ROTTERDAM – Assemblyman Angelo Santabarbara, D-Rotterdam, and state Sen. Michelle Hinchey, D-Saugerties, Wednesday announced support for legislation to authorize the state Department of Health to create a “New York State Rural Ambulance Services Task Force” assigned to conduct a study on the challenges facing ambulance services in rural areas.
The announcement comes at a time when on a consensus of local Emergency Management Service officials agree that the major problems facing rural ambulance services include:
• A diminishing pool of volunteer EMS candidates, making it harder and harder for companies to recruit and retain these professionals.
• A lack of reimbursement when caring for patients on the scene.
• Fewer ambulance companies have led to longer ambulance drives to the nearest hospital in many rural areas.
The two-state legislators have each introduced an identical bill in the state Assembly and Senate to authorize the creation of the task force and they hope to get it passed into law by the end of the current legislative session on June 10. They spoke Wednesday at the Rotterdam EMS on Cardiff Road to explain the need for a task force to gather data and provide recommendations to the Legislature for how to improve the situation.
Santabarbara said that in 2019 when the Ambulance Service of Fulton County [ASFC] and the Johnstown Area Volunteer Ambulance Corps. [JAVAC] both shut down within a two-month period it highlighted the need for the state to find ways to improve the funding and operation of rural ambulance companies.
“What brings us here is, before COVID-19 even happened, an alarming number of these life-savings services were forced to close their doors just in recent years,” he said. “The last count I had, before COVID-19, 26 ambulance services closed their doors and never reopened. When an ambulance service closes its doors, whoever is left behind has to cover those areas that are left in their wake. You can’t just not serve those areas.”
When the ASFC and JAVAC shut down, the Greater Amsterdam Volunteer Ambulance Corps. [GAVAC] received local and state approval to expand into their former territory. Now GAVAC has renamed itself Lake Valley EMS and has applied to receive state regulatory approval to be acquired by a private equity firm Enhanced Healthcare Partners, which owns a for-profit ambulance business called Priority Ambulance.
Santabarbara said it would be the job of the task force to study all of the issues that pertain to ambulance companies, including how they are funded, the reimbursement rates set by New York state, labor shortages and funding models. He said he doesn’t yet have a view on whether GAVAC’s pending acquisition by a for-profit company is a positive or negative development, but he wants more information, and he believes the task force can get it and provide the Legislature with the data it needs to develop legislation aimed at supporting rural ambulance services.
“The community need to weigh in on this,” he said. “The point of this is to get long-term solutions, set clear goals, and then, whether it’s legislation, whether it’s funding, whether it’s other agencies that need to get involved — we can make those decisions once we have the information from the people on the ground.”
Rotterdam EMS Executive Director Dean Romano spoke at the announcement and later commented on some of the trends he’s observed among rural ambulance companies in recent years. He said the Rotterdam EMS has two stations, about 50 employees, five ambulances and a ‘fly car,’ and handles approximately 4,000 EMS calls per year with an annual budget of $1.5 million. He said when Rotterdam EMS first came into existence in 2013 it had to fulfill the requirements of a Town of Rotterdam Request for Proposals process that spelled out precise vehicle response times, although the town does not provide any revenue to operate the ambulance service. He said many rural ambulance services would have stronger fiscal balance sheets if they had a local municipal funding stream to back up their operations, but most don’t have that.
Romano said he thinks one of the potential dangers of too few ambulance services occurs when an ambulance service provides both non-emergency inter-facility transfer calls between hospitals and emergency EMS calls without strict rules for making certain enough ambulances remain available for the emergency calls.
“When you mix the two together, and you put the 911 ambulance onto an inter-facility transport, that’s one less ambulance available to the 911 call, and that happens often,” he said. “Or the opposite happens, sometimes the hospitals have to wait four hours to get a discharge out to go to a nursing home because all of the ambulances are on 911 calls. If you’re going to do both, you have to have definitions within the scope of your organization that you will never go below a certain number of ambulances for the 911 work. There’s no hard state standard that you have to meet your ambulance calls by a certain number of minutes.”
Romano said he doesn’t support New York state mandating an arbitrary response time for ambulance companies, but he thinks each community served by an ambulance company should study the issue and come up with a standard that suits that community. He said mixing call volumes between emergency and non-emergency transfers can occur for both non-profit and for-profit ambulance companies. He said he’s a former employee of GAVAC, and he was surprised to hear the nonprofit was in talks to sell to a for-profit company. He said Rotterdam EMS has never had formal talks to sell to a private equity firm, but informally inquiries have been made a few times and his board has always rejected them.
“I was surprised that GAVAC actually did this,” he said. “GAVAC has the model where they do emergency and non-emergency calls and when I worked there they had a standard that they never go below a certain number of ambulances available for emergency calls. I hope that that standard remains under the new owners.”
Initially after the Ambulance Service of Fulton County shut down, the now-defunct Johnstown Area Volunteer Ambulance Corps and GAVAC had worked together as part of a patchwork of ambulance services assembled to cover the territory. During that time, Nathan Littauer Hospital inked a non-binding agreement with JAVAC for it to provide for the hospital’s transfer calls, but GAVAC disputed whether JAVAC had the authority to be the primary service for those calls, asking the Adirondack-Appalachian Regional Emergency Medical Service Council to rule on the issue.
JAVAC ultimately shut down before a ruling was ever made, leaving GAVAC in sole control of the hospital calls and most of the 911 emergency EMS calls. At the time, both GAVAC and JAVAC told authorities the revenue from the hospital calls was vital for them to remain financially viable in Fulton County.
Earlier this month GAVAC Executive Director Thomas Pasquarelli said GAVAC’s ability to quickly expand into Fulton County and secure both the non-emergency hospital transfers and the 911 EMS calls was the key to attracting the interest of Enhanced Healthcare Partners in buying the nonprofit operation.
“When Fulton County collapsed we had a number of agencies reach out to us, and when they saw us succeeding in Fulton County, obviously, that piques the interest of anybody,” Pasquarelli said.
During the presentation Wednesday Hinchey described the scope of the problem facing rural ambulance companies.
“The health and well-being of our rural communities is directly tied to the success of our local EMS systems and right now they’re facing a crisis,” she said. “Our rural ambulance services operate with extremely limited resources, including budget and staffing shortfalls, and many are closing because of these detrimental challenges. This legislation will create a dedicated Rural Ambulance Services Task Force charged with examining the difficulties facing rural EMS providers and developing actionable recommendations to strengthen and sustain the system for years to come.”
Tom Coyle, chairman of the United New York Ambulance Network and president and CEO at Monroe Ambulance, provided a statement endorsing the Santabarbara and Hinchey proposal.
“By enabling the state Department of Health to study the unique challenges faced by EMS providers operating throughout rural New York, we believe that such a task force will be able to uncover a number of long-term solutions for providing greater support to these essential EMS operators and the patients who rely on them,” Coyle stated. “Rural providers are stretched thin, and we believe that the New York State Legislature will recognize the importance of establishing this Task Force in hopes of improving rural emergency medical services for all residents across New York.”
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