Ambulance services face falling revenue
Fleets confront uncertainty during pandemic
In the early months of the coronavirus pandemic, crews with Cetronia Ambulance Corps saw the number of emergency runs they were making drop by about a third.
The nonprofit’s nonemergency transports — such as rides for people to doctor’s appointments or from one medical facility to another — also fell by about 50%.
And while call volume climbed in subsequent months, finally reaching normal levels this fall, CEOBobMateff still expects revenues to be downabout 15% for the year. The organization has an annual budget of about $12 million.
“2020 has certainly been an extremely challenging year,” Mateff said.
It’s a sentiment echoed by several organizations across the Lehigh Valley, which not only found less demand for ambulances in the beginning of the pandemic, but also rising costs related to personal protective equipment and disinfectants.
While state and federal grants helped offset someofthelosses, Lehigh Valley ambulance crews still work in an incredibly stressful environment with the threat of COVID-19 constantly looming.
The grants are not enough to completely overcome the financial hit of the pandemic, said Heather Sharar, executive director of the Ambulance Association of Pennsylvania.
“There is a little help out there, but EMSisstill struggling,” she said, adding that moregrant moneycould be onthe way.
Across the state, Sharar said, ambulance services are dealing with a storm of bad conditions, some of which existed before the pandemic and then were exacerbated by it.
“Before the pandemic there was low reimbursement, a staffing shortage, [a need for] education, the same things they’re grappling with now, but it’s highlighted even more because they’ re having to really try and cut more costs, which is difficult to dowhen you’re required to staff and equip at a certain level to maintain your license,” she said.
Over the last decade, the number of emergency medical technicians in the state dropped by 16% and the number of paramedics dropped by 44%, according to a Pittsburgh Tribune-Review analysis of state data.
Mergers and closures of organizations are likely to continue, Sharar predicted, as ambulance services grapple with the revenue shortfalls.
Managing costs
At Suburban EMS, a nonprofit that covers 19 municipalities, including 14 in Northampton County, officials are taking capital purchases quarter by quarter. For example, instead of purchasing four new ambulances, they bought two, said Ryan Hoff, the operations director.
More than finances, hesaid, the emotional and mental stress of the pandemic weighs heavily on first responders, who recently became eligible for a coronavirus vaccine.
It takes longer to clean an ambulance after a run, said Michael Ratt, an operations administrator at Suburban. Before COVID19, ambulances were cleaned if there were bodily fluid or a reason to clean them. Now, trucks have to be wiped down after every call.
The process takes 10-15 minutes, and at Suburban, it’s not uncommon for EMTs or paramedics to respond to 10 calls during a shift.
Generally, he feels more protected at work than whenhe’s not working.
Jonathan McCombs, another operations administrator, said the needfor extra personal protective equipment adds strain to the day to day, as does losing staff to quarantines.
“[It] creates more openings, so there’s lots of people to work and it also creates more[overtime], so a lot more of us have to work more shifts,” he said.
Jeff Young, executive director at Suburban, said the service was lucky to be fully staffed when the pandemic started. Suburban has since lost some employees and laid off others, but has been able
to bring some back.
The organization started with about 155 people on staff, now it’s closer to 130.
Suburban EMS has transported more than 1,600 COVID-positive or presumed positive patients, Young said. He said five employees have tested positive.
“It amazes me how they put their nose down and go at it day after day after day with this cloud hanging around,” Young said
In Emmaus, call volume dropped so much that the borough stopped running its second ambulance, Borough Manager Shane Pepe said.
Emmaus Ambulance Corps’ revenue was at $734,000 instead of the budgeted $957,000.
But expenses also are down, thanks to the idled second ambulance and a delay on hiring an
ambulance chief. In all, Pepe said, expenses are at $818,000 instead of the budgeted $1.57 million.
“We cut everywhere,” Pepe said. “We cut a lot of operational expenses, a lot of capital stuff, cut that second truck, pulled back on different transports, where we were breaking even at best.”
Pepe said the borough wouldn’t have been able to cut so much if demand wasn’t also down. Even with just one ambulance, the borough is missing three or four calls a week, about the same number before the pandemic, when the borough was running twoambulances. (Another ambulance service responds when the borough can’t.)
He said that if calls go back up, the borough will put its second ambulance back in service.
Calls ticking up
Not every ambulance organization has seen a decline in emergency runs.
The nonprofit Macungie Ambulance Corps saw a reduction in call volume early in the pandemic. But those calls ticked up, with October being its busiest month ever. Crews are now on track to meet or exceed the numbers of calls they responded to last year.
Christopher Greb, Macungie’s operations manager, suspects people initially didn’t know what to expect from the coronavirus, and deferred care rather than calling for an ambulance.
“My guess is as the pandemic has worn on and maybe some folks haven’t been personally impacted, they aren’t maybe as scared as they were previously,” he said. “So, take regular call volume, which always goes up each year, and add COVID call volume and that’s why I think we’re caught up.”
Eric Gratz, Allentown EMS chief of operations, said his
department is an anomaly. While most ambulance organizations have seen a 10%-25% decrease in call volume, his department has seen an increase. He pegs the difference on the underinsured and uninsured population in Allentown, where people have poor access to health care.
“We become a lot of folks’ primary access to health care,” he said.
The Easton Emergency Squad, another nonprofit ambulance service, did about 4,500 runs this year, compared with 6,500-7,000 last year, Director Ashlee Vaughn said.
“It’s just a rough time for health care providers, especially ambulance workers,” she said. “Everyone looks to hospitals and stuff, but the EMS community ... [is] consistently going out there and putting themselves literally onthe front line.”