Is EMS Recession Proof ?????

[Doczilla]

Like every business nationwide, EMS will see it's bottom line hurt by the recession, even city services. Less income from constituents equals less city tax revenue equals smaller budgets. Tighter budget for Medicare and Medicaid means that payments will be delayed to providers even longer than they are now. Less people being able to pay premiums on health insurance + poor stock market performance (that's where the insurance companies gamble your premiums) = less payouts from insurance companies. It's ugly, but not the perfect storm to destroy EMS.

I wouldn't sound the death knell for the hospital based services just yet. Remember that these are designed to bring business into the hospital, particularly when there are competing hospitals around. Nobody has the bulk purchasing power, insurance power, and employee benefits power that the hospital does, and therefore nobody can do things cheaper. The ER is a money-loser for the hospital (spending more per patient than they are reimbursed), but 50-60% of admissions come through the ER. The ER is therefore a money-maker if it can attract patients. Just as the ER is now recognized as the front door to the hospital, so must they recognize EMS as an extension of that front door.

We will learn to get by. That means we will probably put off the purchase of the new truck and eek another 50K miles out of the old one. We'll keep humping the old stretcher and throwing our backs out because we can't buy the new stretcher this year. We'll still wear the old jackets and throw a cheap Gall's reflective vest over it because we can't afford the new 5.11 reflective EMS coat (which is awesome, BTW). We'll shut the trucks off and bring the drugs inside with us to keep them from freezing instead of leaving the truck cranked all night. Con-ed will be done in house by senior personnel instead of sending everyone to EMS Today. Overtime will be limited, Christmas bonuses will be smaller, and the JEMS Buyer's Guide will make us drool with all the cool stuff we don't have (and have always done fine without). There is still money to be made in this business. We'll get by.

'zilla

[Just Plain Ruff]

excellent post doc, I agree.

The iv fluids that we get have a cost to us of 91 cents. Not sure what the patient gets billed for but it costs our hospital 91 cents to purchase them. I'd be surprised if most private or municipal services get them that cheap.

[naturegirl]

Geez, perhaps it will be the rise of the volunteers as desperately broke EMS services cannot answer all the calls. Maybe patients will have to provide pre approval from their insurance before they get picked up by an ALS service. Or, God forbid, family and friends will have to transport the sickest and everyone else will just, well, suffer.

Or not.

Maybe they'll just print more smiley faced monopoly money and all will be good after all.

[crotchitymedic1986]

Alot of what doc says is true, hospital based has better purchasing power. I would argue that the benefits are not that great at most hospitals (unless you are part of a large national chain), as most Hospital based EMS providers are either stand-alone urban indigent care/ trauma centers, or are stand-alone rural providers, which means they are basically a small business, and usually have poor benefits as compared to a municipality (403B, insurance is more expensive, may not cover doctor's office visits, or may only be a 70/30 or 80/20 plan, usually no vision coverage).

Although the medicare reimbursement rate for hospital based services has improved, it is still substandard compared to private or government. For instance, if your hospital ems brings a chest pain pt to your ER and it is not diagnosed as MI, you can only either bill for the ER charges or the EMS charges, not both. Hospital base services do have an advantage in their yearly "charge-off" to medicare, but it doesnt make-up for the poor reimbursement rate year-round.

The reason I see hospital based EMS going under is as follows: Hospitals will see cuts in indigent care funding (if they had it to start with), they may not be able to float bonds as they normally do to raise capital, and with more layoffs - more patients will be uninsured. Hospitals usually only make single percentage point profits (<5%), if they are making a profit at all. So when they cut, they have to cut where it will do the least harm: The Education department is usually first along with commuinity outreach or mobile services, followed by EMS. Some are opting to drop OB as well.

EMS people may subscribe to the theory that they wont cut us, because we bring patients to the hospital, and they cant afford to lose patients. But the reality is that most patients have already chosen their hospital based on preference or where their doctor practices, not on the suggestion of EMS (especially in a rural environment where there may only be 1-2 hospitals within a 50 mile radius). They can not close the ER, as it would damage the community; they can argue that privatizing EMS would not (and it may not depending upon the quality of that provider).

[spenac]

Some are opting to drop OB as well.

(especially in a rural environment where there may only be 1-2 hospitals within a 50 mile radius).

I've seen the OB discussion. They will deliver in the ER and ship mommy and baby to another hospital for recovery, or ship by ambulance before delivery if not dialated beyond certain point(which is stupid as some women go from 1 to 10 in minutes). Makes no sense if all goes well with delivery just send them home but thats another discussion.

2 hospitals in a 50 mile radius wow that would be nice. If thats rural what is mine? Nearest hospital is 90 miles from our community of over 6000, plus at least another 6000 people in the county, some over 2 hours drive by ambulance to the hospital. The next hospital is 154 miles away. And both hospitals are bandaid hospitals not major trauma centers. Nearest level 3 is about 250 miles away. Nearest level 4 is 350 miles away. Nearest helicopter is now 45 minutes away once airborn, but they allow 20 minute launch, so really over an hour out. Used to be no helicopter to could reach us w/o refueling.

[crotchitymedic1986]

Spenac, that isnt rural, thats GOD' COUNTRY !

[spenac]

Spenac, that isnt rural, thats GOD' COUNTRY !

Yes sir. Nothing better than miles and miles of beautiful mountains with limited human impact. Rare nowadays.

[crotchitymedic1986]

First of many 911 providers who have started doing non-emergency totes as well:

http://www.4029tv.com/news/18396977/detail.html

[crotchitymedic1986]

And the snowball starts rolling downhill:

http://www.wdxe.com/wdxe.php?rfc=narticle.php&id=12212

http://www.news-tribune.net/local/local_story_027141416.html

http://www.tribune-democrat.com/local/loca..._026232559.html

http://www.wivb.com/dpp/news/council_votes..._service_090126

http://www.kval.com/news/local/38430399.html

http://www.reporter-times.com/stories/2009...s.nw-857710.sto

http://www.chestertontribune.com/PorterCou...tudy_ambula.htm

http://money.cnn.com/news/newsfeeds/articl...ire/0466742.htm (this one and one above involve hospital based providers)

http://www.kimatv.com/news/38035894.html#

And these are just this week's

[spenac]

911: Sorry we have no ambulance service your community decided parades were more important than staffing an ambulance.