{"id":324,"date":"2022-10-28T10:32:49","date_gmt":"2022-10-28T10:32:49","guid":{"rendered":"https:\/\/healthynewsusa.com\/?p=324"},"modified":"2022-10-28T10:32:52","modified_gmt":"2022-10-28T10:32:52","slug":"ambulance-company-to-halt-some-rides-in-southern-california-citing-low-medicaid-rates","status":"publish","type":"post","link":"https:\/\/healthynewsusa.com\/?p=324","title":{"rendered":"Ambulance Company to Halt Some Rides in Southern California, Citing Low Medicaid Rates"},"content":{"rendered":"

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For 23 years, the private ambulance industry in California had gone without an increase in the base rate the state pays it to transport Medicaid enrollees. At the start of the year, it asked the state legislature<\/a> to more than triple the rate, from around $110 to $350 per ride. The request went unheeded.<\/p>\n

In September, American Medical Response, the largest U.S. provider of ambulance services, announced it had \u201c made the difficult decision<\/a>\u201d to end nonemergency transports in Los Angeles County and blamed the state for having one of the lowest Medicaid reimbursement rates in the country. \u201cWhat\u2019s more,\u201d the company, which sold for $2.4 billion<\/a> in 2017 to private equity firm KKR<\/a>, said, \u201cwe are not subsidized by taxpayer funds like public agencies, and almost 80% of our patients pay nothing or below cost for our services.\u201d<\/p>\n

The company, which also cited high operational costs, said its nonemergency division in that area was on track to lose $3.5 million in 2022.<\/p>\n

The California Department of Health Care Services, which administers the state\u2019s Medicaid program for low-income people, known as Medi-Cal, did not contest that the base rate hasn\u2019t increased since 1999, but said that reimbursements have increased through add-on payments for supplemental costs<\/a> and emergency rides<\/a>.<\/p>\n

In its initial announcement, AMR mentioned the phaseout of nonemergency services only in L.A. County. However, the company told KHN that it would stop servicing five hospitals in Orange County in addition to seven hospitals in L.A. County.<\/p>\n

Jason Sorrick, vice president of government affairs at KKR-owned Global Medical Response, which is now AMR\u2019s parent company, said AMR would exit over the next six months and shift vehicles and as many of the 170 crew members as possible to its core emergency services.<\/p>\n

AMR\u2019s pullout equates to a loss of 28,000 nonemergency transports a year and could create a predicament for the hospitals that contracted with the company. L.A. County said it does not track the total number of nonemergency rides provided by ambulances in the county, while Orange County wasn\u2019t immediately able to share its figure.<\/p>\n

Although ambulances are typically associated with 911 calls, many are used to transport frail or vulnerable patients between health care facilities. A patient may need to go to a rehabilitation facility after hip surgery, or someone who attempted suicide may need to be moved from an emergency room to a psychiatric facility. Such transfers, known as interfacility transports, enable hospitals to free up beds and maintain patient access.<\/p>\n

There isn\u2019t consensus on what the impact of AMR\u2019s pullout will be. The state told KHN that it will review and address access issues on a \u201ctargeted basis\u201d if it becomes aware of any. Patient advocates said it\u2019s too early to draw conclusions about the effect on patients, particularly those covered by Medi-Cal. The California Ambulance Association flagged concerns that companies are already stretched thin by staffing and vehicle shortages.<\/p>\n

Though the two counties and the insurers that serve their Medi-Cal populations did not express immediate concern about AMR\u2019s decision, some hospitals may have trouble dealing with the loss.<\/p>\n

\u201cHalting these services will undoubtedly impact hospitals\u2019 ability to efficiently manage\u201d the flow of patients from arrival to discharge, said Adam Blackstone, senior vice president of communications for the Hospital Association of Southern California.<\/p>\n

AMR said its pullout will primarily affect Providence, a Catholic health system operating in several states, including California. It did not respond to a request for comment.<\/p>\n

AMR now also attributes its exit to avoiding a labor dispute. Sorrick said that because of Medi-Cal\u2019s rates, AMR could not staff both emergency and nonemergency ambulances and raise wages for unionized emergency staffers who were threatening to strike. So it shuttered its lower-priority nonemergency division, which wasn\u2019t unionized. It planned to use the savings to increase wages for emergency staff members.<\/p>\n

Michael Diaz, an EMT and president of the International Association of EMTs and Paramedics Local 77, which represents 350 EMTs and paramedics for AMR emergency services in L.A. County, confirmed that AMR\u2019s announcement came the day before the union planned to march in protest for higher wages.<\/p>\n

Diaz, whose national union had joined the industry in lobbying the California legislature for higher rates, said AMR\u2019s announcement could also have been politically motivated. \u201cThey\u2019re sending a message,\u201d he said.<\/p>\n

So far, it\u2019s unclear whether elected officials have noticed the pullout. Leaders of legislative budget committees declined to comment or did not respond to inquiries.<\/p>\n

Medi-Cal spending on all medical transportation services totaled about $975 million in fiscal year 2021-22, according to data from the Department of Health Care Services.<\/p>\n

The department said Medi-Cal\u2019s insurers are ultimately responsible for maintaining an adequate network of medical transportation providers and noted that the insurers are allowed to pay above the base rate. The ambulance industry said it\u2019s uncommon for insurers to pay more.<\/p>\n

Jimmy Pierson, president of the California Ambulance Association, said other ambulance companies usually pick up the slack when one exits a market. But he warned that competitors may not be able to cover all of AMR\u2019s nonemergency ambulance rides this time, given unprecedented labor and supply shortages \u2014 including two-year waits for new ambulances<\/a> \u2014 and rising Medi-Cal enrollment and inflation. A recent national survey found that EMTs turned over at an annual rate of 36%<\/a>.<\/p>\n

\u201cHow are you going to find 170 employees in a labor shortage?\u201d Pierson asked. \u201cHow will you find those ambulances?\u201d<\/p>\n

Ambulance companies said that hiring and retention have been battered by low wages, burnout, and lasting effects of EMT school closures during the pandemic \u2014 and that low Medi-Cal reimbursements make paying EMTs competitive salaries difficult.<\/p>\n

A few other companies in the state have already shut down or scaled back services, Pierson added. In 2016, AMR ended nonemergency and emergency services<\/a> in Tulare County, a region in the Central Valley with one of the highest<\/a> shares of residents on Medi-Cal.<\/p>\n

Sorrick said AMR believes enough companies provide nonemergency transports to absorb the volume.<\/p>\n

Chad Druten, president of the Los Angeles County Ambulance Association, said the county has approximately 1,200 licensed private ambulances operated by about 35 companies<\/a>, most of which are small to medium-sized and focus on nonemergency transports. A few large companies, including AMR, cover emergency calls.<\/p>\n

Melissa Harris, who owns AmbuServe Ambulance Service in L.A. County, said she plans to compete for small portions of AMR\u2019s contracts, focusing on the ones with fewer Medi-Cal patients. Harris said she loses money on every Medi-Cal-covered transport and can\u2019t easily buy and staff new ambulances. If she wins any contracts, she will likely have to \u201ctrade\u201d away her existing contracts that serve the highest portions of Medi-Cal patients.<\/p>\n

The consequences of that, Harris said, would hit underserved patients the hardest.<\/p>\n

This story was produced by KHN<\/a>, which publishes California Healthline<\/a>, an editorially independent service of the California Health Care Foundation<\/a>.<\/em><\/p>\n