EMS is not an essential service in NY. Why local providers say public safety is at risk

When New York lawmakers rolled out their first lockdown orders in March 2020 in response to the COVID-19 pandemic, one word in the plan gave Emergency Medical Services staff members and volunteers pause.

Only "essential" travel would be allowed, it read. Only "essential" businesses could remain open, provided they institute robust social distancing policies.

Matthew Fellows, CEO of Union Volunteer Emergency Squad in Endwell, remembers the confusion that word sparked among local EMS providers who wondered whether they ought to report for work or not.

Because technically speaking in New York, EMS is not an essential service.

The uncertainty didn't last long — EMS was exempt from the statewide travel ban — but it demonstrated how unclear and convoluted Fellows believes the rules surrounding the EMS industry are in the state.

Lawmakers across New York have put forth legislation in 2024 proposing sweeping changes to the state's EMS policies. None of those policies have been included in the New York State Assembly one-house budget resolution, the Senate's included it in part. Assemblywoman Donna Lupardo, a staunch advocate for EMS, said one of her priorities this year is finally designating EMS an essential service.

“The bill that I’m most focused on is acknowledging that ambulance services are as essential to public health and safety as police and fire,” said Lupardo. “It seems like something you wouldn’t even need to say, but in state law, we leave it up to the municipalities.”

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Municipal, private, volunteer crews provide EMS in Broome County

According to the National Conference of State Legislatures, at least 13 states have designated EMS as essential in statute, and at least 39 states and territories enacted 113 bills in 2022 to address various aspects of EMS systems, including administration, funding, rules and regulations, systems of care and workforce.

In New York, EMS is not an essential service, so the state isn't required to fund it and local municipalities are not required to provide their own EMS.

In Broome County, the only municipal EMS provider is part of the City of Binghamton Fire Department.

All other ambulance services are either private services — such as Superior Ambulance — or part-paid and volunteer crews. Eight ambulance agencies in Broome County use volunteer EMS personnel. Full volunteer crews are rare, and include groups such as Binghamton University Harpur's Ferry Ambulance squad.

In January, the New York State Association of Counties and lawmakers from across New York proposed a robust legislation package to boost EMS. Outside of designating EMS as essential, the proposed laws would increase tax credits for volunteer ambulance and firefighters, create special taxing districts to properly fund services and remove EMS from the real property tax cap, allowing expansion and more funding.

"The actions that we are taking today are designed not just to strengthen local EMS services, but are really about protecting public health and safety," Lupardo said at a press conference unveiling the proposal. "As more people learn about the vulnerability of this important service, the more people are committed to rescuing EMS — We owe it to them."

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'Nobody wants to consider paying' for EMS

Last November, a bill mandating insurance companies directly pay ambulance services was passed in New York, alleviating a previous issue where insurance companies gave the money to individual patients, who were then responsible for completing payment to ambulance services.

“We lose somewhere in the range of $300,000 a year to people who receive payment direct from the insurance company, but do not turn those payments back over to us,“ Fellows said.

Fellows said the change to the insurance payment process will make a big difference in terms of operational costs, but there are other losses incurred, including when EMS is dispatched, but does not end up having to transport a patient to the hospitals. These cases often happen with older patients, who may need assistance after an accident or fall.

According to Fellows, over 30% of calls made to Union EMS do not result in a transport and EMS are not reimbursed by Medicare and Medicaid in those instances, despite having spent time and resources on the process.

The industry, Fellows said, is plagued by systemic issues.

"Until there's some recognition that this is an essential and crucial service for the communities," he said, "nobody wants to consider paying for it."

Sweeping EMS legislation package pushed forward in NY

David Tinklepaugh is quality assessment and improvement & training coordinator for the Vestal Volunteer Emergency Squad. During his time with the organization, he said, there have been a concerning amount of instances when services across the county were in Low Resource Condition — In Broome County, LRC occurs when there are two or fewer staffed, on-duty ambulances available.

“That is a significant impact to the time to get to scenes, and to what can happen in the transfer of care from the scene to the hospital,” Tinklepaugh said. “This essential element really does increase the ability to have financial support, which would relate to more staffing and more ambulances.”

Tinklepaugh said the designation of EMS as an essential service, and the support that comes with it, is an indispensable part of moving forward.

“Within Broome County and our region, we have done a phenomenal job of always having resources available, but without funding, it becomes much thinner,” Tinklepaugh said. “We need that kind of resource to maintain staff, grow staff and maintain equipment.”

NYSAC's Rescuing Local Emergency Medical Services legislation package includes six proposals. One of the legislation proposals, to create a mechanism for EMS to be reimbursed for non-transport calls of patients under Medicaid, is still forthcoming.

The other five were all in committee as of Thursday, and include deeming EMS an essential service, creating a property tax exemption for EMS, giving workers property and income tax credits while also increasing the income tax credit, and a targeted Medicaid rate increase for EMS providers.

“We all want to be able to know that our community is safe,” said Tinklepaugh. “Safe with fire services, safe with law enforcement services, and equally so safe with EMS. Making EMS an essential service helps stabilize our EMS system. That’s what we’re looking for — community support and support from our representatives to see this through as an essential service.”

If not included in New York's budget, Lupardo said Friday, "many of us will prioritize passing the corresponding pieces of legislation before the end of session."

This article originally appeared on Binghamton Press & Sun-Bulletin: NY EMS crisis: Binghamton-area providers point to systemic problems