Rural EMS providers share concerns of 'bleeding out' with U.S. Senator Tina Smith's office

Mar. 15—BLACKDUCK — It's not sustainable for any organization to lose money every time they go out the door, but that's the reality for many rural providers of emergency medical services.

"Right now, we're losing money every run we do out the door," explained Adam Mannausau, the fire chief in International Falls, Minn. "I think our problems are very similar to others."

Rural EMS providers in Minnesota are increasingly under financial strain, which was one of the concerns shared with representatives of U.S. Senator Tina Smith's office at Blackduck City Hall on Wednesday.

The senator's office organized the meeting with regional EMS providers, drawing representatives across northern Minnesota, from International Falls to White Earth.

Among the primary concerns for the providers was the financial sustainability of their services, with several raising the specific issue of not being able to bill Medicare easily for their work.

Under the current system, EMS providers are not reimbursed for some of their services by Medicare unless the patient is transported to a hospital. This results in thousands of calls where individuals are aided within their homes going unpaid.

"There are very specific things you have to call an ambulance for," explained Molly Vollbrecht, Blackduck's ambulance director. "(Medicare) will look for any reason to deny payment."

Vollbrecht shared that the reason used to deny reimbursement could be as small as the patient walking to the ambulance themselves, or the exact language used to describe the call regardless of the actual services provided.

With the proportion of EMS runs that are billed through Medicare increasing as Minnesota's population ages, providers are left in a difficult position.

Mannausau shared that only around 46% of the International Falls EMS bills are collectible and that the number is decreasing.

"Every year it's going to get a little lower. The problem does lie with Medicare and what's payable and billable," he said. "We can't budget for not collecting 50% of our returns on bills."

This decrease in reimbursement is coinciding with an increase in expenses, with equipment costs rising dramatically, and the cost to train and retain EMTs and paramedics also increasing.

If things don't change, providers worry that eventually, those costs will hit the communities they serve.

"Every year we're losing about $250,000," shared Harley Droba, mayor of International Falls. "It's the city and the residents of International Falls that are paying 100% of that loss."

Adding to the concern is the fact that many of the rural communities these providers serve would struggle to afford an added tax burden.

"You start double taxing some of these small communities, and it's not fair," Vollbrecht said.

Finances weren't the only concern the rural EMS providers raised to the senator's staff. Another challenge has been staffing and recruiting new EMTs and paramedics, particularly after so many burned out during the COVID-19 pandemic.

"(During COVID) our staff was running on fumes, we were just trying to keep everybody from burning out at the same time," shared Terry O'Connor, the director of Leech Lake EMS. "Personally I think we're bleeding out. We're talking about this four, five years too late."

Training in new emergency medical first responders requires significant time and investment from both the organization and the individual recruited. Unfortunately, many of those who start the training don't complete it, or don't stay in the career long.

EMS providers shared the struggles they've had with retaining and recruiting employees, both from a wage standpoint and enticing candidates to move to rural areas.

"Recruiting to this career (in rural areas) is difficult," Vollbrecht said. "It's a beautiful area, but it's not exactly a destination."

Other representatives at the meeting asked about recognizing EMS as an essential service in Minnesota, alongside fellow first responders like police and fire. Doing so could open up opportunities for state funding.

"We need to do everything we can to maintain and increase funding," said Ronald Fredrickson, a member of the Blackduck City Council. "It's a vital service."

Everyone present agreed that changes need to be made and that it would need to be a joint effort at all levels to end the crisis facing rural EMS providers.

"For many years we've been able to do more with less, but there's a breaking point and I think we're getting really close to that," Droba said.

Jordan Schroeer, Tina Smith's outreach director for northwest Minnesota, shared that the senator and her office will remain committed to addressing the issue. The meeting in Blackduck was the third Smith's office has held in recent weeks, with a hope for more in the future.

The senator has also co-sponsored a bill, titled the EMS ROCS Act, which would address the services' billing concerns with Medicare.

"The fact that I've heard several times now that (rural EMS is) 'bleeding out' is very troubling. They don't use those words lightly," Schroeer said. "The senator wants communities across Minnesota to be able to live safe and healthy lives in the area where they choose to live."