By Jeff Himler
Tribune-Review
JEANNETTE, Pa. — Ambulance crews that provide life-saving intervention are themselves in need of life support, industry officials said.
Insufficient funding is one of the primary factors that prompted the abrupt closure of the Jeannette EMS ambulance service a week ago, said Randy Highlands, director of operations.
It’s an outcome he fears other ambulance organizations could face without improved prospects for covering costs.
“This is not just Jeannette,” Highlands said. “This is an industrywide crisis that’s not going to go away until elected officials realize we’re not just saying this stuff to get a handout.”
The city provided the ambulance service with $12,000 annually, but Highlands said that was just enough to cover a quarterly payment on the service’s insurance policy. At the same time, he said, payments received from the insurers of patients Jeannette EMS served typically covered just a fraction of related operating costs.
“On a $1,100 bill, we might make back $125,” he said, noting the larger amount was the service’s basic fee for responding to a 911 emergency call.
Paid member subscriptions weren’t the answer for balancing finances.
If all those in the Jeannette service area had signed up as members of the ambulance organization, it could have provided about $300,000 in revenue, Highlands said. But, he indicated, only about 10% became members.
“The last 10 years have been a roller coaster ride that got more and more difficult,” he said. “This time we just ran out of options.”
Officials at neighboring ambulance companies have responded to calls in the Jeannette service area since Monday, based on the closest available ambulance unit at any given time. They will continue to do so until the city settles on a longer-term option for ambulance coverage.
City officials are expected to discuss such options at a council work session Tuesday.
That immediate scenario and path for moving forward were confirmed Friday in a meeting involving officials from the city, Westmoreland County Public Safety and Mutual Aid Ambulance Service.
As of Friday afternoon, Greensburg-based Mutual Aid had answered at least eight calls in the former Jeannette service area, according to Ken Bacha, chief operations officer.
Bacha suggested some element of municipal funding might be needed to keep community ambulance services viable in the long run.
“This time it’s Jeannette,” Bacha said. “Who is it going to be next month? The money isn’t there.”
Mutual Aid provides ambulance coverage in 27 municipalities in Westmoreland County and five others in Fayette County. None of them provide direct funding to Mutual Aid, Bacha said.
“Something has got to give,” he said, indicating the service likely is on track for annual financial losses in seven figures. “We have investments, but we can’t continue to deplete that multiple years in a row. A lot of other places are probably in a similar mode.”
The loss of Jeannette EMS stretches remaining area ambulance resources that much thinner, Bacha said. While Mutual Aid was providing backup to the neighboring Jeannette service when needed, the reverse also was true.
“We would rely on Jeannette EMS to back us up in the western part of our area if we would get real busy,” Bacha said.
Penn Township Ambulance responded to about six Jeannette-area calls between last Monday and Friday, according to its director of operations, Edgar Grant.
He said his organization has been able to absorb that additional workload but noted it was not invited to Friday’s meeting and that Fire Chief Bill Frye is the only Jeannette official he’s had contact with since Monday. Grant said he hopes to attend the Tuesday work session in Jeannette.
“We’ve been thrust into this situation,” he said. “We may be able to continue to help (in Jeannette), but we need everybody at the table to share their capabilities and what resources they can offer.”
Grant also is president of the Westmoreland County Ambulance and Rescue Association, which counts more than a dozen county-based ambulance services in its membership.
He said Penn Township Ambulance is able to cover about 15% of its operational costs with funds allocated by the four municipalities it serves — Penn Township and Penn, Trafford and Manor boroughs.
Recognizing that many area ambulance companies receive no such support, the county association more than a month ago sent letters to officials of most Westmoreland municipalities. Grant said the letters suggested municipal officials “ought to connect with their local EMS (emergency medical service) provider, open a dialogue, see if there are any unmet needs and what kind of partnership could occur, or other sources of funding.”
As of this past week, Grant said, there was no indication the letters had generated any responses.
Staffing challenges have added to funding concerns for many ambulance services.
Penn Township ambulance crews include a number of college students, leaving the ranks depleted when they return to campus in the fall, Grant said. That fluctuating workforce determines how many hours the service is able to staff both of its ambulance units, instead of just one, he explained.
“Westmoreland County is not unique,” he said. “These are struggles faced by all EMS agencies across the nation.”
He noted some people opted to leave the EMS field when the covid-19 pandemic arrived, prompting concern for their health and that of their families.
At the state level, the Ambulance Association of Pennsylvania is advocating for legislation that would improve the level of some insurance reimbursements available to ambulance services.
Association Executive Director Heather Sharar supports ending a rule that limits mileage-based payment for ambulance transports of patients insured through medical assistance.
While Medicare pays for every mile an ambulance travels while carrying a patient, that trip reimbursement is reduced by 20 miles if the patient is covered by medical assistance, she said.
“The reimbursement end is heavily regulated,” said Sharar. “How does an EMS agency make up the difference? You’ve got subscriptions, but you may get just 5% to 10% of the population to participate, and the majority of municipalities in Pennsylvania do not provide a sustainable funding mechanism.
“When you call 911, you get a mobile emergency room, but nobody wants to pay for that. The ambulance service has to have a crew ready 24/7, but it doesn’t get paid unless they are taking people to the hospital. It’s a bit of a perfect storm.”
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