By Robert Williams, Perham Focus
Hundreds of people went to the Perham Fire Department on Saturday, June 15, for their annual pancake breakfast. Most of them were just there to make a donation, check out the fire trucks and enjoy some delicious pancakes and sausage.
But U.S. Rep. Michelle Fischbach, a Republican who represents Minnesota's 7th District, and state Sen. Jordan Rasmusson, R-Fergus Falls, came not only to support the fire department, but also to talk about the problems facing rural EMS providers across Minnesota and around the country.
They sat down inside the fire department with Perham Area EMS Director Rebecca Huebsch, Manager of EMS Operations and Training Mark Ebeling, Otter Tail County Republican Party Deputy Chair Vance Bachmann, EMS Joint Powers Board Chairperson Barb Felt, and former EMS Director Jim Rieber.
Rasmusson, who worked closely with Huebsch last session on legislation to benefit rural EMS providers, said that part of the problem with keeping rural EMS providers properly funded is the rates insurance providers will pay. The other part is whether the providers will be reimbursed at all for responding to certain calls.
“For example, a lot of the no-transports where you’re going to help someone with a lift assist, and you’re helping provide them with health care, or you’re monitoring their vitals because they don’t know if they have heartburn or are having a heart attack,” Rasmusson said. “But you don’t get reimbursed for that, that’s all cost for you guys.”
Ebeling, who’s also a member of the Perham Fire Department, echoed Rasmusson’s comments.
“If a diabetic patient’s blood sugar goes low and we go out there, treat them and leave them home, we don’t get paid,” Ebeling said. “Now take that same patient, put them in the ambulance, correct their blood sugar on the way to the hospital, get them an ER visit, get mileage on it, get labs, then they’ll pay.”
Rieber also expanded on the issue of reimbursement from insurance companies. He said patients know that if they go to the hospital their ambulance is paid, so they’ll go for that reason.
“Instead of overloading these ERs, let’s start scheduling them for follow-up the next day,” Rieber said. “Remove that transport requirement to make it reimbursable based upon the response and level of care provided.”
According to Rieber, if patients don’t get transported then they’ll get a personal bill. So they’re better off taking the ambulance ride to the ER. Even though insurance pays for transports, those transports also incur additional expenses for EMS providers compared to treating patients on the scene.
“We should be able to treat on the scene and be reimbursed for that treatment,” Rieber continued. “And there’s many times when you can go, and if it didn’t have that transport element to it, you could talk to the person and say, ‘You should just follow up with your provider tomorrow and have this sore throat checked out.’ Instead of an ER ride and ER costs and all that.”
Huebsch said that making changes to Medicare is the best place to start to fix the reimbursement issue for EMS providers.
“Medicare sets the tone for what everyone else has to do,” Huebsch said. “Because commercial insurance only has to pay at or above the Medicare rate, so when the Medicare rate is paying at 33% it kind of messes up the whole system.”
Rasmusson mentioned that, due to an abundance of calls, the current system is working fine for urban EMS providers compared to rural providers.
“If you go down to Hennepin EMS, they make money,” Rasmusson continued. “The Medicare rates are OK for them because they have more than 100 calls per square mile in their service area in Minneapolis. You guys probably have less than 1 call per square mile, and they probably do more in a day than you guys might in a year. So there’s that cost of readiness. You still have to have an ambulance and have people on call.”
Felt added that if EMS was considered an essential service, that would also help with the funding issues facing rural providers. Rieber also said that there’s grant money available to fire departments that’s not available to EMS providers.
“EMS needs to become an essential service like law enforcement and fire,” Felt said. “Why isn’t it? How many people use EMS compared to fire? Probably 50% more I would bet. Or even from a law enforcement side. How much more EMS is being used than law enforcement in a typical rural area?”
Many other points were made throughout the 40-minute meeting, and throughout most of it, Fischbach listened and asked questions about the problems facing rural EMS providers. However, at the end of the meeting, she made her own point regarding the problems rural providers are facing.
“One of the disadvantages of what happens with rural areas is, you guys make it work,” Fischbach said. “You serve the people. You want to make sure that they’re getting the kind of service, care and attention that they need. Then they don’t see the crisis because, in rural areas, people band together and they make it work. It’s not in your DNA to let it fail.”
