Budget Cutbacks and Healthcare Reform
In celebration of EMS Week, May 16-22, SCAA’s recent Ask the Experts program featured Connie Meyer, President-Elect of the National Association of Emergency Medical Technicians (NAEMT), who discussed how the state of recent cutbacks in funding along with health care reform changes impact the life-saving roles of emergency responders.
SCAA: How are state and local budget cuts affecting EMTs? Also, will proposed reductions in Medicare payments affect EMS services provided to patients covered by Medicare?
Meyer: In today's economy, city, county and state governments as well as the private sector have been experiencing tremendous financial hardships over the loss of revenue. Since EMS practitioners work in all sectors, budget cuts strongly affect us. EMS agencies answering 911 calls have a unique position in the health care system: They have a duty to respond to calls regardless of the patients' insurance coverage or ability to pay. Patients who have no insurance have to pay out of pocket, and it is difficult to collect in those situations.
As stations are closed and services downgraded, EMS practitioners are feeling the effects of layoffs, pay freezes and the cost of having to contribute more out of pocket toward their benefits. Practitioners also often are asked to work more hours with no pay raises, and open positions are not filled due to budget constraints. If Medicare cuts take place, expect more degradation of EMS services and longer response times. Patient outcomes inevitably will suffer.
SCAA: Therapeutic hypothermia has been gaining attention for its positive outcomes in the treatment of cardiac arrest primarily in hospital settings. How commonly is therapeutic hypothermia implemented by EMTs in the field, and if not, what are some reasons?
Meyer: There are new services every day implementing therapeutic hypothermia in the field setting. My local service and a neighboring county service have implemented this protocol within the last six months. The current budget constraints may be one reason that EMS services are not investing in new technology to implement therapeutic hypothermia, although the cost is really very small related to the potential benefit to patients. Therapeutic hypothermia also must be done as a system approach. It does no good for the EMS service to start cooling a patient when the destination hospital does not have protocols for continuing the process.
SCAA: What is NAEMT’s role in establishing guidelines for CPR or the new version of CCR featuring only chest compressions? Has NAEMT noticed any changes in behavior in regards to CCR?
Meyer: Though NAEMT does not have a large role in establishing guidelines for CPR, many of our individual and service members have had experience with implementing the new CCR procedure in suspected cardiac cause for cardiorespiratory arrest. The American Heart Association (AHA) is currently working on upcoming changes to CPR guidelines based on available research of best practices. These guidelines are due to be released this fall, and the research seems to have validated that CCR has a significant impact on return of spontaneous circulation after cardiac arrest.
SCAA: How do EMTs deal with Do-Not-Resuscitate orders, especially if they are unaware that a patient has one? What unique challenges are posed from DNRs?
Meyer: EMS practitioners are trained to save lives. There are still some gaps in education about the process and reasoning behind advanced directives, so some practitioners may not have been prepared to deal with this situation. If an EMT initially is unaware of a DNR order, they will begin resuscitation as their protocols allow. Once the DNR order is presented, in most cases resuscitation can be stopped at that point. Another unique challenge presented by DNRs is that there is not a universal form used that is recognized in the pre-hospital area of practice. A DNR is very specific, but a living will may be worded quite differently and requires judgment to decide how much resuscitation to attempt.
SCAA: What are NAEMT’s legislative priorities?
Meyer: Right now, NAEMT is advocating for three pieces of legislation. The first is extension of federal death benefits – the Public Safety Officer Benefit Program – to all EMS practitioners killed in the line of duty. Currently, the PSOB program only covers government employees, not those in private service. We also are working with the American Ambulance Association on passage of the Medicare Ambulance Access Preservation Act (MAAPA) which would provide a permanent 6% Medicare increase for ambulance transports originating in urban or rural areas and permanently extend the bonus base payment of 22.6% for ambulance transports originating in super rural areas. Finally, we will be asking Congress to establish the National Traffic Safety Administration’s EMS Section as the lead federal agency specifically for EMS. This is necessary to provide a more streamlined, cost efficient, and specifically focused approach for EMS practitioners and agencies to interface with the federal government.
SCAA: How can our members help at the state and local levels with EMT issues/concerns?
Meyer: Emergency medical services at the local level are challenged daily by lack of funding and lack of personnel to respond to an emergency. Individuals can help by understanding and promoting EMS as an essential public service – like law enforcement or fire suppression. From providing public safety in response to accidents and other disasters; comprising a safety net for health care as people wait longer to seek medical attention and call 911 for help during emergencies and educating to the public on CPR, safety and injury prevention, EMS practitioners serve communities in many roles.
Another way to support EMS is by supporting your local EMS agency and through your state’s EMS association. A listing of EMS associations affiliated with NAEMT is posted on our web site, www.naemt.org.