Ambulance Service Providers across the nation are dealing with a financial crisis after the Medicare Extenders program passed its expiration date, leaving several first responder agencies in rural communities without vital funding.
In Missouri, counties are divided into three categories based on the population of a specific zip code; dividing them into three categories, urban, rural and super rural.
When the Medicare Extenders program expired on December 31, 2017, emergency service providers in Missouri suffered a reduction in their reimbursement. Urban providers lost 2 percent of funding; rural providers lost 3 percent and super rural providers lost 22.7 percent in addition to the 3 percent that was already lost to sequestration.
Missouri Ambulance Association President and Atchison-Holt County EMS Chief Gene Bradley said the Medicare program was started to help easy the costs for rural and super rural communities, but since its expiration, every community will start to feel the effects.
“To put in it simple terms of dollars and cents; Every dollar Medicare reimburses Buchanan County EMS for their care, they lose two cents on the dollar, with the cut. Rural areas lose three cents on the dollar. And Super Rural areas, where I’m at, lose 27 cents on every dollar,” Bradley said.
Most super rural communities have smaller populations with very few hospitals, long transportation times and a small number of ambulances available. In Missouri tax districts cover approximately 40-50 percent of the budget for ambulance services and the rest of the cost is picked up by the patient being transported.
While the Medicare Extenders program only provides federal reimbursement for Medicare patients, those patients make up the largest percentage of EMS services used in most rural and super rural communities.
Bradley said his ambulance district had a contingency plan in place for the withholdment of funds, but other districts might have to make sacrifices to ensure patients get proper care.
“When you take roughly 27-78 percent away of the money we’re being reimbursed by the government, it makes it hard to maintain that level of care. We try very hard to give them the same level of care they would get if they were in a city area, living where they do in the super rural areas,” Bradley said.
According to Bradley the average cost to fund a rural ALS crew 24/7 for a full year is approximately $250,000. Bradley said a reduction in educational training and a delay in updating their emergency equipment would be the first steps to conserve funds.
John Barclay, Chief of EMS for the NTA Ambulance District in Bethany, Missouri, said the lack of federal funding may force ambulance districts to cut their budgets to make ends meet.
“The only way we would be able to come up with it is to cut the budget. So we would lose services, lose coverage, lose abilities right now that the community benefits from,” Barclay said.
Barclay said the primary way to cut the budget would be to reduce staff and that could potentially be dangerous for the community.
The super rural community of Bethany would have to cut over $110,000 annually to compensate for the loss of revenue. NTA has started to use their reserve funds to balance their budget until federal funds can reimburse them for their services.
“Basically we are waiting to see a little bit. We have some reserves that are allowing us to wait to see what the federal government might do,” Barclay said. “It will definitely affect us, maybe not right away with the reserves we have in play, but it will [affect us].
Members of the Missouri Ambulance Association and the Ambulance Districts Association of Missouri have been working with Senator Claire McCaskill and Representative Sam Graves to reinstate the Medicare extenders program. However, no immediate action has been taken to insure funding for ambulance services.