News10NBC Investigates: EMS system in crisis

ROCHESTER, N.Y. – Many of the ambulance agencies that respond to 911 calls across Monroe County and the Finger Lakes Region tell News10NBC they are in crisis mode.

Staffing shortages have hit them hard. On top of that, they’re making less and less money.

In many cases, 60 to 70 percent of the calls for service at most local agencies are now for patients who are on Medicare or Medicaid. Generally, the reimbursement rates for those trips is normally about half of the actual cost of service.

“Every ambulance agency in Monroe County is asking themselves, where is the money going to come from to continue to pay our staff and to purchase the supplies and equipment that we need to care for our patients?” asks Mike Hoskins, the chief of Perinton Ambulance. 

Over the last decade, 237 ambulance services across New York state have closed, merged, or been taken over. On top of money problems, there are people problems. There has been a 44 percent decrease in the number of certified EMTs and Paramedics over the last five years, according to data obtained through a Freedom of Information Law request.

The pandemic made staffing shortages even worse, and while ambulance companies would like to increase pay to help with recruitment, they say they simply don’t have the money to do it. Currently, the average rate of pay in Monroe County is $17 per hour for EMTs and $25 per hour for paramedics before overtime. 

“We’re looking at the future saying, if something doesn’t change as it pertains to reimbursement and workforce development, this can’t continue,” Hoskin says. “We will start facing operational losses on a year-to-year basis and once we do that, we’ve started the clock. When the money runs out, so do we.”

While most agencies are supported with some tax dollars, EMS is not considered an “essential service” in New York state, which means: “There is no regulation requiring any level of government to ensure that their community receives an ambulance and to me, that’s mind-boggling,” Hoskins says.

Northeast Quadrant Advanced Life Support covers the town of Webster. CEO Ahmed Mustafa says the agency gets $50,000 annually in support from the town to do so. 

“$176 million goes to fire departments in Monroe County, about $74 million goes to the police departments and about $4 million goes to all the EMS departments in Monroe County and so, there’s obviously a big gap there,” Mustafa says. “No, the fire departments don’t have the opportunity to bill to supplement. Neither do the police departments, and that’s why EMS agencies don’t want full funding, but we do need to help fill the gaps.”

Mustafa says his agency can’t stay in the green without further support from the Town of Webster.

“We cannot rely solely on third-party billing to pay our bills. There is a cost of readiness that the current model does not address. The reimbursements from Medicaid and Medicare are just inadequate,” he tells News10NBC. 

So, what happens to residents if the ambulance agency in your town shuts down?

“I was a bit surprised to find out that Monroe County doesn’t have an ambulance plan,” Hoskins says. “They have a statewide mutual-aid plan but they don’t have a plan for when all of these services start to shutter their doors.”

Monroe County Executive Adam Bello says he understands many of the EMS agencies are nearing a breaking point.

“They have brought those concerns to us and we’ve had a lot of conversations around that,” he tells News10NBC.

News10NBC’s Jennifer Lewke: “Other counties, like Erie, who are facing EMS issues, are transitioning to a county-wide system. Is that something you’re looking into at all?”

Monroe County Executive Adam Bello: “No, a government entity stepping in to provide the service isn’t what’s needed. What we’ve been hearing over and over in Monroe County is the need for additional staff.”

The agencies agree that staffing assistance is needed and jointly applied for a grant to set up an EMS training academy.

“Unfortunately, that request was originally denied by the legislature and the county. It was only about $5 million and would have supported workforce development over a period of four years,” Hoskins says.

Bello says the denial was only because he was going to pull cash from a different pot of federal ARPA funds.

Bello: “We’re putting millions of dollars aside to be able to provide to those EMS agencies.”

Lewke: “Did you intend to use this money that way or were the red flags enough to get you to say, wait a second, let’s pull some money from this fund?”

Bello: “What we did here because the growing need kept being there, what we did was we went back and put additional money out there and then just specifically earmarked it to them. Other levels of government need to step up as well though. New York State has got to provide more funding here. The Medicaid rate has not gone up in a substantial way in a very, very long time.”

News10NBC Investigative Reporter Jennifer Lewke continues her investigation on Friday with a look at how surrounding counties, like Wayne, are moving to a county-wide EMS system. What that looks like, what it costs taxpayers, and how it could impact even those who don’t live in the county will air Friday on News10NBC at 5.