one challenge we currently face.

Recruitment, training, continuing education and retention of both career and volunteer providers will remain focus areas for the EMS Task Force going forward.

In the unfortunate situation that an agency is no longer able to provide service, there are mutual aid plans in place at the state and county level to ensure that ambulance coverage will still be provided.