By Alex Gault
Watertown Daily Times
ALBANY, N.Y. 鈥� EMS leaders, lawmakers and advocates including Guilfoyle Ambulance general manager Jeff Call rallied in the state Capitol on Tuesday to support a package of legislation they say would take great steps to stabilize ambulance services across New York.
Call, who drove to Albany on Tuesday morning shortly after working an ambulance shift and helping to deliver a baby, said the package is incredibly necessary to help stabilize the lifesaving industry.
鈥淚 assure you that New York is well covered by EMS,鈥� he said. 鈥淵ou hear about deserts in places, but what we鈥檙e doing now is we鈥檙e standing up to fill in gaps. But that can only last so long, and we need finances to fix that problem, put ambulances in the deserts, and properly reimburse the ambulances that are currently providing the services.鈥�
The package of seven bills in the state Assembly and Senate would address myriad regulations and state requirements for ambulance services, ranging from deeming EMS an essential service that must be maintained in all communities to boosting benefits for volunteer EMTs, paramedics, drivers and firefighters.
One bill would permit local governments to create special taxing districts for EMS services, which is currently not allowed under state law, as well as recognizing that EMS is a service that must be provided in some manner in every community in New York.
Another bill would exempt taxes collected for EMS services from the statutory state tax cap, which sets a limit on how much a government can raise their property tax levy.
鈥淲e are coming at this from every angle we can think of,鈥� said Assemblymember Donna A. Lupardo, D- Binghamton. 鈥淚n one of my municipalities, they have not been able to increase EMS services the way they would like, because it comes up against the property tax cap.鈥�
Two other bills in the package would increase the number of tax benefits volunteers in EMS and fire departments can access, by allowing them to claim both state income and local property tax credits 鈥� currently volunteers have to pick one or the other. Another bill would increase the personal income tax credit from $200 to $800 for individuals, and from $400 to $1,600 for joint filers.
Another bill would mark a major change in what ambulance services are allowed to bill for. Under current state law, for Medicaid patients and a large proportion of privately insured patients, EMS operators could only charge for service if they drove the patient to an emergency room. Providing care at the scene is unpaid, and operators are not allowed to transport a patient anywhere other than a hospital emergency room, regardless of their actual health needs.
Under the package supported by the group on Tuesday, ambulance services would be paid under Medicaid for providing 鈥渢reatment in place,鈥� or at the scene where the call originated, and for transporting patients to alternative locations besides the emergency room, like a primary care physician鈥檚 office, urgent care or another medical facility not in a hospital.
Call, who recently ended his term as chairman of the United New York Ambulance Network, said those rules are a major financial barrier and are especially burdensome when local ERs are struggling to handle patient volumes. Call said Medicaid patients represent about 50% of the overall patient load for Guilfoyle in Jefferson County, but many of the calls the company responds to for those patients don鈥檛 end in a ride to the hospital, which patients have the right to refuse.
鈥淢ore than 30% of our patients don鈥檛 get transported,鈥� he said. 鈥淲e go to their home, they鈥檙e diabetic, their sugar is low, we give them the sugar, wake them up and they don鈥檛 want to go to the hospital. They know what鈥檚 going to happen if they go; hours and hours and hours of waiting in the ER.鈥�
Call said ambulance services are not paid when they wait with patients to be admitted to the emergency room at a hospital, and when local hospital ERs fill up and go on diversion, where they order local ambulances to take patients to another hospital, the service is often losing money taking the patient to a further-away hospital.
Call said Guilfoyle ambulances frequently have to take patients as far away as Syracuse, Albany or even Westchester to find an open emergency room. And once the patient is admitted there, the ambulance has to drive all the way back to Watertown before it can take calls again, costing hours and hundreds of dollars in unavailable time, fuel, man-hours and maintenance.
鈥淚t鈥檚 a million miles a year worth of just moving patients around the state of New York,鈥� Call said. 鈥淚f some of these patients can be treated at home, and we can get paid for that, that would be a major improvement.鈥�
Call said Jefferson County is generally lucky because the three hospitals in Watertown, Alexandria Bay and Carthage can generally take the patient volume for the county, and there are plenty of other communities that have one or no hospitals, putting significantly more strain on the ambulance services that operate there.
Another bill in the package supported by Call and the other advocates would update the formulas used to calculate Medicaid reimbursement rates for EMS providers that is more in line with the current cost of doing business.
Call said that the current Medicaid reimbursement rate for the calls the company does get paid for is about 30 to 40% lower than the actual cost of taking the call, and does not take into account any of the non-call specific costs that EMS operators incur to be able to maintain the service in the first place.
He said he鈥檚 hopeful that action on some of the ways the Medicaid system negatively impacts EMS services will help spur the private insurers to change their policies as well.
鈥淲e all know how healthcare works, if Medicare and Medicaid do something, the private carriers are going to follow in that path and say 鈥榶eah we should probably do this to,鈥� he said.
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