EMS providers face serious financial threat
As our nation faces the greatest health care challenge of our lifetime, every Coloradan has been touched in some way by this deadly virus. The threat from this invisible enemy feels close, invasive and personal.
Nobody better understands its highly contagious nature and calamitous effects than the brave Colorado paramedics, EMTs and other first responders who serve on the front lines of this battle, dangerously close to patients in dire need.
EMS providers are often the first and usually the only source of emergency and non-emergency care in rural communities. Serving at the intersection of health care, public safety and public health, EMS functions as a safety net across Colorado.
Pandemic or not, when Coloradans and our many visitors dial 911 for emergency assistance, they expect a trained EMS responder to show up within a reasonable amount of time. The COVID-19 crisis has brought to a boil the long-simmering EMS funding problem, and unfortunately, we will soon reach a juncture where response times may be too long to save lives.
EMS providers, both public and non-public, are facing increasing financial strain due to three major factors.
First, with some of the lowest Medicaid reimbursements in the country, Medicaid rates in Colorado do not cover the cost of ambulance services; and given the economic situation, the number of patients with Medicaid has increased, exacerbating the problem. Even before this COVID-19 crisis, EMS providers struggled to fund ambulance activities.
Second, as the number of normal hospital procedures has sharply declined, so has the number of ambulance trips between hospitals. Interfacility transport is a key component of the revenue mix used to fund EMS services.
Third, the substantial decline in patient transportation to hospital emergency rooms due to the COVID-19 virus outbreak poses a serious problem for ambulance providers’ balance sheets. Across the state and the nation, we have seen EMS providers work hard to treat patients away from emergency rooms to prevent overcrowding and to minimize exposure to COVID. Yet perversely, Medicaid does not reimburse EMS providers when they treat patients at home.
In light of these problems, we ask that state and local officials work closely with our congressional delegation to take full advantage of federal funds in the Coronavirus Aid, Relief, and Economic Security (CARES) Act and ensure they are allocated as intended: to support Colorado’s public and private ground ambulance providers among other healthcare providers as we respond to the COVID-19 crisis.
We also ask the state to relieve the financial stress on Colorado’s EMS system by raising the Medicaid payment rates and expanding Colorado’s Medicaid Supplemental Payment Program to include our numerous nonpublic EMS providers. Furthermore, the state should establish a Medicaid reimbursement allowance for in-home treatment in lieu of requiring transportation to an additional point of care.
We at the Emergency Medical Services Association of Colorado kept the state’s severe financial challenges at the forefront of our minds as we considered possible solutions to the looming EMS crisis. As a result, the recommendations appearing in this column would be either revenue-neutral to the state or involve temporary increases in reimbursements, allowing our operations to recover from their current plight.
As part of our state’s emergency response, we believe it is our solemn responsibility to bring this developing situation to the public’s attention. We cannot allow the readiness of paramedic and EMT first responders to be yet another casualty of COVID-19.
All our expert epidemiologists believe the battle against COVID-19 is far from over. As the struggle continues, Coloradans will certainly need a strong line of first defense in the form of an EMS system that works for everyone.