Like many of its peers regionally and nationwide, the Volunteer Medical Service Corps of Lansdale is, ironically, trying to weather a crisis.
While retention remains high at VMSC with 90 career staff and 30 volunteers, it is infected by a 14% funding gap and wounded by Medicare supplemental insurance reimbursement rules and high copays, inflation, and manpower responding to calls outside of their area.
Plus, payment results only from any call that ends with a patient at a hospital. Imagine applying your trained lifesaving skills for a couple hours on a patient, who then refuses transport to the hospital.
No pay to save the day.
"As EMS providers, we get paid only if we are transporting patients,” VMSC of Lansdale CEO and paramedic Shane Wheeler said. "We have roughly 25% of patients that use our services that do not go to a hospital. Insurance won’t pay for those services.”
Sure, VMSC and its other local/regional EMS agencies can try and stitch it up with membership campaigns and its main source of revenue — payments from insurance providers for any call that ends up at a hospital – but steady substantial financial backing remains elusive.
To heal the situation, VMSC has begun approaching municipalities in the North Penn region to help cover its shortfalls. Montgomery Township and Towamencin Township have already pitched in a combined $130,000. It is weathering the storm, and trying to be as proactive as possible moving forward.
"EMS agencies across the country are faced with a lot of challenges, with regard to staffing, with regard to funding, increased complexities with regard to reimbursement on billing, and there are a lot more challenges with inflationary impacts,” Wheeler said. "With the culmination of these issues over the last decade, we see this increase in frequency of EMS systems just failing. … You see it in not just small, rural areas, but in larger urban areas.”
‘An Ounce of Prevention’
Medicare and Medicaid has hit EMS services hard as well. Medicare supplemental insurance, Wheeler said, leaves ambulance services out of covered services. Furthermore, many on Medicare and Medicaid cannot afford a copay for ambulatory and EMS services.
"As an organization, we are financially stable,” Wheeler said. "We come to the municipalities as more of an ounce of prevention versus a pound of cure approach. We’re not asking for a lot; we’re really trying to get an equivalent to a 0.014 millage. We are trying to fix kicking the can down the road.”
While the VMSC was founded in the 1930s by legendary local physician Dr. Frank Erdman Boston, EMS services expanded widely during the Johnson, Nixon and Ford administrations, At that time, Wheeler said, there was a great deal of federal funding available to the states to pass on to local governments to support EMS agencies. "There was a huge drive in that period for volunteerism,” Wheeler said.
EMS funding slowly fell during the Reagan era, he continued. Even the former Emergency Municipal Local Tax, which he said became the Local Services Tax, had provisions to support local EMS services, though few municipalities actually did so.
"As the federal government over the last 40 years, has continually tried to not adjust rates to current values of what it costs to run in a current deficit and Medicaid reimbursements, it’s led to this crisis we’re in,” Wheeler said.
Municipalities Step Up
Municipalities such as Lower Salford Township and Limerick Township, he said, are substantially investing in their EMS systems. "Those two municipalities came together for a regional approach, committing over $500,000 a year for EMS,” Wheeler said. "What we’re asking isn’t unusual.”
Wheeler said VMSC has landed on upcoming agendas for their presentations in Lansdale Borough, Upper Gwynedd Township, North Wales, Hatfield Township, and Hatfield Borough.
"We’ve been in discussion with municipal managers for a year about the best strategy and how to move forward. They are great to work with and understand our wants and listen to our needs,” Wheeler said. "Municipalities are faced with a lot of challenges with funding requests and infrastructure repair.”
Wheeler said the combined ask for the entire North Penn area would be about $1 million. "If you lived in Lansdale, for example, our request is about $13 a year per person. If you lived in Hatfield Borough, it would be $6.90 a year per person. Larger boroughs and townships are shouldering more of the load because of having more population.”
VMSC has invested its own funds to improve services, Wheeler said. He said VMSC consistently outperforms national and state averages in areas of performance. "Our response times are great — we were under eight minutes and we reduced that in half,” he said.
"All things culminate with a reduction in mortality. There’s an expectation that the public has when you call 911 that you not just get somebody in an ambulance and throw you in the back. You expect the best clinical care and to arrive timely. Most of us never really experienced the need for an ambulance. When we do, minutes seem like hours.”
VMSC Looks To The Future
The needs for VMSC right now are in three areas, Wheeler said. First, a good retirement program.
"Staff retention is huge, and we are blessed we invested heavily in staff retention programs. We have health insurance, but we don’t have a matching retirement program,” Wheeler said. "For long-term retention it is paramount to get a retirement program in place.”
Wheeler said VMSC is working with JeffStat and Jefferson Health to have an in-house paramedic program. "We received $100,000 from Montgomery Township and $30,000 from Towamencin last year to help fund the program,” Wheeler said.
A second need is equipment replacement. A lot of calls and a lot of miles on the ambulances means a lot of maintenance. "The turnaround time to order an ambulance and have it show up can be as long as two years,” Wheeler said.
Finally, VMSC wants to improve clinical growth. There are advanced airway procedures and new medications and blood therapy that are evidence-based and can make a difference.
"If we have to do an ultrasonic-guided procedure or sedation for someone to secure their airway, or administer certain medications, there are no funds to support that,” Wheeler said. "Medicare and insurance don’t provide a mechanism to do that. There is no incentive financially for an organization to improve this delivery of repair because it is unfunded.”
Wheeler said a plan is needed to address the EMS issues and foster stability. "Now it’s about rolling up the sleeves and having a conversation,” he said. "We’re open to dialogue of funding. In a perfect world, we’d like to see 0.01 millage, but we also know there are priorities for funding for infrastructure and changing demographics. We are not here to complicate that; we are trying to head off fear in increased challenges for delivery of EMS. These failures are happening more and more in smaller communities and that ends up impacting the area.”
VMSC has responded in the last month to 110 calls outside its coverage area because of a lack of staffing or gaps in coverage. "We are filling a demand beyond North Penn and Indian Valley for services,” he said. "When the system fails or we are struggling to meet demands of funding and staffing to operate, then the total system is a drain regionally.”
