According to a report from Buffalo Business First, it’s not uncommon for emergency medical services (EMS) providers to respond to a calls that eventually become “treat-and-release,” with the patient declining to go to the hospital. However, these calls are also not billable, which means these financial losses must be subsidized by other emergency calls.
In the early days of the pandemic, people feared going to a hospital and dealing with possible risk exposure. Although recent call volumes have largely returned to prepandemic levels, EMS providers are still trying to catch up.
Tim Frost, regional director for Western New York and Rochester at American Medical Response (AMR), the largest EMS provider in Erie County, noted that EMS providers work on a fee-for-service basis, so transporting patients allows them to submit a bill to that patient. He also stated that, although the providers are expected to respond to 100 percent of calls, only a percentage of these responses are billable.
According to the United New York Ambulance Network, the state’s ambulance industry has been among the hardest-hit nationwide. Funding from the federal Provider Relief Fund totaled just $350 million for EMS providers nationwide, compared to $11 billion for rural hospitals. Additional funds came through the PPP program, which awarded 14 forgivable loans totaling $4.6 million to Western New York ambulance services.
Consider that 1,709 loans, totaling $374.6 million, were awarded to regional health-care providers including nursing homes, physician offices, dentists, and medical labs.
Frost also noted that the EMS industry is facing a breaking point; prior to the coronavirus, the industry concerned with costs outpacing the state and federal reimbursement for services, and COVID-19 has added a multiple to this.
For Twin City Ambulance, a privately owned company based in Amherst with 250 EMS professionals and 50 vehicles, call volume decreased by 40 percent at the start of the pandemic. Twin City Ambulance typically answers 50,000 calls per year in the towns straddling Erie and Niagara counties down to the Genesee County line.
The company took a $1.36 million PPP loan, which helped pay its bills, and is earning additional revenue providing standby ambulance service around the clock at the state’s semi-permanent Covid-19 testing site at Niagara County Community College.
Tom Coyle, chairman of UNYAN and president and CEO of Monroe Ambulance in Rochester, said the situation is becoming dire for providers, especially with no changes coming for treat-and-release calls. He stated that a pre-pandemic report by the New York State Department of Health that found ambulance providers were underpaid by $31 million annually for Medicaid transports.
Mercy Flight, which runs a ground operation and emergency helicopter services in Genesee County and parts of Erie and Niagara, stated that its air service has helped to balance losses on the ground from a 40-percent drop in call volume.
Some insurers will pay a nominal amount for treat-and-release calls with no transport. However, Medicaid and Medicare patients, who comprise approximately 60 percent of call volume, do not bring in fees that could pay for fuel, vehicle repairs, payroll insurance, and facilities costs.