Lakes Region EMS is in the business of saving lives. To keep doing that job in the most effective manner possible, the ambulance service has to evolve with the changing economy and health care system, according to Lakes Region EMS Executive Director Aarron Reinert.
Reinert said health care reform has changed the amount of money Lakes Region, a nonprofit emergency medical service, and other emergency services providers are reimbursed from the government when they treat patients who are on Medicare or Medicaid.
“What happens with Medicare is any payments are typically 50 percent less than what our costs are,” he said. “That happened back in 1997 when Medicare put ambulances on its fee schedule. They essentially arbitrarily chose how much they were going to pay for ambulance transport, regardless of what our actual costs were.”
Ambulance providers are taking another hit as a result of sequestration.
“One of the things that was buried in sequestration that might not be known to most of the public is an across-the-board 2 percent cut to all pay made to all Medicare providers and suppliers,” Reinert said. “We’re a supplier when it comes to Medicare.
That means, as of April 1, all of our Medicare reimbursement (was) cut by 2 percent.”
Also part of health care reform, Reinert said, is an index that might be viewed by some as a reason for ambulance providers to not do their jobs to the best of their ability.
“Part of health care reform was putting health care providers on something called a productivity index,” Reinert explained. “You’d think it sounds like the index was about the more productive you are, maybe you would receive more in incentives. The productivity index actually works in the reverse. The more productive you become — the more efficient you become — the less reimbursement you receive from the federal government.”
So since 2008, Lakes Region has been losing about 2 percent per year in federal Medicare reimbursements, which totals about a 10 percent reduction in that four-plus year time span.
He explained the reasoning behind the productivity index might be that if “providers are more efficient, their costs are lower; i.e. they need less reimbursement.” But he noted, “Some readers might see a little disincentive there.”
“I might get more reimbursement if I’m less efficient,” he said. “Obviously, that’s certainly not our goal.”
Challenges and opportunities
Reinert admitted there are some challenges to staying in line with health care reform and providing effective emergency services in a less-than-robust economy, but he noted there are some advantages to the way health care providers are now treating patients and interacting with one another.
He said, as part of health care reform, ambulances are now seen as part of the health care system, when before they were seen more as transportation.
“Health care reform has really formalized that,” he said. “It challenges all providers to be connected with the health care system; how we treat patients is consistent in how (other providers) are treating patients. It has really connected us with the hospitals we serve and the overarching health care system.”
Reinert also explained new technology is helping Lakes Region provide emergency services in a more efficient, cost-effective way.
As an example, he said they can now pinpoint exactly where all their ambulances are at any given time with computer software, which allows the closest ambulance to respond to an emergency, saving time and fuel.
Reinert noted the way Lakes EMS does business is likely going to change over the upcoming years. It will have to look at creative ways to save money in order to keep providing top-of-the-line emergency medical services, and he stressed community partnerships are going to be integral to the survival and success of the ambulance service.
To explain what he meant about community partnerships, Reinert told the story of the Murdo Ambulance Service in South Dakota.
He said the service only takes about 30 emergency calls a year over a very rural, 1,000-square-mile section of the state.
Recently, the Murdo Ambulance Service was in need of a new building, but didn’t have the financial resources for construction.
The community, which Reinert said is very supportive of its ambulance service, stepped in and offered aid.
“So one day as they were talking to folks and asking if they would be able to support this construction, one person said, ‘Maybe,’” he said. “The person said, ‘I really don’t have any money, but I do excavation work. Maybe I could donate my time, and maybe I could do the prep for the building.’ The next person said, ‘I do brick work. Maybe I could help out with getting that done.’ And then the next person and then the next person (offered their help).”
Reinert said he believes the service area of Lakes Region EMS, although substantially larger in terms of people served than the area covered by the Murdo Ambulance Service, is the same type of close-knit community.
“My guess is that we have people we currently serve who have skills and talents that could help us grow and develop our organization down the road,” he said. “We have businesses in our community that we work hard to support by making our purchases locally. My sense is there might be businesses and community organizations that could support us.”
Reinert said some people might look at the challenges facing Lakes Region as “doom and gloom,” but he doesn’t see it that way.
“We see health care reform and its challenges with reimbursement as our challenge to continue to reinvent ourselves, to recreate ourselves,” he said. “We see an incredibly powerful partner in doing that, and that’s the people we serve.”