Emergency. Medical. Services. They are an essential community resource and one many expect is guaranteed like police and non-volunteer fire services.
However, EMS crews in West Virginia are not typically (or at least solely) government- or taxpayer-funded.
Monongalia EMS, which has been left to carry a heavy load with the recent closures of smaller services in the area due to budget constraints, is a nonprofit organization governed by a board of directors that includes citizens, county representatives and representatives from both health systems, WVU Medicine and Mon Health, said Forest Weyen, Mon EMS executive director.
The board approves and oversees the budget for the service, which according to Weyen, runs approximately $12 million-$14 million, if the agency was fully staffed at the current rates.
Weyen said on the expense side of the budget they strive to spend within the amount allotted, but outside factors are making that difficult.
“Just like we all are seeing at the grocery store and gas pump,” he said, “some things such as clinical supplies, medications, fuel, maintenance, uniforms, etc. — basically everything to perform the service — prices are shooting up quickly, so those items have been really impacting our ability to stay within our budget items.”
While the rising expenses of the service seems relatively straightforward, Weyen said Mon EMS does not usually meet its revenue projections, and there are many reasons for that.
The EMS payment model is where EMS operations can get very complicated, he said. But the key takeaway from the model is, with a few exceptions, EMS services can usually only bill a patient for the service if they take the person to the hospital.
So, what does that mean?
“The overdose that we reverse with our medications and equipment, and the patient does not want to go to the hospital?” Weyen said, “No one reimburses for that.
“The car wreck that we respond to and no one wants to go to the hospital? No one reimburses for that.
“Someone fell at home, so you call 9-1-1. We start an ambulance, but after a few minutes you determine that an ambulance is not needed? No one reimburses for that,” he said.
Many years ago, to help offset some of the costs of providing the EMS service, many agencies like Mon, Weyen said, started offering non-emergency services for things like transporting a patient from the hospital after an injury to a rehab facility, specialized facility, or nursing home.
Weyen said that while this was a great use of resources and helps to reduce the burden to provide services, it does not solve the problem.
“What a system like Mon EMS does is it allows for flexibility,” he said. “Say we have extra ambulances on to do [non-emergency] transports — if the county has more emergency calls than predicted, those additional ambulances can be placed into service without delay, ensuring the patient gets care.”
There is one big flaw in that system however.
“No matter how efficient we get Mon EMS, there will still be a need to leave an ambulance available and ready for our residents and visitors,” Weyen said.
“We want the people in Blacksville, Cheat Lake and Triune to have the same access to care as someone downtown. However, it is really expensive to have an ambulance ready 24 hours a day.”
Mon EMS makes up approximately 60% of its expenses from patient billing, Weyen said. Currently, Mon Health and WVU Medicine offset the remaining expenses to ensure services in the county.
Next year, the county is hoping to add to the pot, having approved $1 million to Mon EMS to help offset the added cost of EMS services, he said.
“The path that Mon EMS, along with Mon Health, WVU Medicine and Monongalia County is, in my opinion, one of the great things about this organization when Mon and WVU joined forces in 2019.”
This means the patients transported by Mon EMS will still fall into the normal insurance billing process.
If the levy passes, Weyen said, the county can assist with readiness and infrastructure costs to ensure the county has the resources it needs and the health systems partner to ensure that non-emergency transports are coordinated and efficiently completed.
“Everyone pays a little, and we get a really great system that is super cost-effective for all involved,” Weyen said.
Another big problem EMS agencies are facing is a major staffing shortage.
“EMS is a very tough industry to get into. For years, we have been struggling to pay our folks the wages they deserve,” Weyen stated. “We have made huge strides in that regard in the last year or so, but there is still work to do.”
According to Weyen, EMS has become the ‘’tip of the spear” in the healthcare industry, being the ones that usually make first contact and deal with people in horrible situations in a variety of settings and weather.
“We expect them to know how to solve most problems no matter what we throw at them,” he said. “In the last two years, these folks have lived in a COVID bubble where every patient was either positive or potentially infectious. This took a very difficult job and made it much worse.”
Weyen said there is no one answer to solving the ongoing issue and we have to continue to look at ways to improve the delivery model.
“We have to raise reimbursement rates where we can; however, that cannot be the only answer,” Weyen stressed. “Forward-thinking governmental bodies, like Mon County, have to realize there is a problem and then come up with a plan to address it — and then work to actually implement that plan.”
Weyen said the county is fortunate to have a county commission that cares enough about the people of the county to work to get a plan in place.
“We have a shared vision to ensure that the safety net for the county is here if and when we need it,” he said.
“We have to continue to evolve the profession of EMS, regardless if that is a career department or if you are still lucky enough to have a group of volunteers that provide that service.
“The healthcare environment is not getting any easier, and people are not getting any healthier. We are doing our part to be a very good safety net, but like any good net — we have to have a little bit of support.”
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