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National EMS cuts impact ambulance service in East Texas

By Richard Yeakley
July 15, 2013 at 11 p.m.

Seria Dassing knows having an ambulance two buildings away can't guarantee her safety. But just knowing it's there is comforting.

"It has always been a comfort to me when my mother comes to visit that there is ambulance service two doors down. That concerns me if it has to come from Gilmer or Tyler or Longview because that increases the time a lot," said Dassing, who lives in the 300 block of N. Pearl Street, near the Emergency Medical Services station slated for closure today.

Big Sandy, along with a host of other East Texas towns, were notified this spring by East Texas Medical Center EMS that it would cease its free services July 15. ETMC EMS operates a fleet of 107 ambulances and three helicopters across 17 East Texas counties.

Beginning today Big Sandy, Van, Gladewater and southern Cherokee County will incur un-budgeted expenses to subsidize service or their citizens will have no choice but to wait for potentially life-saving medical help from an ambulance stationed miles away.

The changes are blamed on cutbacks in Medicaid reimbursement for EMS service.

"I think we are going to have a lot to look at. This is a problem, the rural services more specially. If it comes to the point where they start closing some of their rural hospitals and clinics it could be trouble," said Cherokee County Judge Chris Davis. "Just at the tip of the iceberg – kind of a scary unknown."

<h3>Coping across East Texas</h3>

Reeling from the ETMC notice, Gladewater City Council voted in June to contract with Champion EMS $7,500 a month to provide emergency medical service to the town that straddles Gregg and Upshur counties.

Gladewater City Manager Sean Pate said city staff members were told earlier in the year by ETMC EMS that the company was losing money operating a dedicated ambulance there and needed city assistance to continue service - perhaps several hundred thousand dollars a year in subsidies.

He said before a committee could make a recommendation on a subsidy amount, a termination notice was received from ETMC EMS. At that point, Pate said, the city of Gladewater reached out to Champion EMS, which provides service to nearby White Oak and more than two dozen other East Texas cities.

However, the city will still pay $90,000-a-year for a service that was free, and instead of receiving $1,000 rent for the EMS building that ETMC paid - the city will provide it free for Champion.

Big Sandy took another route. Mayor Nancy Church said their station that has housed an ambulance for years will sit vacant.

"We don't have the money to pay what they asked," Church said.

She harkened to the old days.

"There have been times, it (response time) has been longer time. Times that we did not have all hours of coverage. I guess we will wait or somebody will carry them."

Church said Big Sandy may look into other EMS providers but believed the problems, and also the need for money, are striking providers across the board.

Big Sandy's EMS will come from a neighboring city.

In Cherokee County, both the county and city governments will help subsidize EMS service to keep ETMC operating there.

Davis said the most frustrating part of the situation, rather than the expense the county will have to ante up for the historically free service, is that it was an unexpected and sudden change.

"It was very disheartening. The main thing was, we were hit with it so fast, that you don't have time to go through the process. That instantly scares people," Davis said.

Cherokee County will now pay $57,700 annually to keep ambulance service while the cities of Wells and Alto will each pay between $12,000 and $20,000 a year, Davis said.

A release from ETMC, explained ambulance service would be subcontracted to Blanket EMS of Huntsville to cover Alto and Wells and southern Cherokee County effective today.

ETMC EMS will serve as a backup to Blanket EMS and will dispatch their calls," said Neal Franklin, general manager of ETMC EMS in the statement.

Today, ETMC EMS will also cease operation of an ambulance dedicated for the cities of Frankston and Van.

Frankston and Van are in negotiations with other EMS service providers to take over these areas.

<h3>The problem</h3>

Both Franklin and Champion EMS Chief Executive Officer Stan Holden point the blame in the same direction: federal sequestration and cutbacks on reimbursements from Medicare, Medicaid and third-party providers.

"Things are changing in the industry as far as reimbursement goes, and it will hit rural America harder than metropolitan areas," Holden said after Gladewater chose to use his ambulance service. "What it boils down to, as the (reimbursement) dollars decrease, services will still be demanded and needed by local residents. The only recourse is to replace reimbursement at the local level."

At the time he said the American Ambulance Association is lobbying Congress over the situation, which he believes signals the end of privately run EMS services in rural areas.

"They are following on the heels of the 1970's and 80's when small rural hospitals began to close their doors. Why? Because federal reimbursement dollars began to decline," Holden said.

Franklin agreed.

"For many years, ETMC has been able to provide ambulance service in many communities for free or for a small fee, but with the changes in reimbursements we could no longer afford to provide this service," Franklin said.

The problem is not specific to East Texas.

Kevin McGinnis, program manager for the National Association of State EMS Officials, who is also the chief of a rural-urban EMS service in Maine, said rural cities' EMS services are under fire across the nation.

"Nationally, we renegotiated Medicare rates about 2000. Since then there have been some minor increases, but generally rates have stayed the same. They now pay less than the cost of doing your business. At the time, the attempt was to get them up to the cost of doing business, but they haven't kept up with inflation, cost of gas or a number of things," McGinnis said.

"But with the sequestration, Medicare cut us by 2 percent."

McGinnis said a change needs to be seen, because it was unlikely the federal government would reverse course and give more money to EMS providers after taking it away.

"That is our future. Otherwise, we do not see the federal government upping the ante for reimbursement anytime soon," McGinnis said.

<h3>Not money making</h3>

Assistant Fire Chief for the Longview Fire Department Curtis Shaw said an important historical fact to remember is that emergency service was never intended to be a moneymaker.

"In order to have coverage, someone must have people available to respond even if you are not responding. It costs money to put it there and money to keep it there," Shaw said.

"When someone is injured or ill, time is important. You must have resources as close as possible and available, and a high percentage of those calls don't result in full payment or no payment at all. When someone has a heart attack you don't make sure they can pay the bill before you transport them. Emergency service is more expensive to provide and pays poorly. That is why subsidy is absolutely essential."



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