Scanty ambulance access in rural Pennsylvania illustrates nationwide difficulties in sustaining emergency services

Union City in Erie County, Penn.
(Wikipedia map)

An incident last December in Erie County, Pennsylvania, illustrates the growing difficulty in accessing emergency services in rural areas across the nation. Someone called 911 in Union City, pop. 3,320, but at least three nearby volunteer fire departments were unable to crew an ambulance, so 51 minutes later the 911 center canceled the alarm and said the caller was going to the hospital in a private vehicle, Kris Mamula reports for the Pittsburgh Post-Gazette. Last year, the Union City Fire Company couldn't provide an ambulance crew for 200 of the 710 total calls received.

"Problems recruiting first responders, rising operating costs and Medicare reimbursement that hasn’t kept pace with expenses are stressing emergency medical services throughout rural Pennsylvania," Mamula reports. "Outside of bigger cities like Pittsburgh, emergency medical service is not supported by municipal tax money. That leaves the vast majority of nonprofit ambulance services reliant upon billing for care to keep their trucks on the road and staffed around the clock."

Medicare pays medical providers, including ambulance services, according to a set payment list. "To set its rates, Medicare is surveying a number of ambulance services to determine average costs," Mamula reports. "Hospitals are required to file cost reports for providing various services. Medicare payments are typically based on a percentage of costs, with hospitals generally receiving 12 percent."

The Union City fire department hired two firefighters/EMS responders last year with combined salaries of $75,000. The city government gives the department $24,000 a year to help, but that's only a third of the money needed. "The EMS math tightrope is similar across many such services in Western Pennsylvania. Most of Union City’s ambulance patients have Medicaid or Medicare insurance coverage — typical for EMS services — which pay $160 and about $400 per call respectively," Mamula reports. "A new ambulance can cost between $150,000 and $200,000. And new power stretchers — which help load overweight patients while cutting worker’s compensation injury claims — cost between $60,000 and $70,000 each. The latest heart monitor costs about $90,000."

Union City EMS volunteer Larry Obert, 79, said a tax increase was the best long-term solution. "It’s a nightmare," Obert told Mamula. "Somebody has to subsidize it." Fire department leaders agreed recently to ask the local government to fund an eight-person EMS crew that could respond 24/7, at a cost of about $326,000. Raising that kind of money would require a tax hike, according to the borough council president. But a tax increase could really hurt in one of the poorest towns in the state.

The fire department tries to defray costs by selling annual memberships at $40 each; members don't have to pay any remaining balances on ambulance bills remaining after the insurer pays its portion. But without the requested extra funding from the local government, the fire department would have to shut down its EMS service by June. It opened the service in 2016 after a previous volunteer ambulance service shuttered, Mamula reports.

Larger private EMS services can sometimes step in when small services like Union City's close down, but "experts say big ambulance services aren’t immune to the forces threatening emergency services. Pittsburgh EMS, for example, answers some 64,600 calls a year, yet is expected to run an $11.4 million operational deficit in 2020. Tax money will make up the shortfall."