Ambulance services in rural Oklahoma are finding it more difficult to operate because of increased supply costs, lack of paramedics and low reimbursement rates from Medicare, a Lawton ambulance service director said.
Bruce Crowell, EMS director for Kirk’s EMS, points to the rising costs of maintaining ambulances, medical supplies and hiring qualified employees to work as paramedics and EMTs (emergency medical technicians).
“We get no subsidies from any type of government. We operate solely on what we bill,” he said. “Is it going to come to getting a subsidy to better serve our rural areas?”
Some rural counties have adopted 522 Ambulance Districts, which allows them to charge a fee for service. Some ambulance services are funded through a property tax levy or a sales tax. In a few cities in Oklahoma, a monthly ambulance fee is tacked onto residential water bills.
“It’s getting harder and harder each day (to operate),” Crowell said. “We need to replace ambulances now. It costs 30-40 percent more to replace ambulances and that’s basic, no-frills. The cost of maintenance and medical supplies are going up. We’re probably looking at another year of 10,000-plus calls and it’s getting harder to get some (supplies).”
If Kirk’s EMS ordered an ambulance today, the company would not receive the vehicle until April or May “if we’re lucky,” Crowell said.
If an ambulance service goes out of business, the effects on customers and those calling 911 will be disastrous, Crowell said.
“I think you’re seeing that issue throughout the U.S.,” he said. “We’re hoping for an increase in Medicare or Medicaid funding, but that’s not for sure. For us, it’s not quite that bad, but we are watching things closer now than ever before.”
Dale Adkerson, director of emergency services for the Oklahoma State Health Department, said closures would create struggles in rural communities at all levels.
“When an (ambulance) agency closes, it puts a burden on everyone providing services as well as needing healthcare services. When an EMS agency closes, then any ambulance service responding into that area must travel further to go to a patient, then travel further to go to an appropriate destination.”
Adkerson said he’s learned from some EMS agencies that Medicare fee adjustments are being proposed but is unaware of any significant increases.
Kirk’s EMS has operated in Comanche County since 1972 providing basic and advanced life-support medical services. Recently, however, finding qualified paramedics has been difficult due to many people leaving the medical profession because of COVID-19 and the stress it creates.
“You don’t know what you’ll encounter on a daily basis,” Crowell said. “There’s a lot of mental anguish with being a paramedic and EMTs.”
Kirk’s EMS prefers to “grow them” by paying for paramedic students to attend school provided they commit to working for Kirk’s upon graduation.
“It’s a big expense to us for a two-year program, but we have them for a minimum of two years after graduation,” Crowell said. “We have to offer these guys a good package deal to keep them with a 401K, insurance benefits and paid time off. We’re a small service and it’s costly, but’s it’s something we have to do.”
Kirk’s also needs qualified EMTs who might advance to the paramedic level.
The problems facing ambulance services have been ongoing the past two decades. Ten years ago, an Oklahoma legislative panel heard of similar woes — low Medicare and insurance reimbursement rates, a growing number of Oklahomans without health insurance and the fact that although emergency medical service workers require extensive training, pay is far below other public safety professionals — making recruitment and retention difficult.
Urban issue, too
The paramedic issue isn’t solely a rural problem. The Oklahoma City Council recently listened to EMSA officials as they sought an amendment to its agreement that would allow the company to use EMTs instead of a required paramedic on non-life-threatening calls.
Currently, the agreement requires a paramedic and EMT on all calls. The proposal would allow two EMTs on non-life-threatening calls while paramedics would be used on emergency runs.
EMSA officials explained the shortage of qualified and licensed paramedics is one of the factors impacting the company’s ability to consistently meet response time obligations. Another major factor, they said, is that for many months, Oklahoma City hospitals have no beds for the patients EMSA brings them due to the COVID-19 pandemic. As a result, EMSA’s paramedics are experiencing four or more hours of wait time at local hospitals as EMSA cannot leave the patient until the hospital is able to assume care, said James Winham, EMSA’s president and chief executive officer.
Creating the tiered call system would allow EMTs to respond to more 911 calls, increase EMT patient care experience, increase frequency EMTs are used and may stimulate EMT interest in paramedic training, company officials told the council.
When a request for service is received in the 911 center, available paramedic and EMT units will be dispatched simultaneously, EMSA reported. Once protocols determine which unit is needed, the appropriate ambulance unit will continue to the scene. When an EMT unit is utilized, the paramedic unit will return to service and is then ready to respond to another call.
“This will allow the paramedics to go to the right calls at the right times,” Winham said.