It is often accepted as conventional wisdom that healthcare, the largest sector of the economy, is recession-proof. The belief is that people get sick and injured no matter what’s happening to the economy. Furthermore, many people presume publicly funded safety net programs ensure people who need care receive it. As a result, it is assumed that healthcare institutions will continue to prosper in spite of a declining economy.
As EMS healthcare administrators, we know this type of logic is a recipe for disaster. For the last several years, both public and private EMS agencies have faced significant financial challenges. Those challenges are caused by the fact that nearly 50 million Americans are without health insurance, and those who have it are struggling with cutbacks in what’s covered, higher copayments for services and rising deductibles for out-of-pocket expenses. Moreover, agencies have been plagued with Medicaid and Medicare cuts and squeezed by rising costs and decreasing reimbursements from insurers.
As we now know, healthcare and EMS are not so recession-proof. We have to treat and transport individuals regardless of their ability to pay. Now that we recognize this, how do we not only survive in this new economy, but prevail? How do we manage our declining finances while at the same time increasing the quality of services we provide? How do we become stronger as individuals and organizations at a time when many businesses and their leaders are capitulating to mediocrity or worse?
There is no one blueprint to answer these questions. However, this article provides insights and theories that will help EMS leaders build their own unique strategies. It does not necessarily provide answers, but rather poses questions intended to spark your curiosity, create dialogue and help EMS leaders find the answers inside themselves.
Beware of “Creep”
Get back to the basics—the most fundamental relationships we all share as employers and employees. This relationship can be summed up in one word: value. When an employee is first offered a job, he/she is promised a salary and benefit package. Every pay period, a check is issued to the employee, and benefits accrue. In return for the salary and benefits, the employee meets the expectations of the position for which he/she was hired. Both employee and employer receive an agreed-upon value from each other. In a weak economy when financial resources are scarce, squeezing every ounce of value out of everything we do is crucial.
What happens if the employer violates the agreement and stops paying the employee? There are laws to protect employees and ensure they get the salaries they were promised. But what happens if the employee breaches their part of the agreement? If expectations were outrageously compromised, the employer has legal rights and may dismiss the employee from the organization. This is not the norm, however. What usually occurs is a slight continual decrease in performance over time that goes undetected until inertia sets in. This sliding decrease is similar to a slow, progressive contagious disease that isn’t identified until obvious signs and symptoms appear. I refer to this disease of diminishing performance as the “creep.” When creep infects employees, they violate the agreement they made with their employers. In other words, when an employee produces 95% of the agreed-upon expectations, he still accepts 100% of his paycheck. When employee performance drops to 90%, she still receives 100% of her pay and benefits. When employees are infected by creep, the basic principle of value is compromised. When that happens in a good economy, the impact is painful. When value is compromised in a declining economy, it can be deadly.