Disappearing ambulances

A story on the Mississippi Today website provides insight on yet another growing concern in the medical care field: the cost of operating an ambulance service.

Featuring Franklin County paramedic Tyler Blalock, whose company Rapid Rural Response has provided ambulance service there since 2012, the story illustrates both the benefits and the risks of hiring a small firm for the emergency transportation.

The main benefits are that Blalock’s company is small and local. County supervisors chose him for the service precisely because of his personal touch and his familiarity with residents in Franklin County, population 8,000.

Blalock told Mississippi Today that he can only compete with larger, more profit-oriented ambulance operators by placing a priority on patient care. But he conceded that there will be no such care if he’s losing money.

The risk is that there are plenty of forces aligned against small ambulance services. Naturally, these forces involve money.

The story said the average reimbursement for ambulance calls ranges from $200 to $300, but research indicates these rates are at least 6 percent less than the actual costs of the service. More than 70 percent of ambulance calls are made below cost, which makes profit margins more difficult for smaller companies.

Part of the problem is that Medicare, Medicaid and most private insurers classify ambulance services as a “transport supply” instead of medical treatment, under which reimbursements would be larger.

Emergency medical services providers have a good point when they contend that today’s ambulance crews provide a lot of care in the bus while en route to a hospital. Thus it is both transportation and medical treatment.

Another issue is service cutbacks at rural hospitals, along with a few that have closed. This puts greater demands on larger hospitals, especially the University of Mississippi Medical Center, where many ambulances with seriously ill or injured patients arrive. When it takes significantly longer for a hospital to accept these patients, the ambulance companies lose money because their vehicle must wait there until the patient is admitted.

Low profit margins in ambulance services have been a problem for a number of years. Blalock said he’s fighting this battle in Franklin County, but the good news is that he’s seen fit to expand his business into Lawrence County.

However, it does not take a crystal ball to see the potential for greater financial trouble ahead. Companies that don’t make much money are often unable to pay their employees, which leads to greater turnover and less experienced paramedics. The EMTs who literally have lives in their hands earn an average of $33,000 per year.

The state has a trauma fund, through which it assists counties for ambulance service. But it’s clear that more needs to be done before some parts of Mississippi find themselves without any ambulances at all.

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