Every day in America, someone relies on an ambulance, the service of EMTs, and quick response to provide them life saving treatment. Insured or not, ambulance service is available for them. In 1986, the Reagan administration passed Emergency Medical Treatment and Active Labor Act (EMTALA), a measure designed to make sure that all Americans had access to a hospital and could not be refused — no more patient dumping. It also meant that patients with EMC — Emergency Medical Conditions, would be guaranteed access.
With so much focus put on Meals on Wheels and other elements of Trump’s budget, too many may have overlooked provisions in the ACA rollback which may upend the emergency access industry. While EMTALA was designed to provide access, it was an unfunded mandate — meaning the providers themselves had to foot the cost if the patient couldn’t. Under the ACA, with more individuals insured, the emergency treatment wing service, required under EMTALA was finally looking as though it would have some support to make it less of a financial loser.
Now, with ACA on the chopping block, providers to rural health care initiatives and ambulance services are looking at whether now is the time to get out of town — or change their business entirely.
The social medic, an official blog for EMS workers, began this story by noting the lay of the land here: thesocialmedic.net/… and David Konig concludes his review with a pretty on the point punch:
EMS has historically been plagued with underfunding from the government and over expectations of the public. This has created a lowly compensated work force in a demanding environment with a greater provider churn rate then the other Allied Health Services. This spiraling downward cycle will continue until private EMS agencies are no longer viable business models, forcing municipal funded services to take on the inter-facility work draining their resources more, and finally resulting in the complete Federalization of the Emergency Medical Services across the board. This isn’t a 5-year, 10-year, or even 20-year outlook (hopefully). However in 50-years or maybe 100-years, this is where I think EMS will be. You won’t trace that result back to the AHCA of 2017 or ACA of 2009, but rather to EMTALA of 1986.
While EMTALA may be the source of the business implosion, it is the moral requirement of the American way… until of course it isn’t anymore. In the meantime AMR, the largest Emergency Medical Service provider in the United States is up for sale.
And while Emergency Medical Service members should certainly be concerned about major changes in AMR, other elements of Envision are also potentially on the chopping block — like Evolution Health, a mobile treatment division designed to help those with post-care treatment.
The reason why many are backing away? It’s because with fewer individuals having means to pay, for-profit hospitals are less likely to succeed.
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14 million more people would be uninsured under the law in 2018, increasing to 24 million by 2026. The CBO projected that as many as 14 million more Americans would be without health insurance under the AHCA in 2018.
With fewer hospitals and the nation’s largest emergency medical service potentially on the chopping block, not only is the Trump administration making health care more expensive, but also far more difficult to get. After all, if emergency care service isn’t available, you aren’t getting to a hospital in time.
AMR services, the largest in the nation, have often been criticized regarding putting profits ahead of patient services; but the sale of AMR would most certainly exacerbate that problem, pushing localities to take in services they have long outsourced to the company.
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The San Bernardino County Professional Firefighters Union, or Local 935, recently decided to go public in detailing problems with ambulance response times in the region. In a series of social media posts, the union claimed ambulances from American Medical Response, or AMR, are frequently unavailable to cover their response area -- a scenario described as "Level Zero."
"The issue of Level Zero is a growing problem and AMR is consistently not staffing enough ambulances for the areas they are responsible for," the union said in a Facebook post. "This has been a problem of concern for several months in the High Desert."
Union president Jim Grigoli stressed that AMR paramedics and emergency crews are not part of the problem.
"We have a good working relationship with EMTs and the medics. The issue is with the corporate office," Grigoli said. "There's this belief that the system is working, but it's not."
AMR, which was already dealing with concerns it was putting profits above patients, may find itself sold to a smaller entity with fewer resources available to staff a service that is federally required to run, insurance or not, patients to the doctor. The end result?
We are likely to see a contraction in the ambulance service industry. An increase in cost to local taxpayers who will have to foot more direct ambulance service, and of course, a likely rise in responses.
And if you’re an American patient needing emergency health care, none of those things are good.