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911: Will Local Ambulance Squads Flatline?

Narberth Ambulance
Facing financial emergencies, EMS squads from Narberth to Kennett Square, Radnor to Conshohocken and Berwyn ask for state and local support.  

by Davis Giangiulio, Managing Editor

Call 911 and EMS squads arrive within minutes to perform lifesaving measures. Now, it’s the EMS squads that need saving. In Montgomery, Chester and Delaware counties, leaders of ambulance companies say they are facing financial crises because they aren’t receiving adequate funding from the state or municipalities they serve.

Failure to solve EMS funding problems is having drastic consequences. In June, Tower Health announced that its Tower Direct EMS services, also known as Medic 93, will stop serving western Chester County by September 1. Tower Health did not respond to requests for interviews, but the Daily Local News verified the information via letters sent to local municipalities.

In other parts of the region, EMS services could become slower and less efficient. They could be further regionalized to make them more cost-effective and other squads could close. “I’m not saying that everybody’s going to shut down,” said Brian Zimmerman, executive director for Radnor Fire Company and EMS. “But ultimately you can only run a deficit in your budget so long before that’s it.”

Local EMS squads have been in the red for years. Berwyn Fire Company has had a budget deficit since at least 2017, said Michael Baskin, its EMS captain. “Most of that was related to shortcomings of EMS billing, stagnant fundraising, and increased cost of medical supplies, staffing,” he said.

The COVID-19 pandemic exacerbated the situation. Despite assistance from  state and federal grants and PPP loans, squads’ finances took big financial hits. With fewer people going to then-feared hospitals, EMS squads saw steep declines in insurance billing revenues.

Why don’t EMS squads have adequate funding? Most agencies aren’t run by the municipalities they serve. They’re separate entities that rely on funding outside of taxpayers’ wallets. EMS squads have other sources for funding, but many aren’t consistent and can lead to fluctuations in revenues while costs rise. Part of that is because EMS is a relatively recent development, said Al Davey, executive director of Narberth Ambulance, which serves Narberth, Lower Merion Township, Conshohocken and Haverford. “The idea of moving patients rapidly to a hospital is only something that has happened since the 60s,” said Davey. “These are not long-standing township commitments.”

Narberth Ambulance
Courtesy of Narberth Ambulance

In 2013, 1,645 EMS agencies existed in Pennsylvania. By 2017, there were just 1,278, according to the SR6 report by state lawmakers completed in 2018. The commission concluded the finances of EMS agencies are a key reason for their decline. “It’s not feasible for any agency to operate at a loss,” said Matthew Eick, assistant chief of EMS at Longwood Fire Company, which runs the ambulance squad that serves Kennett, East Marlborough, Pennsbury and Pocopson Townships. “So we need to figure out these problems now.”

Longwood receives around 30% of its funding from its municipalities, a relatively strong figure considering Narberth Ambulance receives 1%. But Eick said that’s not enough to create a sustainable budget. Longwood and other squads rely on billing revenue from insurance companies, Medicare and Medicaid.

But squads aren’t guaranteed that billing revenue. Insurance companies send their payments to the ambulance company through patients. “Patients  don’t realize they’re supposed to turn that over to the EMS provider,” Zimmerman said. “It’d be very helpful from a cash flow perspective of being able to receive those payments directly.”

Rising costs are straining finances; the most drastic is salaries. The decline in EMS volunteers has squads relying on paid staff. Baskin said at Berwyn the number of active volunteers is half of what it was 25 years ago. “These days, it’s definitely harder to find volunteers,” Baskin said.

Squads compete for a small talent pool. The SR 6 report revealed the number of EMTs in PA fell by 6,000 from 2012 to 2018, and paramedics declined by 4,000. To attract staff, companies often find themselves raising pay and creating a benefits scheme that is unaffordable for the squad. “What agencies have to do is look at the financial impact and realize it has to be sustainable,” Zimmerman said. “If not, you’ll have to go to employees and say, ‘We can’t afford to pay you anymore.’”

Berwyn Fire Department and Ambulance
Courtesy of Berwyn Fire Dept. and Ambulance

What’s the solution to the EMS financial quagmire? Many insiders say that townships and municipalities need to allocate funds to ambulance squads.  “If municipalities increased their contributions by 15-20%, it would give us a breather,” Davey said. “We need to spend more time walking up the hill asking for help from politicians.”

Narberth Ambulance is doing that. Over the last five years, squad leaders  slowly became closer with their local government officials. Eick said Longwood has an EMS regional commission that works across the six municipalities to consistently look at funding options. “If you have multiple municipal bodies working together, that’s going to make the cost a little more manageable because it’s shared over different places,” Eick said.

Creating sources of sustainable funding could allow squads to properly staff, equip and execute their life saving services. “We need to spend our time and energy on our clinical care,” Davey said, “not making sure trucks are fueled.”

Eick said the way to deal with this is through legislation at the statewide level, but the powerful insurance lobby makes progress difficult. Not just that, but the billing structure means ambulance squads that serve more prosperous communities with higher insured rates tend to have more success. Other squads that serve patients on Medicare and Medicaid or are uninsured, don’t fare as well. That’s what makes billing an unstable source.

Video courtesy of Rainman 14

The Longwood squad relies on a subscription drive, which creates revenue for the squad and allows residents to have a portion of the costs of a potential EMS trip already covered. Baskin said Berwyn seeks grants from all levels of government for additional funding for specific areas, like the SAFER grant which he said helps them with staffing and recruitment.

Fundraising events are another source of revenue. Jeanine DiTomasso, chief philanthropy officer for Narberth Ambulance, often does small fundraisers for new tools or materials the squad needs. The squad’s big annual event is Ardmore Rock N’ Ride, scheduled for Aug. 20. “This is the way local businesses and corporations demonstrate their investment in public safety,” she said. “That community engagement aspect benefits them as well.”

For more information about Ardmore Rock n’ Ride, visit ardmorerocknride.com.

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