Labor Shortages

Many EMS agencies report that the unprecedented labor shortage has become their number one challenge. The COVID-19 pandemic fueled a mass exodus from countless healthcare jobs, including the EMTs, paramedics, dispatchers, and other skilled roles an EMS agency requires. With many employees discovering they could earn a similar wage for work that’s less stressful and allows better work/life balance, agencies scrambled to stay staffed. The situation has only gotten worse, as wage inflation has increased competition for skilled talent. That’s making it tough to maintain good response times and keep patient service quality high.

Greater Demand for Healthcare Services

Demand for EMS services is on the rise due to an aging population and a sharp increase in the incidence of chronic diseases (which affect an estimated six out of ten Americans, according to the Centers for Disease Control). When rising service demand intersects with a shortage of labor, the community’s access to timely, quality care is often jeopardized.

Reimbursement Pressures

In the wake of the Affordable Care Act, fewer ambulance transport claims fall under traditional Medicare. Now, the majority of ambulance billing goes through a commercial Medicare Advantage or supplement plan, leaving agencies to deal with many more payers and plans, all with different coverage rules and billing requirements, often paying insufficient reimbursement rates. These realities make ambulance billing more complex and increase the odds a claim will be denied or delayed. Meanwhile, agencies are often reimbursed only for calls that result in a transport, forcing them to absorb the cost of a treat/no transport call. Though the Emergency Triage, Treat, and Transport (ET3) Model was proposed to address this issue, the Centers for Medicare & Medicaid Services pulled the plug on the pilot due to a reported lack of interest.

Aging Equipment and Infrastructure

Financial pressures have forced many EMS agencies to postpone replacing older vehicles and equipment, though they can’t keep service quality high and handle the growing volume without making critical upgrades at some point. Yet, post-COVID supply chain constraints persist, especially within vehicle manufacturing. Production timelines for a new ambulance extend out a year or longer in some cases, impacting community care and reducing revenue opportunities.

Rising Costs

Inflation has hit EMS agencies hard, driving up wages, insurance premiums, supply costs, and other expenses. In this strained environment, they’re struggling to find ways to optimize revenue and maximize reimbursement on every transport, while keeping cash flowing to meet their growing financial obligations. Unfortunately, this challenge is surfacing at the very time that state and county EMS funding is shrinking in many areas of the country.

Evolving Regulations

National, state, and local regulations that impact EMS operations are complex and ever-changing. For example, the National Conference of State Legislatures database details the many EMS-related legislative actions that vary by state, including pending and enacted bills affecting EMS administration, workforce, and rules that regulate care delivery, among others. When staff is in short supply, keeping current with these changing regulations and ensuring compliance becomes even more difficult