Rural emergency medicine is struggling to reach the far corners of Minnesota

[MUSIC PLAYING] CATHY WURZER: In about an hour from now, Governor Tim Walz will be in Hoyt Lakes to sign into law one of the bills that passed in the final days of the legislative session. It sends $30 million to emergency medical services in the state.

24 million goes to short-term aid for rural EMS providers who say they're struggling to meet the needs of large geographical areas with thin staffing levels and budgets. The other 6 million sets up pilot programs meant to cut down wait times in three counties-- Grant, Saint Louis, and Otter Tail.

The money is about a quarter of what EMS advocates and some greater Minnesota lawmakers asked for. Joining us for some perspective on this is Becca Huebsch, Director of EMS and Emergency Preparedness at the Perham Health Care Center in Otter Tail county. Becca, thank you for joining us.

BECCA HUEBSCH: Yes thank you so much for having me.

CATHY WURZER: Obviously, you've been following what was happening at the state legislature. What did you think when you heard that the state passed $30 million in funding?

BECCA HUEBSCH: Yes, we've been tracking tracking it very closely all session and really pushing for that full 120 million. That was the need that was estimated by the Emergency Medical Services Regulatory Board.

But we knew it was going to be an uphill battle. And I'm very thankful that lawmakers were able to come to a solution that did find aid for ambulances this year. It's not the dollar figure that would cover our full need, but it's something to tide us over while we search for longer term solutions.

So I'm very thankful. I do expect it to make a big difference for us here in Perham and in Otter Tail county. But obviously, it doesn't solve every issue that we have. And we'll be continuing to seek out more solutions.

CATHY WURZER: Now, for folks not familiar, I mean, 30 million sounds like a lot. I know that it fell short of what you wanted. But what will the $30 million do here in, say, the next year or two to shore up EMS services in rural Minnesota?

BECCA HUEBSCH: Yeah, it's an issue that's really coming into light now. For EMS professionals, we've been aware that this was a growing problem for the last, you know, over a decade.

But since COVID, it's really come to a breaking point where the EMS system has been strained so far with more calls, more unpaid bills. And also a lot of people have left the industry as staff. So there's all these staffing shortages as well. So the combination of all these things means that financially, a lot of rural ambulances are not able to sustain themselves anymore.

And so at a state level, it was about 120 million of projected subsidy needed for one year of EMS services in the state of Minnesota. So 30 million is just a very small portion of that. It's actually 20 million-- or 24 million that will be allocated as aid out to these jurisdictions.

So it will have an impact. In Perham, we are hopeful that our portion of that would maybe cover about a quarter to a third of the subsidy that we need for our ambulance for one year.

But there were some other really creative innovations that came out of this 30 million as well, because there's also 6 million out of-- or allocated to innovative sprint medic paramedic pilot programs in the state. So that's something that we're very excited about as well.

CATHY WURZER: I do want to ask about that, but I just want to kind of drill down just a little bit. You mentioned bills are not getting paid. Who's not paying EMS services? Is it municipalities, hospital systems, insurance companies? Who's not coming to the table with the money?

BECCA HUEBSCH: It's a combination. On average, ambulances are paid at about 30, maybe 35% of what their billed amounts are. So that includes Medicare, which really sets the tone for all payers, Medicaid, commercial insurance companies, and even patients that are paying for their own care as well.

We just find that reimbursement is only a very small portion of what the actual billed amount is and what the actual cost of these services are.

CATHY WURZER: And are you seeing-- you alluded to this, more individuals using EMS services. I mean, I'm thinking my own mom is 87. She lives in rural Minnesota. We've had to call EMS a couple of times when she's fallen. Are you seeing instances like that?

BECCA HUEBSCH: Absolutely. Year over year, we're seeing increases in call volume across pretty much the entire state. And it's partially for the reasons that you just mentioned. More people are living at home and rely on EMS for when they fall and can't get up, or even for some of their home health care needs, or feeling nervous and having an assessment done in their home can be a very convenient thing.

But for ambulances, many insurance companies still think of us as a transporting service. So these are all community services that we provide. But there's no option for insurance companies to reimburse us or allow us to bill for those services. So while it's very important to the community to have that available, it's not something that's helping sustain the ambulance.

CATHY WURZER: I see. And, of course, Minnesota's population is aging, which is what's causing some of the problem, too. So you mentioned the $6 million for something you called sprint medics. Is that right? What is that?

BECCA HUEBSCH: Yes, it goes by a lot of different names. It's not necessarily a new concept, but it is new to our region. So it's also been called like fly car paramedics or pilot medics, intercepting paramedics.

But the concept is there are a lot of calls that maybe only require one person to respond. Maybe they can provide care on scene and not require the full transporting ambulance and a crew of two people. So that's one benefit.

There's also a lot of geographic inequity in ambulance service coverage. Many people are not aware, but there are actually two levels of service for ambulances. There's what's called the basic life support level, and then there's advanced life support.

So as the name suggest, basic life support is the more common emergency cares. They can be very helpful with traumatic injuries or common medications, allergic reactions. They can give an EpiPen. Very well trained and helpful services.

But they don't provide that higher level of emergency care that people have become used to. So an advanced life support service would include someone that's trained as a paramedic, which is a longer educational course.

And it would include more services that you would receive at an emergency department like advanced pain medications, cardiac monitoring, helping maintain people's airways and breathing. Everything that-- all the medications and equipment and procedures that could help save someone's lives in the first few hours of their emergency.

So really more like a portable ER. But coverage of advanced life support is not even everywhere. Your zip code really does dictate whether it's that basic life support ambulance that's responding first or whether it's an advanced life support ambulance that's responding first.

So part of the sprint paramedic model is allowing these roving paramedics out in the community to help provide that advanced level care because they're already embedded in those less service areas. So getting that advanced care faster when it's needed.

CATHY WURZER: I know your neighbors in Grant County have been piloting that kind of program. See, I wish I had more time with you, but I have this question. So you have the $30 million. And as we have talked about, you were hoping for 120 million. What really needs to be done to fully fund EMS services long-term? I mean, what's the solution going forward?

BECCA HUEBSCH: I think there's kind of a two pronged solution. One is making sure that insurance companies and Medicare and Medicaid are compensating ambulances for the actual cost of services. And that's going to be-- require some state, and especially federal changes to what our reimbursement rates are.

And then the other part of that solution is rethinking how we deliver EMS. For a long time, EMS was delivered by volunteers. They weren't nearly as busy as we are now. Maybe they ran a call every other day or every few days.

And now, even in very rural communities, it could be multiple calls a day. So it's not necessarily sustainable by volunteers. So we have to start thinking about this as part of our public safety system.

We have to think about it as part of our community health system and public health outreach, and rethink how we're delivering it and how we categorize it. It's not just a volunteer transport service anymore.

CATHY WURZER: That sounds like that is a tall order to try to change the system. But it sounds like you've got your work cut out for you. But you're working toward that end, Becca. Thank you so much. I appreciate your time.

BECCA HUEBSCH: Well, thank you so much for your attention to this issue. We really appreciate it.

CATHY WURZER: Absolutely. Becca Huebsch, she has been with us. She's the director of EMS and Emergency Preparedness at Perham Health.