Another example of how existing services models are not sustainable with skyrocketing costs of service delivery and historically low reimbursement rates, regardless of who the provider is, public, private, hospital-based, etc.
Community leaders need to be educated on the true cost of EMS service delivery, the cost differences based on service levels and provider types (public, private, 3rd service governmental, hospital-based, etc.), decide what service level the community really wants based on the levels of investment needed for each level, and begin to fund EMS delivery the way other essential public services are funded.
Click here to view a recent webinar hosted by the Academy of International Mobile Healthcare Integration discussing costs and funding models based on service delivery levels.
This may be the latest, but it WILL NOT be the last!
AMR to discontinue service in Youngstown
by: Jennifer Rodriguez, Megan Lee
Sep 14, 2022
YOUNGSTOWN, Ohio (WKBN) – American Medical Response (AMR) sent a letter to the City of Youngstown Wednesday notifying the city that it will be discontinuing service in Youngstown.
According to the letter sent to the city, AMR will not renew its agreement with the city, and the current agreement will end on December 31, at 11:59 p.m.
The letter states AMR has been serving the city for over 30 years without any cost to the city or taxpayers. It also states that the company is not being reimbursed for medical calls.
“We have discussed throughout the last three years, the subsidy is needed to overcome inadequate Medicaid reimbursement which makes up a significant portion of our services and which is below our costs,” it stated.
It goes on to state, “The current Ohio Medicaid base rate for a basic life support emergency transport is $120 and has not been re-based by the state in years. When we treat and transport Medicaid patients, we are reimbursed far below the cost of providing service — approximately 42% of our cost. More than half our transports, or 54%, are Medicaid recipients.”
In April, Youngstown City Council voted down a $625,000 subsidy to “ensure continued EMS and ambulance services” for the city. All council members voted no except Third Ward Councilwoman Samantha Turner.
At that time, Fourth Ward Councilman Mike Ray said the door was not completely shut, but there were some details that needed to be worked out first.
We don’t know if that’s still the amount to keep AMR in place. When asked if the city should reconsider the vote, Turner said, “We should. If they’ll take it.”
Today, we asked several council members their thoughts on the notice and AMR stating they need more money.
“We asked admin months and months ago to go out for an RFP to see who else may be interested with that much money on the line, it’s only responsible of us to do that but the admin hasn’t done it, surprise, surprise,” said Fifth Ward Councilwoman Lauren McNally. “They are the largest EMS service in the country and I feel they are bullying us into a money grab since we have ARP money right now.”
“They are the largest ambulance company in the country, I feel like they are extorting us because we have some extra money now. I’m not sure what’s going to happen. My ultimate feeling is, have their services improved, what are they willing to give in return? Are they adding trucks, are we going to get better response terms, are the citizens of Youngstown going to be served any better because of the extra money? If not, what’s the point of payment? We can’t get or continue to get mediocre or bad service,” Oliver said.
“What we see in front of us doesn’t make sense to pass at this point, so we definitely wanna continue the conversation,” Ray said.
In January, AMR Regional Director Ed Powers used a computer presentation to explain the problems, saying while an average ambulance run costs about $300, Medicaid only reimburses the company $130 – a gap of 48%.
“Medicaid currently covers about 48% of our expense. We need another 52% just to break even,” Powers said.
“During that three years, we’ve explored all kinds of different models, trying to create a sustainable model. I mean, we knew five years ago that the model wasn’t sustainable,” he said.
Youngstown Law Director Jeff Limbian said the letter from AMR was not unexpected.
“The City of Youngstown, under Mayor Brown’s direction, has been to negotiate with AMR for many months now. Some members of City Council would like a more expansive analysis to see if there are other ambulance companies available to come into the city,” he said. “There is currently a request for proposals to determine if there are other interested ambulance entities. If that process does not produce an additional option, we anticipate that discussions will continue with AMR.”
According to Powers, AMR gave the city a 115-day notice to find new services. And if services aren’t found…
“Oh, it would mean a holy disaster to be perfectly blunt. We don’t anticipate that’ll happen. Mayor Brown is going to move heaven and earth to make sure that the citizens are protected. There will be ambulance service one way or another,” Limbian said.
Powers says the company hopes that the administration in Youngstown sits down with AMR to discuss any future plans or negotiations because he says AMR has invested a lot in the City of Youngstown.
“We actually hire residents off the street that are non-medical providers. We train them to be a medical provider and then give them jobs to work on our ambulances, and then they’re paying taxes to the City of Youngstown. So they’re… everybody here is invested in the City of Youngstown and nobody wants to leave,” Powers said.
Limbian hopes AMR will want to go back to the drawing board if the administration is unsuccessful in finding an alternative company.
“You know, it was a hard lesson for us to learn, to come to that realization, but now that we do understand that there just isn’t the money for them to make in the town the size of Youngstown with the volume that we have. So their requests are reasonable,” Limbian said.
The Youngstown Fire Department recently stopped using its fire trucks for emergency medical calls after it was determined what they were doing was illegal. The fire department needs what is known as “standing orders” from a hospital and is working to get them.
The Youngstown Professional Fire Fighters IAFF Local 312 responded to AMR’s announcement calling on city leaders to talk about the future of pre-hospital care for the city:
“Now is the time to address the inequalities that have plagued Youngstown for years. We are witnessing firsthand the ramifications of putting profits over patients. The citizens of Youngstown deserve access to basic infrastructure like public safety, which includes a sustainable, professional EMS system. The Youngstown Professional Fire Fighters urge the city leaders to finally recognize our abilities to help our citizens and negotiate the implementation of a first-class pre-hospital system.”