As various changes have come down the pike in the health care industry, we are fortunate in Columbia County to enjoy five strong ambulance services and a financial setup designed to ensure their long-term viability.
Equally as important in terms of patient care, EMS Coordinator PJ Keeler and the county Board of Supervisors pushed – successfully – to change an archaic state law that stood in the way of expedited response times.
The five services are the Valatie, Chatham, Greenport and Copake rescue squads and NDP (based in Rhinebeck).
In the early 2000s, county EMS agencies averaged 17 to 18-minute response times. At that time, when an agency went out on a call, the law did not allow another agency to move its ambulance to backfill that area.
The only way an ambulance could move into the other agency’s district was to answer a specific incident, such as a heart attack or accident. In a large, rural county such as ours, this issue clearly needed correcting.
With the recognition the EMS agencies in operation were already doing a good job of operating their businesses, the county had no vision of getting into the ambulance business. However, there was a remedy to solve the response time problem.
After a process that took around 10 years, it was established the county could hold a license, through which it could contract with the individual EMS agencies. At that point, those agencies, through the county EMS system, could be moved into areas needing coverage prior to any incident.
For instance, if the Valatie area was depleted of resources, a Greenport ambulance could be moved into Valatie’s territory. Thanks to this change, response times have been reduced by 40 percent. Over time, many lives have been saved that might otherwise have been in peril.
On the financial side, in that case, the county compensates Greenport for moving its ambulance with additional compensation if they take a call. In turn, the revenue the agency realizes from billing for its call is returned to the county.
In this sense, the county guarantees the agency a payment — when all is said and done at the end of the year, the cost to the county stands at around $200,000.
For agencies that were struggling financially, this system has proven extremely efficient. Without it, they all would be forced to add another ambulance and crew, at an annual cost of approximately $400,000, which ultimately lands with the taxpayer.
If imitation is indeed the sincerest form of flattery, I should note other counties have begun to replicate this system.
What are challenges facing EMS in the future? One is the push toward value-based reimbursements, which calls for payments to the agency based on patient outcomes, versus the fee-based system currently in place. A second is transport to alternative locations, such as primary care centers, or, no transport at all. While this results in savings to Medicare, Medicaid and private insurers, in turn, it amounts to reduced revenues for EMS agencies.