Do you think EMS will change under Obamacare?

[HERBIE1]

I started a separate thread on this to specifically address this question. I am referring to only how our jobs may or may not change, not our personal lives. I had someone ask me this question the other day, and I had to stop and think because my first instinct is to express my personal displeasure for the idea.

Personal opinions-

First, a lot of this is predicated on the notion that we WILL see a single payer, government run, public option plan- which is the ultimate goal of Democrats.

I think there will be many consequences, but many may not necessarily be immediately felt. I think that restrictions on Medicare payments will be further reduced(Medicare is being cut 500 billion under the plan) so we will see more and more doctors refuse to take new Medicare patients-similar to what happens now with Medicaid. More stress on ER's.

I think that like salary caps on CEO's and execs of companies the government has now taken over, I see the salaries of doctors being regulated in order to cut costs- less insurance pay outs. Look at the salaries of docs in Canada vs the US. (More stress on ERs.)

I think that because there already is a severe shortage of docs in many specialties, it will only get worse. Things like tort reform and enormous malpractice insurance(which causes docs to opt out of high risk practices) has not even been addressed in this bill. These specialties include trauma, OB/Gyn, high risk neonatal, neurosurgery, which directly impacts the quality of care available for our patients and what facilities will be available to them(and us).

Medical school enrollment is already down, and the shortage of family practioners will only get worse for the above reasons. Medical school(and education debt in general) has skyrocketed, which means future docs will opt for more higher paying specialities. Family practice and preventative care is supposedly a cornerstone of this bill, so how do they address this? Additionally, the government will now be controlling the issuance of most student loans, and as such, they could have a huge impact in potentially deciding what type of education they will finance. Will a future doc want this type of regulation and control? Will many of the best and brightest opt for another career? More shortages.

I have more, but I'll cede the floor now.

As for EMS in particular, I think that by necessity our roles will expand under Obamacare. Couple the push for expanded primary care, the huge influx of more patients who are "covered", and the shortages of primary care providers, and I cannot see how our roles would not be changed and expanded. They can provide extra training for EMS providers, and pay us a few extra bucks, we will be doing far more primary care to cover the shortages in this field, and they will save billions. For many problems, the difference will probably be negligible, but what happens when you really need a doc and none is available, or the wait is too long? We're back to square one again. I know it's happening in some places, but it would be a huge departure for most providers and a fundamental shift in our focus. Would the AMA fight such initiatives? Good or bad for EMS? That remains to be seen.

So- what say you, folks? How do you think EMS will change- if at all? Short term? Long term? Will these changes affect whether or not you stay in the business? How do you think it will affect future providers? Personally, since I'm in the home stretch of my career, I'll probably be retired before our jobs significantly change, but it also depends how quickly things move ahead.

[Chief1C]

In my opinion, and I really don't want to dig deep or speculate with out more information; but I foresee it being bad for smaller services. Small, one town companies, "mom and pop" services, possibly voluntary services that do bill. I don't support EMS that doesn't bill the patient for costs. We're a "rural" service, so we get more reimbursed. Medicare is definitely in the red, as far as what they owe us. I see more bills going to collections. I don't like to see a monopoly of ambulance companies. But I do think that Obamacare, with bundled costs, will have less of that money going to the EMS end of health care. Thus, the loss of services that are fighting to hang on, tooth and nail as it is.

[crotchitymedic1986]

First and foremost, remember that it is never as bad as people make any new thing out to be. The sun rose this morning, and will rise again, despite all the claims of the pending armegedon. This debate is much like that of the "fair tax" issue. People who are against the fair tax claim it is bad because everyone would have to pay a new huge tax on top of consumables that they buy; what they don't understand is that you are currently paying that tax now when you buy something, it is just embeded. For instance, if you buy a loaf of bread for $2.00, the cost of taxes paid by the farmer, the bread company, and the transportation company (and any other assoicated cost you can think of is in that $2.00/loaf price.

The same is true of healthcare. We are all paying the price for the uninsured through higher fees and premiums. Thats why an aspirin cost $10.00 in the hospital, because you (who are insured) are paying for all the free aspirin that was given to others. If they can get everyone to buy insurance, all of our rates will come down.

[HERBIE1]

In my opinion, and I really don't want to dig deep or speculate with out more information; but I foresee it being bad for smaller services. Small, one town companies, "mom and pop" services, possibly voluntary services that do bill. I don't support EMS that doesn't bill the patient for costs. We're a "rural" service, so we get more reimbursed. Medicare is definitely in the red, as far as what they owe us. I see more bills going to collections. I don't like to see a monopoly of ambulance companies. But I do think that Obamacare, with bundled costs, will have less of that money going to the EMS end of health care. Thus, the loss of services that are fighting to hang on, tooth and nail as it is.

I agree that it's unclear exactly if and how EMS will be impacted by this- too soon to tell, but you can certainly extrapolate, based on what has been proposed. Because this is so complicated, it's hard to know what's in store.

[scubanurse]

Does anyone believe that since more will have the insurance and opportunity to see a PMD, that the stress on ER's might in fact go down? Right now ER's are flooded with "non-emergent" problems because people can't afford to go to the doctor and they know that the hospital will work with them or even just ignore the bill whereas a PMD would send debt collectors and harass the patients for money.

Also, with some sort of government control over insurance companies, we could see the cost of services go down. Right now say a private insurance company states they will pay 50% of what the doctors office or hospital bills them because that is what they seem fair. Say the hospital needs to charge $1000 for every ER patient just to make a slight profit (because lets face it, healthcare will never be a non-profit organization), they know that if they charge the insurance companies that $1,000, they will only see $500 in the end. So they raise their ER prices to $2,000 knowing that the big insurance company will then pay them their $1,000 that they need to cover operational costs and the costs of those who won't pay or don't have big insurance covering their asses.

If there were some sort of government regulation on the COMPANIES (not the individuals), like there are regulations on banks and auto manufacturers, then we might actually see the cost of healthcare come down in this country.

The effect on EMS will vary throughout the regions, as it does now with the economy. Some will see benefit, while others may not. It is no different than the effects we have seen over the last 8 years or so with the economy falling to pieces and the unemployment rates so high.

[Dustdevil]

The same is true of healthcare. We are all paying the price for the uninsured through higher fees and premiums. Thats why an aspirin cost $10.00 in the hospital, because you (who are insured) are paying for all the free aspirin that was given to others. If they can get everyone to buy insurance, all of our rates will come down.

You seem to forget that no law is going to put money in anybody's (except politicians and government employees) pocket. Those who cannot afford health insurance will still not be able to afford it. Consequently, we're either going to pay for their health insurance, 100 percent, or pay to incarcerate them for not having it. Not to mention that we will now be paying for one more level of bureaucracy that did not previously exist. We may get our aspirin cheaper, but we'll be paying twice that "savings" for the privilege of it.

Smoke and mirrors.

[brentoli]

As for EMS in particular, I think that by necessity our roles will expand under Obamacare. Couple the push for expanded primary care, the huge influx of more patients who are "covered", and the shortages of primary care providers, and I cannot see how our roles would not be changed and expanded. They can provide extra training for EMS providers, and pay us a few extra bucks, we will be doing far more primary care to cover the shortages in this field, and they will save billions.

I think one of two things will happen

A) Pay will become worse, supplies will becomre more scarce, and response times will get longer.

The economy will catch up with EMS and we will start seeing job reductions.

Medicare is dropping and will continue to drop reimbursment rates. Costs are rising, EMS providers will now have to provide insurance if they didn't before. Supply costs are rising. Fuel is rising.

Whats supposed to happen?

[FireMedic65]

Does anyone believe that since more will have the insurance and opportunity to see a PMD, that the stress on ER's might in fact go down? Right now ER's are flooded with "non-emergent" problems because people can't afford to go to the doctor and they know that the hospital will work with them or even just ignore the bill whereas a PMD would send debt collectors and harass the patients for money.

Also, with some sort of government control over insurance companies, we could see the cost of services go down. Right now say a private insurance company states they will pay 50% of what the doctors office or hospital bills them because that is what they seem fair. Say the hospital needs to charge $1000 for every ER patient just to make a slight profit (because lets face it, healthcare will never be a non-profit organization), they know that if they charge the insurance companies that $1,000, they will only see $500 in the end. So they raise their ER prices to $2,000 knowing that the big insurance company will then pay them their $1,000 that they need to cover operational costs and the costs of those who won't pay or don't have big insurance covering their asses.

If there were some sort of government regulation on the COMPANIES (not the individuals), like there are regulations on banks and auto manufacturers, then we might actually see the cost of healthcare come down in this country.

The effect on EMS will vary throughout the regions, as it does now with the economy. Some will see benefit, while others may not. It is no different than the effects we have seen over the last 8 years or so with the economy falling to pieces and the unemployment rates so high.

Primary care physician's offices are flooded too. Just an FYI.

[Lisa O]

I am scared as hell quite honestly. I have no idea what will be of EMS by the time I am done with all of my schooling and training.

1)I have no idea what will happen under the new Obamacare bill as far as EMS jobs, and now, education wise as well.

2)I keep hearing (reading blips on here) how fire wants to take over EMS. I do not want to be a FF, thats not my goal. If I did, I would go for that. Not knowing exactly whats going on between the two, I do what I do best, think the worst..lol

The only thing I can do is just buckle down, get what I need to get done, and just hope, pray and cross fingers that everything will work out best, and be just fine. I can only hope that where I live, within an hour (give or take) in each direction of me is a larger city, I hope my options are greater.

[JPINFV]

Medical school enrollment is already down, and the shortage of family practioners will only get worse for the above reasons.

Err... source? The number of applicants might be down, but I have a hard time thinking that the number of students is going to decrease anytime soon considering that there's twice the number of applicants as spots. Similarly, off the top of my head, the following medical schools have opened up in the past few years: Commonwealth Medical School (PA), University of Central Florida, Florida International University, Touro University: New York, and Rocky Vista University (Colorado). Additionally, several more medical schools (both MD and DO) are getting close to enrolling their first class of students. If anything, the number of US medical students is going up and will continue to go up. What hasn't changed is the number of residency spots to accommodate new graduates, which will force more students into the primary care fields simply due to a lack of options.

Additionally, the government will now be controlling the issuance of most student loans, and as such, they could have a huge impact in potentially deciding what type of education they will finance.

It's been like that for a while. The last time I took out a non-government backs loan was my first year of undergrad for the 2003-2004 academic year, and that was a university backed loan, not a private 3rd party loan. Given the current benefits of student loans, I can't think of any reason not to take out Stafford subsidized, unsubsidized, and GradPLUS loans. As far as I'm concerned, with those loans it doesn't matter if I'm taking them out from Fannie Mae, Citibank, or through the direct loan program. In fact, in a lot of cases, I don't have a choice who services those specific loans as that is decided by the financial aid department. Where else can I find a fixed rate 6.8% (Staffords) loan where part of it I don't pay any interest at all until I graduate, have automatic deferment through school with a single capitalization (so no paying interest on interest until I graduate), that I can defer through residency, and can choose to repay in 10 years or 30 years with no prepayment penalty? Additionally, I can return any unused funds at any time during that term and get back the origination fee and the interest on that portion. Now, yes, interest rates are currently low, but what's going to happen 10 years from now when I'm in the middle of repayment?

Say the hospital needs to charge $1000 for every ER patient just to make a slight profit (because lets face it, healthcare will never be a non-profit organization)

Um, even non-profits have to take in more money than they spend (i.e. profit) or else they won't survive. Now what's different is where the spend the money. One of the big non-profit hospitals in So. Cal. makes a tidy profit, so what do they do? Well, in the past 10 years they've built a new patient care tower, a new central plant, and are currently expanding their already large emergency room to handle more patients. In the end, there's nothing really non-profit about non-profits.

Edited March 28, 2010 by JPINFV