Critical Call

The EMS service in Meadville has been at the forefront of discussion for quite some time. What began as a concern over staffing, and low or non-existent reimbursement for services, has turned into a city-run ambulance service. How did we get here? What will this require of an already fragile city budget? We're not going to stand around waiting for the call to come in, we're going to dive in and explore this topic today.

Let's begin with the first of many questions; how did we get here? According to Evan Kardosh (newly appointed EMS coordinator) at an EMS town hall meeting that was held on December 20, 2022, this is the result of decade-long discussions. But, this suddenly quickened discussion and presentation to council was a result of the Meadville Area Ambulance Service asking for a 0.5 mill tax increase from municipalities. For the city of Meadville, 0.5 mill is equal to $75,000. This request was made as a result of a budget that wasn't sustainable for MAAS. This brings to light a couple of questions; why is MAAS struggling? What kind of other problems are they facing?

Let's start with the tax increase request. Where is this coming from? According to Jason McPherson, at an EMS commission meeting on February 28, 2022, there is a lack of funding, lack of personnel, and the average age of responders is 50. The EMS system is close to system failure. It's also interesting to note, that when calling 911 and being questioned, some callers know how to answer the questions to receive a higher level of response. Whereas, in years prior people would take themselves to the hospital. At a city council meeting on January 18, 2023, they discussed insurance reimbursements potentially not meeting the cost of care. There is also the possibility of insurance company refusal to pay, based on a number of various factors. The main cause, according to Kardosh, is likely due to billing errors that result in the bill coming back as denied.

In a meeting with West Mead township, Eric Henry stated the following;

What kind of solutions were proposed by the EMS commission? From a June 30, 2022 meeting;

For understanding purposes, ALS means Advanced Life Support, whereas BLS is Basic Life Support. QRS means Quick Response Service, which is a non-transporting level of EMS. IRP means Immediate Response Personnel.

One would now likely be wondering, how will the city solve the issue of low reimbursement from insurance, without a tax increase? The solution for the city of Meadville? Create their own ambulance service. Won't this cost money? Yes. But, the city also plans to explore grant options for the purchase of ambulances and equipment for those ambulances. To this point, the city has already received a $38,000 grant to purchase the two ambulances that the city will have. The city has paid $20,500 out of pocket for these ambulances. There are a lot of assumptions surrounding grant availability and approval. But, we're not going to get into that, it's above our paygrade (in case you're now wondering, no we're not paid to do this). There was also discussion surrounding a new fee for lift assists. This is something the fire department already covers at no cost, but it may be a fee that they impose in the future.

Now, what about staffing? Councilman Roha asked if six additional people would be needed to staff an ambulance, to which Kardosh replied in the affirmative, provided that all new staff was hired. The plan would entail the fire department hiring three new people and rotating a fourth shift with the current staffing. There is of course a cost associated with hiring more staff, correct? That cost is $48,082, plus insurance and benefits. The EMS coordinator's salary is $58,150 plus benefits. Benefits would include health insurance, a defined contribution retirement account, and paid vacation. According to a quote from March 18, 2023, the department has hired 4 paramedics. (That is a potential $48,082 that was not initially accounted for in the projected cost analysis, considering they planned for 3 staff and have hired 4)

How do these salaries stack up against Meadville Area Ambulance Service? Well, according to a Facebook post from August 5, 2022, MAAS was hiring for essentially the same duty requirements, minus the potential of being cross-trained to assist a fire department. This job posting listed a base pay of $50,024, which included health insurance, dental/vision, life insurance, 401k match, and vacation/personal days.

One could argue the two are comparable. If there is an EMS staffing shortage, how can this be resolved? Higher pay? Maybe. But, higher pay increases expenses. With no increase in insurance payment, you would be facing a budget deficit.

It seems as though staffing is an issue. You need more staff to not overburden current staff and cause staff turnover. More staff costs more money. More money from insurance companies is unlikely. What then is the solution?

What about educating consumers on ways EMS services can be more efficient? The unnecessary use of the EMS system in non-emergent 911 calls is a concern. There's also the issue of getting insurance checks sent to the ambulance and not to the patient. This would take either a commitment to lobby for a change to this procedure, or patient accountability to ensure the check pays the intended bill.

At the end of the day, MAAS sought ways to solve the EMS budget crisis and staffing crisis by doing what they could do by state law, which was to ask municipalities to impose a tax for EMS services. The real goal with this seemed to be to encourage a state-level change. The state mandates municipalities to provide an EMS provider but fails to provide money to do so.

The city's solution seems to be utilizing state and federal grants to fund its EMS equipment and supplies. Staffing costs would then be offset by money brought in by insurance reimbursements.

In theory, this seems like a viable solution. Long term and in practice, that remains to be seen.