Recently, as I went through my archives, I found an article from January 2002 written by John Erich titled “Surviving Tough Times: How to Ride Out an Uncertain Economy,” in which I was quoted extensively. As I read the article I realized the EXACT same things could be written today. In 10 years the fundamental issues facing EMS—management, leadership, funding and public awareness—have grown no less difficult, and are arguably even worse.
Let’s step back to January 2002. National unemployment was 5.6%; the Medicare fee schedule was in final rule form, about to be deployed but still open for public comment; the new HIPAA regulations were still being discussed, while scheduled for implementation in late 2002 and 2003; ePCRs were just becoming available and only early adopters had any interest; and we were at war, still reeling from the September 11th attacks on our nation.
Fast-forward to June 2012:
- The national unemployment rate is 8.2%.
- The Medicare fee schedule is fully implemented and pending a review, based on a Medicare cost survey currently underway. We are still grossly undercompensated for our services—even though the allowable for BLS is $111 higher, the allowable for ALS-1 is virtually the same, at least in my state of Connecticut (2002 BLS was $265.64 compared to a 2012 BLS of $376.97; 2002 ALS-1 was $447.95 compared to a 2012 ALS-1 of $447.65). There is a bill worming its way through Congress, the Medicare Ambulance Access Preservation Act of 2011 (MAAPA), which was introduced in the Senate on March 1, 2011 and in the House on March 10, 2011. MAAPA (S. 424, H.R. 1005) would provide a 6% increase under the Medicare ambulance fee schedule for ambulance transports originating in urban or rural areas for the next five years, but apparently it can’t get onto the floor for a vote.
- HIPAA regulations are in their second version, yet it’s tougher now to exchange information with hospitals and other medical caregivers because of data breach liability concerns raised by hospital attorneys. We are now required to provide more data security or face fines, so costs of compliance have risen. Property values in most jurisdictions have dropped and so have tax revenues, making budgets even tighter.
- We’re still at war, although on the bright side bin Laden is gone.
So, after that dismal recap, let’s look toward the horizon, where we see…are those more storm clouds? Yep, and regardless of your political views, the Supreme Court decision on the Affordable Care Act (ACA), and the November 2012 elections, will have a profound effect on us all. I firmly believe the past five years and the next five will go down in EMS history as the most difficult decade in which we’ve operated.
From where I sit, here’s what we have to look forward to:
On the surface, making sure everyone we transport has some kind of coverage seems like a laudable goal. However, the implications of the ACA could be troublesome. If millions opt for Medicaid coverage, states and taxpayers will have to pick up part of those costs. That could mean higher state taxes along with lower per-call reimbursement. Which means, down the road, there could be fewer reimbursement and tax dollars to support EMS and fire budgets.
There’s been a lot of merger and acquisition activity around the country in the hospital market, just as there continues to be a lot of activity in the SNF market. As hospitals consolidate, or close services like emergency departments, it becomes increasingly likely transport times will slow, waits at triage will get longer, diversions will be more common and EMS resources will be further stretched as a result. On a positive note, I do see an expanded role for EMS in the adjunct role of providing non-emergent community healthcare, and not just transportation.
According to predictions by David Houle and Jonathan Fleece, authors of The New Health Age: The Future of Health Care in America, 33% of hospitals will not make it to 2020.