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Stefan Hofer’s ambulance company West Traill EMS in Mayville, North Dakota has only received one or two calls unrelated to Covid-19 in the past two months. But he said the number of cases had risen by 20 to 30 percent due to the pandemic. At the same time, the company’s expenses have increased, its revenues have soared and its workforce is being decimated by the virus.
The company – which is privately owned and supported by volunteers, a few employees and four trucks – covers more than 1,500 miles of the North Dakota prairie and serves approximately 10,000 people in the far eastern part of the state.
Private EMS services, in both urban and rural centers across the country, collectively received $ 350 million in Covid-19 relief funds in April, but these companies said the money ran out within weeks. . Months later, the need remains great as they face yet another outbreak of the coronavirus.
Hofer said he doesn’t know how long his business could maintain its current pace – let alone how it would handle the increase in the number of cases expected from the Thanksgiving holiday – if ambulance services like his didn’t receive it. no additional federal aid. He said he could soon lose employees. It could also mean answering fewer calls.
“It won’t be over tomorrow, and that’s the big deal,” he said. “We have to make sure that we can still take care of people six months from now, and that’s what has become really hard to figure out.
In a letter sent to the Department of Health and Human Services and obtained exclusively by NBC News, the American Ambulance Association said that “the 911 emergency medical system across the United States is at a breaking point. Without further relief, it looks likely to shatter, even as we enter the third wave of the virus in the Midwest and West.
A spokesperson for HHS said the agency paid nearly $ 107 billion to more than 550,000 vendors across the country and opened a third round of $ 20 billion in funding last month, which they said is available for ambulance services.
This third phase of funding, however, has a limit. It is available to all healthcare providers and suppliers up to 2% of their 2019 revenue. EMS services said they are grateful for the money, but that won’t stop them from going bankrupt. .
All the funding that the federal government has given us, whether it is P3s or HHS funds, is long gone.
The problem for private ambulance companies like Hofer is that they no longer receive the precious 911 or hospital transfer calls they once received as hospitals, nursing homes and people postpone surgeries. and other medical procedures due to the pandemic. Meanwhile, ambulance services have been forced to purchase more personal protective equipment, which has become 20-25% more expensive in recent months, to stay safe.
But revenues have slumped further because ambulance services are now also expected to treat those in place at the scene of an emergency. It’s the new standard of care during the pandemic, but the Centers for Medicare and Medicaid Services refuse to reimburse companies for this method of treatment if the patient is not technically transported.
It’s a huge financial blow to ambulance companies that answer 911 calls across the country, especially because if Medicare doesn’t cover it, most insurance companies won’t either.
“All the funding the federal government has given us, whether it’s P3s [Paycheck Protection Program] HHS funding or money, it’s all long gone, ”said Jim Finger, the executive director of the Vermont Regional Ambulance Service who chairs the American Ambulance Association’s Rural Provider Task Force. “But we still have all these problems and we are trying to find ways to survive financially and to continue doing our job.”
‘Reality doesn’t look good’
Private ambulance services serve about a third of communities in the United States, often in rural areas, but they have only received $ 350 million in federal relief – about the same amount as the dentists.
Hospitals and nursing homes, meanwhile, have received a total of more than $ 30 billion.
“US ambulance services are providing 24-hour, on-demand, skilled health care to every family in our country, despite soaring costs and declining income due to the Covid-19 pandemic,” Aarron Reinert said , president of the American Ambulance Association. in a report. “These financial challenges are exacerbated by the staffing shortage as paramedics and paramedics are quarantined after exposure or infection with coronavirus.”
The association said in its letter to the Department of Health and Human Services that the paramedics and emergency medical technicians who make up ambulance services across the country need $ 2.62 billion – about $ 43,500 for each of the roughly 60,000 ambulances that answer 911 calls. They suggested that the funds be withdrawn from the Provider Relief Fund, a $ 175 billion pot created by the CARES Act (Coronavirus Aid, Relief, and Economic Security ) to support healthcare workers and distributed by HHS.
Despite the continued request for support from the paramedics association, they received nothing beyond the $ 350 million they received in April.
“Compared to what other people we know in the healthcare industry have received, it’s a fraction, and it’s a fraction of the losses we have suffered,” said Hanan Cohen, paramedic and director of business development at Empress EMS, which operates in the Bronx and Yonkers in New York. “We hope for more, but the reality is not good for the aid. We are also researching structural changes in the way EMS and ambulance services are reimbursed in the United States. It has been a problem for 20 years.
While the fact that ambulance services are increasingly cash-strapped in the United States is not a new problem, the problem grows worse during the pandemic.
The growing number of cases across the country is also worsening. Many ambulance companies have said the current wave looks as bad in their communities as what New York EMS experienced in March and April.
“We had no idea when we saw all the peaks that happened in New York City that we would be one of those places where the peaks were just amazing and intense,” said Rachel Harracksingh, President of Life Ambulance Service in El Paso, Texas. . “I would love to give a risk premium because of the conditions we have to get into and what we have to see every day. It’s nonstop. “
No help in sight
President Donald Trump was asked about the financial challenges facing ambulance services at a press conference in early August. The American Ambulance Association, he was told, feared EMS companies nationwide had not received the help they needed.
Trump said it was the first time he had heard of it.
After praising the “paramedics” as well as healthcare workers, law enforcement, the military and the Federal Emergency Management Agency, he said: “I will definitely examine it. I mean, you’re telling me something for the first time. No one is complaining about not being overpaid, but we’ll take a look at the ambulance drivers.
Four months later, the White House declined to comment. Meanwhile, ambulance companies – especially the smaller ones serving rural areas – have said they are seeing their staff’s nerves unravel amid the relentless nature of the pandemic and little promise of relief. .
“I can tell you that the mental stress is about 10 times what it would normally be for us healthcare workers,” said Ronald Nichols, director of emergency services at Chambers County EMS, which serves a large rural county 50 miles east of Houston.
Yet further support is unlikely to come from the current pot of money or even from a new aid program.
All of our guys are on the front lines doing the same things these doctors and nurses do. We just have less access to funding than they do.
A Republican staff member from Capitol Hill, who is familiar with the current pandemic relief fund negotiations, said it was doubtful ambulance companies would get the help they asked for in the program. help being negotiated, although additional funding of $ 50 billion to $ 100 billion health care providers are currently seen as part of this bill.
However, this money will not go specifically to groups like ambulance companies.
“If we start making nominations, then all of a sudden we’re asking to put relentless pressure on how the pot is divided,” the staff said, tentatively noting that negotiations seemed to be on the right track recently. “I just don’t think Congress wants to put in any language that would hold anything specific to industries.”
They would prefer to use the same language that was used in the CARES Act, which delegated much of that decision-making to HHS.
But the ministry also uses similar reasoning, fearing that if it accepts requests from ambulance companies, they will come under pressure from growing numbers of people in the healthcare industry.
Ambulance companies across the country insist, however, that something must be done. They are the first to respond to the needs of Americans with the greatest medical emergency in modern history, and they say they are the closest to breaking up.
The situation, according to many, is increasingly demoralizing and emotionally trying.
“We have stressful lives to begin with, but we have chosen to serve our communities, to serve the public,” Nichols said. “We’ve always done it without recognition – and now we have a lot more with Covid-19 than we’ve ever done – but state lawmakers and Congress need to realize that all of our guys are on the front lines. and do the same things as those. doctors and nurses. We just have less access to funding than they do. “
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