News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. Since January, 2021, over 1,900 news reports have been chronicled, with 49% highlighting the EMS staffing crisis, and 34% highlighting the funding crisis. Combined reports of staffing and/or funding account for 83% of the media reports! 96 reports cite EMS system closures/agencies departing communities, and 95% of the news articles reference staffing challenges, funding issues and response times.

Click below for an up to date list of these news stories, with links to the source documents.

Read Only - Media Log as of 4-8-24.xlsx

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  • 27 Mar 2024 7:16 AM | Matt Zavadsky (Administrator)

    Without commenting on the continued frustration of the media referring to ambulance ‘rides’, negating the fact that personnel provide medical care, what this report hints at, but does not specifically state, is that most new state legislation requires insurers to pay essentially billed charges, hence limiting out of pocket expense to the patient’s deductible or coinsurance.

    You can see recently passed state legislation at the National Conference of State Legislatures’ EMS Bill Tracker here:

    Or view other example EMS legislation at NAEMT’s database here:


    More states are adding protections against big ambulance bills

    March 27, 2024

    Maya Goldman & Tina Reed

    More states are jumping in to shield patients from large, unexpected bills for ambulance rides in the absence of federal protections.

    Why it matters: Ground ambulances are a major source of surprise bills, and it's unlikely Congress will pursue nationwide protections anytime soon after excluding them from the landmark No Surprises Act in 2020.

    The big picture: Patients in an emergency can hardly shop around for an ambulance covered by insurance. More than half of ambulance rides are out of network, putting patients on the hook for surprise bills that typically cost hundreds of dollars.

    • Congress carved out ground ambulances from its surprise billing legislation that prevents patients from paying more than the in-network cost for care unwittingly received out of network.
    • At the time, it was seen as too challenging to figure out regulation for this unique corner of the health care system, and lawmakers ordered further study.

    Driving the news: Washington state last week became the 16th state to pass consumer protections for ambulance bills, and Indiana's governor signed a similar bill earlier this month.

    How it works: State laws cap patient costs for out-of-network ambulance rides at what the patient would pay if it was covered by insurance, and health plans are on the hook for the rest.

    • Some state laws, like the new one in Washington that takes effect next year, peg health plan charges to local or Medicare rates.
    • Other states, like Delaware and Maine, settle payments through an arbitration system, similar to the federal surprise billing law.
    • Colorado only bans surprise bills at privately run ambulances, which accounted for about 30% of emergency rides nationwide in 2020, per KFF. Meanwhile, Maryland only covers those provided by fire departments and other public agencies.

    The ambulance industry has largely been on board with how states are approaching these laws, Tristan North, a lobbyist for the American Ambulance Association, told Axios.

    • But insurers have raised concerns that some states are setting benchmark rates far above what Medicare pays, said a spokesperson for insurance trade group AHIP.

    Yes, but: The state laws are ultimately limited, because most employer-sponsored health plans — a huge chunk of the private market — fall under federal regulation.

    • "It's good to know that Washington has this new law now, but we're hoping to see it go one step further to the federal level," said Christy Shum, who received a bill for about $7,000 when her infant son was transferred from one hospital to another last year.
    • Shum's employer-sponsored insurance initially covered only about $1,000 for the out-of-network ride, but the charges were eventually wiped without much explanation, Shum said.

    What's next: A commission created by the No Surprises Act to study ground ambulances will soon formally submit recommendations to lawmakers, which will include a $100 cap on patient costs and linking insurer payments to locally regulated rates when possible.

    • President Biden recently called for extending surprise billing protections to ground ambulances, but there's little expectation that lawmakers will take up legislation this year.
    • This Congress has struggled to pass modest bipartisan payment changes, and some of the biggest champions of the No Surprises Act are no longer in office.

    The bottom line: "We really need to build the groundswell of support — more than we already have, apparently — to see Congress address it," said Patricia Kelmar, a director at Public Interest Research Group and member of the federal ambulance billing advisory committee.

  • 25 Mar 2024 10:37 AM | Matt Zavadsky (Administrator)

    A link to download the report is at the end of the report.


    Ambulance service in N.H. faces problems from big surprise patient bills to struggling companies



    Ambulance service might be one of the most basic and important parts of the health-care system, but it’s also a financial mess in New Hampshire, both for patients and private companies.

    “We’ve talked to consumers who say, ‘I’ve fallen at home and clearly need to be seen in an emergency room, but I sat there thinking, ‘Can I wait it out, to try and get a family member to take me to the hospital?’ ” said D.J. Bettencourt, commissioner of the New Hampshire Insurance Department. “Someone who is in need of urgent transportation to a hospital should not be having to think about whether or not their particular health coverage is in network with that (ambulance company).”

    A high-profile example occurred in February when a hiker suffering from hypothermia and frostbite was carried off Mount Washington in extreme winter weather following an 11-hour rescue, only to drive himself to the hospital because he feared how much an ambulance ride would cost.

    At the same time, Bettencourt said, “We began seeing reports this summer that private ambulance providers were experiencing significant financial distress … particularly in rural areas of the state.”

    One issue is that around 80% of transportation covers people using Medicare or Medicaid, “which do not pay anywhere near” the cost, Bettencourt said. That’s particularly true in rural areas, where spread-out population makes it very expensive for a private, profit-driven company to maintain 24/7 coverage.

    Municipal services, which are part of fire department or other emergency service budgets, see less immediate financial straits but face many of the overall headwinds, he said.

    Problems like these are not unique to New Hampshire and have caused legislators in Washington and Concord to consider various changes to billing, network assignments and reimbursement rates, including some bills percolating through the State House. They also prompted the state Insurance Department to hold an “ambulance summit” that has resulted in a lengthy report issued Friday carrying a number of recommendations for lawmakers to consider.

    “This is a perfect opportunity to talk about an issue that has lingered on for … two decades now,” said Bettencourt.

    One thing that is clear, he said: “We’re going to need higher (reimbursement) rates (from insurers), particularly in the rural and super-rural areas of the state.”

    The report makes several recommendations.

    One is to ban on “balance billing,” in which patients have to pay the difference between the ambulance service cost and the amount that the insurance company will cover. The difference can be hundreds or even thousands of dollars if the patient’s health insurance doesn’t consider the ambulance firm to be part of the network.

    That is a particular problem, said Deputy Insurance Commissioner Keith Nyhan, because particularly in rural areas, there’s often only one ambulance service available.

    “In an emergency situation in particular, consumers have no option to choose whether the ambulance company is in-network or out-of-network. They just show up,” Nyhan said.

    Consumers concerned about a balance bill can call the Insurance Department’s consumer service hotline, 800-852-3416 or email to get help.

    Also recommended in the report is direct payment, a big desire for ambulance providers.

    The problem, Bettencourt said, is that when insurance companies cut a reimbursement check for the ambulance provider they sent it to the patient who owns the policy, and expect the patient to pay the ambulance.

    “In many cases the consumer is unsure why they’ve gotten this check and run off with it. They think, ‘Oh, this must be a reimbursement’ … so it never makes its way to the provider,” he said.

    Both of those suggestions have been included in separate bills making their way through the legislature.

    The recommendation says that the changes should be part of overall changes to the system that include gathering better data from all providers, private and public, and doing a better job monitoring costs and availability of service.

    Congress is also considering legislation to limit balance billing for ground ambulances, although it’s unclear when or if that will go through.

    The full report can be found on the New Hampshire Insurance Department website at

  • 6 Mar 2024 3:23 PM | Matt Zavadsky (Administrator)

    Another example of the challenging times for communities and their EMS systems, regardless of provider type, trying and combat the workforce shortage.

    The most recent national EMS media tracker has documented over 1,800 local and national news reports about EMS since 2021, with 74% of the reports citing the EMS staffing and economic crisis.


    Conn. FD drops experience requirement to increase number of EMS applicants

    Wallingford officials removed the one-year experience requirement hoping it will lead to an increase in applicants

    March 06, 2024

    WALLINGFORD, Conn. — The fire department has reduced its work experience requirements for EMS workers in response to an ongoing employee shortage.

    Previously requiring at least a year of experience, the town opted to change its qualifications in response to a sharp reduction in applications.

    The guidelines for EMS personnel were revised four years ago, when the department was looking to fill 16 positions, and had 38 people apply. But in 2023, the town received only two applicants for open positions during the year. The department currently has three EMT vacancies, as three members who were previously EMTs were hired as firefighters.

    Two of those members left for other departments.

    According to Human Resources Director James Hutt, he and Fire Chief Joseph Czentnar had discussions between themselves and with Mayor Vincent Cervoni and determined that the one-year experience requirement wasn’t necessary.

    “To meet the needs, the chief and I met, we discussed it with the mayor, the chief was confident that the one-year experience requirement was not necessary,” Hutt said.

    This is part of an ongoing employee shortage across the fire department. Czentnar said recently that the department had five vacant full-time positions due to long-term injuries firefighters have sustained while on duty. As a result, many existing full-time members have had to put in more overtime to cover their shifts.

    The department has undertaken several initiatives to try to bolster its numbers and increase awareness in the community about the need for volunteers and full-time positions. In recent years they’ve been more active at approaching students at job fairs and have even opened an Instagram account to advertise openings.

    “We’re finding the pool of candidates for EMTs and paramedics is very small, and we’re competing statewide from a small pool of candidates,” said Czentnar. “EMS in the state of Connecticut and regionally is an impending failure. There’s a lack of people that want to get into public safety, and typically emergency services. We’re having a difficult time recruiting firefighters, paramedics, EMTs.”

    Councilor Craig Fishbein questioned the decision to reduce the experience requirement to bolster the numbers when the lack of applicants could be attributed to other factors.

    “When this division was started it needed to be stood up very quickly, and we needed experienced people to come in and a one-year minimum was determined to be the minimum criteria for it at that time,” Czentnar said in response at the meeting. “Since then we’ve implemented a field training evaluation program throughout the department where we have certified field training instructors and those people would go through an orientation with the new folks that come in. This brings it in line with all our other job descriptions.”

    There was no minimum one-year requirement for any other position in the fire department.

    Despite the decrease in experience, due to contractual agreements, the pay for the EMT positions isn’t being changed — with an average salary of $78,000. EMTs would go through an orientation and training period where they accompany an existing team, and after an evaluation will be added to the rotating schedule once they’re deemed ready for duty. The training takes around four weeks.

    Base salary without overtime, according to the chief, is in the $40,000 range, which is lower compared to other towns. The distinction, said Czentnar, is most other EMT agencies are private and for-profit — so while they will pay more, he said their department offers better working conditions and better work environment working with the municipality.

    Democratic Town Councilor Jesse Reynolds expressed concern about the amount of base pay without overtime, stating that given the current state of the market people who wanted to do EMT work wouldn’t be able to afford to live in town on that salary.

    “That’s something we should consider if we want people to work here, and live here, and want to stay here they have to be able to afford that. I’d like to hear more about what we could do in the future to improve that situation,” Reynolds said. Czentnar said that they were currently developing plans in the future to react competitively to the market.

    “I support this. I see this as a necessary reaction to the supply and demand of the market for staff,” added Town Councilor Tom Laffin.

    The motion was approved following a unanimous vote of the Town Council.

  • 6 Mar 2024 3:04 PM | Matt Zavadsky (Administrator)

    One of the interesting statements in this news article is that their transport rate “climbed to 48% in 2023”, up from 35% in 2021.

    While every community is different, even with our multiple programs designed enhance patient experience and reduce healthcare expenditures by avoiding preventable transports to the ER, MedStar’s average transport rate is 80.3%, compared to the referenced national data from ESO of 83%.


    In 'doorbell recording' case, Phoenix firefighters violated ambulance refusal policy

    ABC15 Investigators: Why Phoenix firefighters convince people not to use the city ambulances and what's changing now

    Mar 06, 2024

    PHOENIX — A Phoenix fire crew, caught on a doorbell camera video dissuading a sick woman from taking an ambulance to the hospital, violated multiple city policies, according to the fire department's administrative investigation.

    ABC15's airing of that video prompted the investigation about the August 2021 medical call to Haydee Pate's south Phoenix home. She had COVID and was having difficulty breathing at the time of the 911 call.

    Pate was sitting outside on a bench when the Phoenix fire captain, a paramedic, and a firefighter/EMT arrived in a fire engine.

    "Do you just want to take her to the hospital?" Paramedic Caleb Kountz asked Pate's son who was standing in the driveway.

    "Yeah, she wants to go to the hospital," the son replied.

    "Do you want to take her?" the paramedic asked.

    Pate later explained to ABC15 that her son needed to remain at home to care for her young daughter. Both were also sick with COVID.

    As minutes pass, the crew takes Pate's vital signs but doesn't call for an ambulance.

    "That ambulance is $1,500 bucks," Captain Gerald Ingallina said. "I mean, we'll take her, but if you have $1,500 bucks, I know what I'd like to do with $1,500 bucks."

    After the firefighters left, Pate's son ended up driving her to the hospital, and she was admitted for pneumonia.

    "It's been over two years, and not even once did I receive any apology," Pate said in an interview with ABC15 last month.

    But she did receive a copy of the administrative investigation, which found all three crew members violated multiple fire department rules including failing to follow a 2021 memo about refusal of treatment and transport, as well as not protecting the public.

    Pate still has questions about who signed the medical report as the patient "refusing" ambulance service because she says it wasn't her.

    "That's not even close, that's not my initials, that's not my signature," Pate said.

    The fire captain who responded to Pate's house retired before the investigation was completed, but the firefighter and paramedic remain with the department. Phoenix fire officials would not say what discipline they received, if any. A spokeswoman did write to ABC15, saying the department "strives to address any complaint consistently within our policies and values" and "necessary corrective actions are taken".

    "Very bad," Pate said about her experience. "I don't want that to happen to [anybody] else."

    ABC15 has covered multiple cases of ambulance denials in Phoenix over the past two years, including at least one death, despite the city's longstanding policy that everyone who wants an ambulance gets one.

    The administrative investigation in Pate's case also included an explanation from one firefighter about why they would persuade a relative to drive a patient instead of using a city ambulance.

    "It takes time for an ambulance to get to them, it takes time for us to load them up, and it takes time to get them to the hospital," firefighter Christopher Flores told investigators, according to the PFD report. "Sometimes, time is crucial."

    When the investigator asked, if time was crucial, wouldn't it be wiser to have a medic versus someone who is not trained, Flores responded, "Yeah."

    "They contradict themselves back and forth with their comments," Pate said after reading the report. "It just made me wonder 'what's going on.'"

    In a statement to ABC15, the Phoenix Fire Department said it wants to assure the public that the department "is committed to providing the highest levels of customer service."

    At the same time, PFD data may partly explain why firefighters may feel time pressure. There have been an increased number of 911 medical calls and longer ambulance response times in recent years.

    The ESO EMS Index, which looks at the big-picture performance of emergency medical providers across the country, calculated nationwide data from 2021 finding, on average 83% of people who called 911 for medical help got an ambulance ride to the hospital. Just 17% were non-transport cases. But Phoenix's ambulance transport data, which the agency provided to ABC15, showed a much lower ambulance use rate. In 2021, patients made hospital runs on just 35% of calls.

    When questioned about the disparity, a Phoenix Fire Department spokeswoman responded that patient transport percentage rates can vary significantly from one jurisdiction to another. As a result, any comparison of Phoenix to any other reported percentage would require a thorough review to ensure that all variables are consistent.

    Phoenix's data shows the city's ambulance transport rate climbed to 48% in 2023 after firefighters were trained on a new state law saying paramedics and EMTs "may not counsel a patient to decline emergency medical services transportation."

    "I've been thinking, maybe, there's not enough ambulances," Pate said.

    Trying to increase the available ambulances and reduce response times, the fire department is asking Phoenix City Council this week to approve a plan to convert 10 part-time ambulances to 6 full-time ambulances. More than 50 jobs would be added to staff those ambulances.

  • 5 Mar 2024 7:27 AM | Matt Zavadsky (Administrator)

    MedStar Mobile Healthcare – Mobile Integrated Health Designated Age-Friendly

    March 4, 2024

    The Institute for Healthcare Improvement recently recognized MedStar Mobile Healthcare – Mobile Integrated Health as an Age-Friendly Health System Participant. 

    MedStar is the first emergency service provider to be recognized for their efforts in implementing age-friendly care, which includes a focus on fall prevention. 

    Health Resources and Services Administration Geriatrics Workforce Enhancement Program (HRSA GWEP) funding has supported a Geriatric Practice Leadership Institute to educate and support healthcare organization teams across the country for implementing age-friendly initiatives within their services and practice. 

    As a result, several teams have received recognition as an Age-Friendly Health System (AFHS) Committed to Care Excellence – including our own HSC Health Center for Older Adults and HSC Health Family Medicine Clinics, and now MedStar as well.

    This designation is also in alignment with the city of Fort Worth, which has been recognized as Age-Friendly and Dementia-Friendly, as well as educational efforts.

    Students who are involved with EMS experiences become familiar with these data-driven, evidence-based Age-Friendly approaches for older adult care that then align with care received in HSC Health clinics.

    As part of the Age-Friendly Health Systems movement, we are among the first health systems in the country to implement age-friendly health care.

    MedStar now joins an international group of more than 2,700 health systems working to tailor care to patients’ goals and preferences and to deliver care that is consistently of the highest quality.

    The four essential elements of an Age-Friendly Health System are known as the 4Ms:

    • What Matters: Know and align care with each older adult’s specific health outcome goals and care preferences including, but not limited to, end-of-life care, and across settings of care.
    • Medication: If medication is necessary, use Age-Friendly medication that does not interfere with What Matters to the older adult, Mobility, or Mentation across settings of care.
    • Mentation: Prevent, identify, treat, and manage dementia, depression, and delirium across settings of care.
    • Mobility: Ensure that older adults move safely every day to maintain function, prevent falls, and do What Matters.

    You can learn more in the Guide to Using the 4Ms in the Care of Older Adults.

  • 4 Mar 2024 7:24 AM | Matt Zavadsky (Administrator)

    Another example of departments struggling with response volume and economics, leading to staffing issues.

    This one at FDNY.

    The most recent EMS News Tracker through February 2024 reveals over 1,800 local and national news stories related EMS, with 74.4% of them referencing the EMS staffing and economic issues.


    Brooklyn EMS workers say they can't keep up with growing 911 call rate

    By Hannah Kliger

    February 29, 2024

    NEW YORK -- While data shows Brooklyn has New York City's highest rate of 911 calls, EMS workers say they borough doesn't have enough resources to keep up.

    Brooklyn also saw the largest increase in 911 calls since 2021.

    Julianne Tien has been a paramedic with FDNY EMS for more than 15 years.

    "Sometimes you absolutely can see that you've made a real difference in someone's life. There are certain jobs that are for me, really enjoyable, like when someone gives birth and we get to be there," said Tien.

    Tien works at Station 57, which serves parts of Bushwick and Bed-Stuy. The department is stretched thin, she said.

    "My ambulance personally that is designated for my unit, I haven't seen it in at least well over six months. I guess it went out for mechanical reasons and then it just never came back. So we're in a spare vehicle," said Tien.

    Natasha Nembhard, a paramedic from EMS Station 58 in Canarsie, agreed with Tien after being on the job for eight years.

    "I can't remember it ever being this bad," Nembhard said . "Job after job, we're not getting any breaks because of the call volume."

    Data compiled by the EMS union backs up their experiences.

    In Brooklyn, life-threatening emergencies have increased by 15.7% since 2021. It's the highest increase in the city and in a borough already with the most calls.

    Oren Barzilay, president of FDNY EMS Local 2507, said the EMS budget hasn't increased, even though the work has.

    "I think the people at the Office of Management and Budget and the FDNY budget crunchers are to be held accountable to this. We've constantly been asking them for additional resources," Barzilay said.

    The union for EMS workers said the rise in 911 calls could be linked to Brooklyn's growing population.

    New York City's data shows ambulance response times between 2021 and 2023 increased by more than one minute, while the number of ambulances on the road dropped by 11%.

    That combination can be the difference between life or death in a medical emergency, Barzilay said.

    "We are budgeted to handle about 4,200 calls a day. And there are days where we are doing 4,500, 46, sometimes we touch 5,000 calls a day," he says.

    An FDNY spokesperson responded with a statement, saying, "Emergency calls to the 911 system have been increasing for the last several years. We had seen a spike in EMS activity in and around the pandemic, which we used additional resources for. We have returned to pre-pandemic level ambulance numbers and manage our available resources in order to respond to New Yorkers who need us."

    The EMS agency has a high turnover rate.

    "Give us more money, give us a reason to stay, give people a reason to want to join EMS and then we'll fill those spots," Nembhard said .

    Employees said raises can help recruit and retain qualified workers.

  • 3 Mar 2024 9:43 PM | Matt Zavadsky (Administrator)

    We have been watching this for about a week… 

    Some EMS agencies use billing agencies or systems that are part of Change Healthcare or rely on their back-end I/T systems, which means that for these agencies, revenue cycle management/billing may be disrupted.

    We strongly encourage EMS agencies to reach out to your billing service to see if this cyber-attack may have an impact on your revenue cycle. 

    If the answer is ‘yes’, please reply to this note and let us know so that we can measure, track and potentially advocate the impact this may have to the nation’s EMS providers!


    Change Healthcare breach forces providers to find workarounds


    February 26, 2024

    Pharmacies and providers are still struggling with disarray six days after UnitedHealth Group division Change Healthcare suffered a cyberattack.

    The incident, which the company blames on an unnamed foreign government, continues to disrupt operations for Change Healthcare customers and will persist until at least Tuesday, Change Healthcare disclosed Monday. Clients have faced significant obstacles completing basic tasks such as handling prescriptions and claims.

    Change Healthcare is one of the largest claims processing vendors and manages 15 billion transactions a year.

    Pharmacies use its technology to transmit claims to health insurance companies and pharmacy benefit managers and to determine how much to charge patients for medications.

    “We are working on multiple approaches to restore the impacted environment and will not take any shortcuts or take any additional risk as we bring our systems back online,” Change Healthcare said in a statement posted to its website at 8:04 a.m. EST Monday. UnitedHealth Group declined to comment.

    Change Healthcare has a "high level of confidence" that the breach is limited to its dedicated systems and has not affected other parts of UnitedHealth Group's technology infrastructure, the company said. UnitedHeath Group acquired Change Healthcare in a $13 billion deal in 2022 and incorporated it into Optum.

    Reuters reported Monday that the hacker group BlackCat, also known as ALPHV or Noberus, was behind the cyberattack, which would make Change Healthcare the latest victim of a ransomware incident, including a growing number in the healthcare sector.

    “People are just scrambling around trying to figure out what to do as far as getting the patients taken care of,” said Patrick Berryman, senior vice president of special projects and relationships at the National Community Pharmacists Association.

    The Change Healthcare cyberattack has "touched every hospital in the United States one way or another, directly or indirectly," John Riggi, the American Hospital Association's national advisor for cybersecurity and risk, said Monday. Claims processing, payment reimbursement and pharmacy operations are affected, he said.

    The AHA, which urged members to disconnect from Change Healthcare last week, wrote Health and Human Services Secretary Xavier Becerra Monday requesting federal assistance.

    "This unprecedented attack against one of America’s largest healthcare companies has already imposed significant consequences on hospitals and the communities they serve," AHA President and CEO Rick Pollack wrote. "Although the full scope of the impact is still unclear, Change Healthcare’s vast nationwide reach suggests that it could be massive."

    The incident is having an "immediate adverse impact on hospitals’ finances," Pollack wrote. "It is particularly concerning that while Change Healthcare’s systems remain disconnected, it and its parent entities benefit financially, including by accruing interest on potentially billions of dollars that belong to healthcare providers."

    Hospitals and health systems such as NewYork-Presbyterian Hospital in New York City, New York-based Weill Cornell Medical Center, Froedtert and the Medical College of Wisconsin in Milwaukee, Pigeon, Michigan-based Scheurer Health, and Marshall, Michigan-based Oaklawn have reported difficulties.

    "We have identified a solution that allows our pharmacies to resume close-to-normal operations at all locations. Most patients should not experience any significant delays at our pharmacy locations," a Froedtert and the Medical College of Wisconsin spokesperson said Monday.

    In its letter, the AHA asks the Health and Human Services Department to provide guidance on how hospitals may request advanced and accelerated Medicare reimbursements, ease enforcement and evaluations of quality, safety, electronic prescribing and other standards, and advise hospitals on how the disruption may affect value-based care arrangements.

    Pharmacies are trying workarounds, but risk billing and claims mistakes that could be costly, Berryman said. For example, a drugstore may unknowingly fill a prescription that required prior authorization, which could result in nonpayment, he said.

    CVS Health activated continuity plans to limit disruption, a spokesperson said Monday. The Defense Department is filing prescriptions for military personnel, civilian employees and families manually, TRICARE said last week. Walgreens and the National Association of Chain Drug Stores did not respond to requests for comment.

    “Pharmacies across the nation are reporting significant backlogs of prescriptions they are unable to process,” the American Pharmacists Association said in a news release Friday. “Pharmacists are working overtime to continue their work, to treat patients and to do this in as timely a fashion as possible,” the professional organization said.

    OptumRx advised pharmacies to continue filling prescriptions using emergency protocols and that its pharmacy management systems can process offline claims, according to a notice sent to pharmacies Thursday. The National Community Pharmacists Association shared the document with Modern Healthcare.

    Healthcare vendors have increasingly become targets for cyberattacks because they possess a wealth of patient information and are perceived as more vulnerable than large health systems and health insurance companies with more robust security.

    "A lot of the risk we are exposed to in the healthcare sector comes from third parties," Riggi said. "We can spend our entire budget on cybersecurity but we're plugged into third parties who may not be as secure as us, and we have to depend on their technology."

    UnitedHealth Group is evaluating the financial consequences of the cyberattack, the company notified regulators last week. Fitch Ratings does not anticipate it will have a material impact while Moody’s Investors Service declared it to be credit-negative for the company.

  • 22 Feb 2024 5:18 PM | Matt Zavadsky (Administrator)

    While Rural communities are at the tip of this spear – many of these same issues are happening in urban and suburban areas as well.

    NAEMT is working on a project to try and create a Critical Access Ambulance Provider designation that would function with the same eligibility and reimbursement model and Critical Access Hospitals.


    Rural emergency hospital model exposes ambulance service gaps


    February 22, 2024

    Anson General Hospital needed to transfer a pediatric patient to a specialist at Cook Children’s Medical Center in Fort Worth, Texas, but the only ambulance in Anson wasn’t available.

    If it had made the 340-mile round trip during a night of heavy rain on Feb. 10, no ambulance would have been available to handle 911 calls. As a result, Anson General had to keep the patient overnight in the emergency department.

    The next morning, the ambulance transported the child 25 miles to the airport in Abilene, where Cook Children’s had dispatched a plane for him.

    “We are the only hospital left in Jones County, since the other two hospitals closed," said Anna Doan, chief nursing officer at Anson General. “Those communities bring us patients on a daily basis. When a patient has more acute needs and needs to be transferred to a tertiary facility, the problem arises: How are we going to get them there?”

    It doesn't take much to upend emergency transportation services in rural communities, which have been plagued for years by limited ambulance networks.

    Many hospitals used to operate ambulance services, but that dynamic has shifted as rural hospitals finances have deteriorated. Rural hospitals often rely on one or two ambulances, oftentimes operated by volunteers, to transfer patients and handle 911 calls. A new hospital designation—rural emergency hospital—threatens to derail the fragile system.

    Twenty hospitals have converted to rural emergency hospitals about a year since the federal program was implemented. Hospitals forgo their inpatient beds, among other trade-offs, in exchange for a 5% increase in Medicare outpatient reimbursement and an average facility fee payment of more than $3.2 million a year.

    More hospitals are expected to convert, potentially requiring more ambulance transfers of patients to hospitals with inpatient beds. Since Anson General converted in March, on average it has transferred roughly 20 patients a month, versus 15 previously.

    “The rural emergency hospital legislation was notably missing considerations about ambulance services,” said Gary Wingrove, president of the Paramedic Foundation, a nonprofit research and advocacy group and a member of a federal advisory committee on ground ambulance and patient billing. “That is a big unintended consequence.”

    Ambulance services are typically fueled by a tenuous stream of subsidies from local jurisdictions and providers. When funding falls through, communities can lose emergency transportation services, potentially overloading area hospitals and causing delays in patient care. The situation has prompted pushes from local, state and federal policymakers to overhaul the reimbursement model.

    According to the latest Medicare cost report data, only 18% of rural hospitals bill Medicare for ambulance services, meaning that communities largely lean on volunteer-run and third-party contractors, according to a data analysis by consultancy the Chartis Center for Rural Health.

    Jones County, where Anson General is located, is reviewing a contract expiring in March for the city’s sole ambulance.

    “Not having a 911 service would be detrimental to the community. People could lose their lives,” Doan said. “It could have a big impact on patient care, changing the patient flow in ERs and how long transfers take.”

    Other rural communities could face similar predicaments since many towns are grappling with declining populations, worsening socioeconomic conditions and Medicare reimbursement cuts, particularly as more people age into the program, Anson General Interim CEO Ted Matthews said. 

    It costs roughly $1 million a year to fund an ambulance service, research shows. Roughly 4.5 million people live in an ambulance desert, defined as an area where a dispatch station is at least 25 miles away, according to a report published in May by the Maine Rural Health Research Center, which is associated with University of Southern Maine.

    The cost is prohibitive for many hospitals, cities and counties. In those areas, ambulance services are operated by volunteers and owned by third-party contractors.

    “We’re expecting the people who are going to decide whether you live or die to be volunteers,” Wingrove said. “That just doesn’t work.”

    Only one of the ambulances covering Friend, Nebraska, operates 24/7. The other two volunteer-run ambulances have limited hours and select routes.

    In July, Warren Memorial in Friend had a complex bariatric patient who needed to be transferred to a larger hospital in Lincoln, Nebraska. Administrators called 12 different transport companies and none would take him. Their vehicles lacked the specialized equipment to shuttle an obese patient.

    “He ended up staying here all night when he could’ve gotten better treatment in Lincoln,” said Jared Chaffin, chief financial officer and interim co-CEO of Friend Community Healthcare System, which operates Warren Memorial. While care was delayed, the patient ended up OK, Chaffin added.

    Administrators at Warren Memorial, which converted to a rural emergency hospital this month, are worried about the impact to the area's transportation network since the hospital no longer has inpatient capacity.

    Not everyone expects the rural emergency hospital program to strain transportation services. Most of the hospitals that convert were not admitting many emergent patients, said Eric Shell, board chair with the consultancy Stroudwater Associates who specializes in rural healthcare. Even if they did, most of the hospitals would be able to treat those patients under observation, as permitted by the rural emergency hospital program, as long as the average annual length of stay for observation patients remains below 24 hours, he said.

    That's the case at Santa Rosa, New Mexico-based Guadalupe County Hospital, which converted in September. The hospital hasn’t seen an increase in transfers since it already had relatively few admissions, and those who had been admitted were treated as observation patients, Administrator Christina Campos said.

    Still, regardless of the impact of the rural emergency hospital program, a more sustainable funding model is needed for emergency transportation services, experts said.

    Some industry observers are pushing for cost-based reimbursement for ambulance operators, similar to the critical access hospital model. As part of the No Surprises Act, legislation implemented in 2022 intended to shield patients from surprise bills, the federal government appointed an advisory committee on ground ambulance and patient billing. Ground ambulances are exempted from the law.

    That committee will soon publish a report that supports a cost-based payment model for ambulance services, said the Paramedic Foundation’s Wingrove, a member of the committee.

    “It is a misnomer to think you can pay for an ambulance service through reimbursement alone. The math simply isn’t there,” said Andy Gienapp, deputy executive director of the National Association of Emergency Medical Services Officials.

    “This problem has been a festering wound for decades now.”

  • 14 Feb 2024 12:50 PM | Matt Zavadsky (Administrator)

    Excellent Op-Ed by a well experienced fire service leader!

    Important quotes from his Op-Ed:

    • As EMS has been pulled into filling the gaps, it’s become clear that it’s not sustainable or effective in that role. Meanwhile, its ability to respond effectively to life-threatening emergencies has been strained.
    • Recognizing that it’s hard to improve something you don’t measure, the LAFD has been a leader in EMS research. One example was an evaluation of more than 33,000 calls for abdominal pain over a three-year period to see how many turned out to be life-threatening emergencies. The answer, astoundingly, was just seven.
    • Los Angeles is not alone; the staggering growth of nonemergency calls has plagued services around the country. A 2021 study of nearly 6 million 911 calls involving nearly 1,200 U.S. agencies found that while 86% of the responses sent crews racing with lights and sirens on, less than 7% resulted in a potentially lifesaving intervention.
    • Above all, any large-scale solution will require systemwide primary care access for 911 callers. The ultimate goal — one our modern EMS system has largely lost sight of — is to help people get the most appropriate and effective care.

    Tip of the hat to Kolby Miller at Medstar, Inc. in Michigan for finding this….


    Opinion: Why that ambulance racing through L.A. traffic may not be going to a life-or-death emergency


    FEB. 14, 2024

    The lights and sirens of emergency medical services are pervasive in the United States. Not only are our screens saturated with them, but it’s hard to go far in any large city without seeing an ambulance race by.

    The public often assumes that the vehicle is on its way to a life-or-death emergency. But those who have worked in EMS know that is overwhelmingly not the case.

    What started in the 1960s as an answer to rapidly increasing carnage on the nation’s freeways has evolved into a complex subspecialty of American healthcare. Early research on the field demonstrated that prompt emergency medical care benefits a small subset of patients, namely those who suffer cardiac arrest and certain kinds of severe trauma. The hugely successful marketing of the 911 system also drove the expansion of EMS.

    Between 1980 and 2010, while the U.S. population increased 36%, the country’s fire departments experienced a 267% explosion in EMS runs. The number of life-threatening emergencies obviously didn’t grow that rapidly, so what happened?

    The EMS system got too good at its job — not the job of saving lives so much as the job of showing up in a matter of minutes at any time, day or night, for anyone who dials those three numbers. As affordable access to healthcare continued to erode, 911 was a reliably, readily available substitute.

    In its fifth decade, the modern EMS system doesn’t look much like it did when it was formed. In most cities, it’s become a catchall for everything that can fall through the cracks in our healthcare networks: communities with poor primary care access, homeless populations, and people with mental illnesses and substance abuse problems, to name a few.

    All these people need and deserve access to healthcare. The trouble is that EMS systems were not designed to handle this volume or breadth of patients. While emergency medical services are less expensive than byzantine hospital systems, they are by no means cheap.

    EMS is a labor- and equipment-intensive industry that struggles to recruit personnel, collect insurance reimbursement and, more recently, transfer patients to emergency rooms in a timely fashion. As a result, its ability to respond to any rapid increase in demand for care is very limited.

    Take the Los Angeles Fire Department, which responded to nearly half a million calls for service in 2022 — a 10.3% increase from 2018 — for a ratio of 1 response per 7.8 residents. To accomplish this feat, the department staffs approximately 150 ambulances per day out of its 106 fire stations. While that sounds like a lot of resources, the truth is that it’s only enough to cover 0.004% of the population at any given time. This is just one example of the vulnerability of our overburdened EMS system.

    Further exacerbating the difficulties in providing EMS coverage, use patterns are notoriously uneven; certain neighborhoods rarely use the system, while others rely on it for most of their healthcare. But it can’t just be removed from neighborhoods that don’t use it much.

    Unhoused people are an extreme example of these divergent patterns. They represent only 0.8% of the population but account for 10.2% of the city’s EMS calls, using the service at 14 times the rate of housed residents.

    Recognizing that it’s hard to improve something you don’t measure, the LAFD has been a leader in EMS research. One example was an evaluation of more than 33,000 calls for abdominal pain over a three-year period to see how many turned out to be life-threatening emergencies. The answer, astoundingly, was just seven.

    Los Angeles is not alone; the staggering growth of nonemergency calls has plagued services around the country. A 2021 study of nearly 6 million 911 calls involving nearly 1,200 U.S. agencies found that while 86% of the responses sent crews racing with lights and sirens on, less than 7% resulted in a potentially lifesaving intervention.

    The repercussions of inadequate healthcare run rampant in EMS calls and emergency departments. Only 8% of Americans 35 and older receive all recommended preventive services and screenings, and 1 in 8 of those ages 12 to 65 doesn’t have health insurance. Complications from diabetes, uncontrolled hypertension, obesity and alcohol use overwhelm the healthcare system in volume and cost. According to the Centers for Disease Control and Prevention, 90% of U.S. healthcare spending goes to treat chronic conditions.

    As EMS has been pulled into filling the gaps, it’s become clear that it’s not sustainable or effective in that role. Meanwhile, its ability to respond effectively to life-threatening emergencies has been strained.

    Many local leaders are aware of this and looking for answers. The strategies they have deployed include referring nonemergency calls to nurse hotlines, employing alternative transportation to sobering facilities and urgent care clinics, and bringing mental health practitioners to patients. Much effort has been expended trying to discourage nonemergency 911 calls with minimal success.

    It’s become apparent that the answer isn’t dissuading the public from calling 911 as much as it is changing what happens when the calls come in. One stumbling block has been accurately identifying non-life-threatening conditions. EMS systems have generally opted to err steeply on the side of tolerating nonemergency calls to avoid liability. Refining dispatch algorithms and integrating physician and nurse assessment may help alleviate the impulse to just send an ambulance.

    Ultimately it will be necessary to view 911 centers as healthcare hubs and ambulance transport as just one spoke for delivering it. The ability to triage patients as an emergency room does and send the appropriate response — whether an ambulance, taxi or mobile laboratory — may help conserve resources.

    Above all, any large-scale solution will require systemwide primary care access for 911 callers. The ultimate goal — one our modern EMS system has largely lost sight of — is to help people get the most appropriate and effective care.

    Jon Nevin is a battalion chief for a Southern California fire department and a longtime emergency medical services practitioner and researcher.

  • 14 Feb 2024 12:49 PM | Matt Zavadsky (Administrator)

    Notable quotes from these two articles on the same study released yesterday…

    • “EMS systems in the United States have traditionally relied upon operational measures, like response times, to measure performance of the system. However, this study highlights how patient care and experience are not solely determined by how fast an ambulance can arrive at the patient’s side,”
    • Over half of all EMS agencies failed to meet multiple performance measures, and only one in 10 dispatches followed the exact safety guidelines set, according to the study published Tuesday in Prehospital Emergency Care.
    • The rate of injuries in EMS workers is almost 15 times higher when ambulances use lights and sirens compared to when they don’t.
    • Researchers looked at how many patients who were transported using lights and sirens received interventions at the hospital, and only 4.5% of patients got this type of intervention.
    • The rest received interventions from EMS workers before arriving at the hospital, so the researchers recommended more research was needed to justify the use of lights and sirens in patients who need hospital intervention.

    You can view a PDF of the study here.


    Quality of Care for Patients Who Call 911 Varies Greatly Across the United States, Study Finds

    Mount Sinai research could lead to more consistency and safety measures

    February 14, 2024

    Emergency medical service (EMS) systems are not consistently providing optimal care based on new national standards of quality to patients who call 911, according to a new study from the Icahn School of Medicine of Mount Sinai.

    The study demonstrates that EMS performance on key clinical and patient safety measures varies widely across urban and rural communities. The findings, published in the February 13 issue of Prehospital Emergency Care, identify opportunities that could lead to improved care during 911 responses and improved outcomes for patients across the United States.

    “EMS systems in the United States have traditionally relied upon operational measures, like response times, to measure performance of the system. However, this study highlights how patient care and experience are not solely determined by how fast an ambulance can arrive at the patient’s side,” explains lead author Michael Redlener, MD, Associate Professor of Emergency Medicine at Icahn Mount Sinai. “While fast response times are essential for rare, critical incidents—like when a patient’s heart stops beating or someone chokes—the vast majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency. It is essential for EMS systems, government officials, and the public to know about the quality and safety of care that is occurring and find ways to improve it.” 

    This is the first study to use specific safety and clinical quality measures to assess patient care across the entire 911 system in the United States.

    The research team reviewed all 911 responses in the United States for the year 2019, more than 26 million responses from 9,679 EMS agencies. They assessed specific quality measures in each call outlined by the National EMS Quality Alliance – a nonprofit organization that was formed to develop and endorse evidence-based quality measures for EMS and healthcare partners that improve the experience and outcomes of patients and care providers. This includes the treatment of low blood sugar, seizures, stroke, pain, and trauma, as well as medication safety and transport safety. Some of the notable findings were:

    • Pain for trauma patients improved in only 16 percent of cases after treatment by EMS.
    • 39 percent of children with wheezing or asthma attacks did not receive breathing treatments during their EMS call, even though earlier treatment can lead to earlier relief of distressing symptoms.
    • Nearly one-third of patients with suspected stroke did not have a stroke assessment documented, potentially delaying or missing time-sensitive treatment.

    The researchers also analyzed performance of all EMS agencies, looking at agency size and location—urban, suburban, and rural. They discovered substantial differences in agencies that primarily responded in rural communities compared to urban and suburban areas. Agencies with responses in mostly rural areas were less likely to treat low blood sugar or improve pain for trauma patients, and more likely to use lights and sirens unnecessarily when compared to EMS systems in urban and suburban communities.

    Previous studies have shown that when lights and sirens are used during EMS transport there is a higher likelihood of accidents, injury, and death, so unnecessary use may be more dangerous. Dr. Redlener says the difference between the highest- and lowest-performing agencies on these key measures is notable.

    “This work is not about blaming bad EMS services, but about uncovering opportunities to improve patient care,” Dr. Redlener adds. “We have to move away from solely looking at response times and start looking at performance that directly impacts the people we are meant to treat.”


    Rural EMS Patients Face Worse Health Care—And Too Many Sirens, Study Finds

    Arianna Johnson

    Forbes Staff

    February 13, 2024

    Emergency medical services in rural areas are less likely to reduce pain in trauma patients provide proper care to kids with asthma attacks, and are more likely to use lights and sirens unnecessarily, according to a study published Tuesday, adding to previous research that found rural health systems struggle more compared to urban and suburban areas.


    The team of researchers from the Icahn School of Medicine of Mount Sinai looked at all the 911 dispatches in the U.S. in 2019—which consisted of over 6 million responses from 9,679 EMS agencies—and graded EMS agencies based on some of the National EMS Quality Alliance’s performance measures, like effectiveness of pain management and taking trauma patients to trauma centers.

    Over half of all EMS agencies failed to meet multiple performance measures, and only one in 10 dispatches followed the exact safety guidelines set, according to the study published Tuesday in Prehospital Emergency Care.

    EMS agencies with responses in mostly rural areas were on average more than 25% more likely to use lights and sirens unnecessarily when responding to calls, and 5% less likely to improve trauma patients’ pain and treat low blood sugar compared to agencies in suburban and urban areas.

    Almost 40% of children who suffered asthma attacks or breathing problems from all communities didn’t receive treatment from EMS, but those in rural areas received it at a rate of about 10% less, according to Tuesday’s study.

    Almost a third of patients in all communities suspected of a stroke didn’t receive a stroke assessment, which the researchers believe could have delayed or completely stopped the patients from receiving timely treatment.


    The national average from the time of a 911 call to arrival on scene is seven minutes, but that time doubles to 14 minutes in rural areas, and around one in 10 encounters take 30 minutes, according to a 2017 JAMA study.


    “While fast response times are essential for rare, critical incidents—like when a patient’s heart stops beating or someone chokes—the vast majority of patients benefit from condition-specific clinical care in the early stages of a medical emergency,” lead author Michael Redlener, an associate professor for the Icahn School of Medicine of Mount Sinai, said in a statement.


    Rural communities have worse or struggling medical systems because they’re often isolated from bigger cities, and they tend to have a shortage in doctors, according to the National Institutes of Health. EMS agencies in isolated areas respond to more critical, life-threatening calls that require more timely response times than suburban and urban EMS providers, mainly because rural areas are poorer, older and sicker.

    Large geographic areas with scattered populations, longer travel distances and challenging weather conditions and terrain are all factors into longer dispatch times in rural communities, the federally funded Rural Health Information Hub says.

    Another factor at play is the closure of hospitals in rural areas. There were 136 rural hospital closures between 2010 and 2021, with a historic 19 in 2020 alone—the most of any year in the past decade—according to a 2022 report from the American Hospital Association. Hospital closures means still-standing hospitals have an increased coverage area: rural ambulance travel times increase 76% in the year directly following a closure, a 2019 University of Kentucky study found.


    The use of sirens and flashing lights by ambulance vehicles has been a long-debated topic within the medical community.

    Lights and sirens are meant to decrease response and transport times, and research suggests they cause a “modest” reduction in EMS response time between 1.7 to 3.6 minutes, and reduce transport time between 0.7 to 3.8 minutes.

    However, some argue they do more harm than good. The risk of crash more than doubles when emergency vehicles use lights and sirens while transporting a patient, according to the National Safety Council.

    The rate of injuries in EMS workers is almost 15 times higher when ambulances use lights and sirens compared to when they don’t.

    Researchers looked at how many patients who were transported using lights and sirens received interventions at the hospital, and only 4.5% of patients got this type of intervention.

    The rest received interventions from EMS workers before arriving at the hospital, so the researchers recommended more research was needed to justify the use of lights and sirens in patients who need hospital intervention.

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