Editorials, Opinion

How to save EMSs

The lack of emergency medical services (EMS) — and strain on those remaining — is a national crisis, but we feel it keenly in our area.

Between 2019 and 2021, West Virginia lost nearly 30% of its certified EMS providers: approximately 1,643 emergency medical technicians and 258 paramedics. Recently, Star City Volunteer Fire Department announced it’s suspending emergency medical services, and Preston County has lost two EMS operations.

Forest Weyen, Mon EMS executive director, spoke before the Joint Committee on Volunteer Fire Departments and Emergency Medical Services in May and to The Dominion Post at the beginning of June, and the message was largely the same: EMSs are struggling with recruitment, retention and reimbursement and it all comes down to money.

On the recruitment side of the problem, he pointed to the $250 certification fee for EMS workers, to be paid up front. Fortunately, MTEC recently received a grant to work with WVU to offer free EMT training for 50 applicants. Meanwhile, the Preston County Commission dedicated $6,000 to cover EMT training in exchange for the newly minted emergency responders working for the county for one year. The Legislature and various local governments have also been throwing federal rescue dollars at the EMS crisis. But these are only temporary solutions to a chronic problem.

 In West Virginia, EMTs make an average of $19.45 an hour and paramedics make just under $25 an hour (both 8% less than the national average), according to Indeed. Wages vary by  region and employer, and though this seems like a decent salary, it’s just barely enough to cover cost of living. These are also people we expect to respond to our emergencies — even save our lives — at a moment’s notice, day or night. They deserve pay in line with the expectations we place on them.

Of course, to pay employees, operations have to bring in money. EMSs bring in most of their revenue from actually taking people to the hospital. As Weyen said, they don’t get paid for cancellations, changed minds or being ready 24/7. Mon EMS has kept afloat by partnering with Mon Health and WVU Medicine for non-emergency transports.

Weyen complained that government insurances — Medicaid, Medicare and PEIA — don’t pay enough. It’s not unusual for these programs to pay less for medical services. But if we had to guess, the larger reimbursement problem probably comes from other insured, or non-insured, individuals refusing services after the ambulance has already arrived. And who can blame them?

According to a FAIR Health study, in 2020, an advance life support ambulance ride cost about $1,300, of which insurance would likely pay about $760, while a basic life support ambulance ride cost about $940, of which insurance might pay about $520. This is dependent on whether the ambulance service is in the individual’s insurance network. Even then, according to a 2020 study from the Michigan University Institute for Healthcare Policy and Innovation, 79% of patients will receive surprise bills for ambulance services, despite having insurance. 

And that is why a lot of patients refuse services once the ambulance arrives. Many patients not experiencing a fatal emergency will choose to take a car-share service or drive themselves specifically to avoid ambulance costs on top of other medical bills. In turn, EMSs struggle financially.

The best solution would be to make emergency medical services a taxpayer-funded program, like police and fire departments. A small fee or tax increase across a large population would give EMS outfits the guaranteed revenue they need to maintain operations, instead of depending on large bills from individuals who can’t pay. A levy could help, but like the extra federal dollars being fed into the programs, it is only a temporary solution.

Like other taxpayer-funded services, EMS is one that we hope we never need, but if we do, we want it to be the best possible — and one people can afford to use.