Rural emergency medical service workers are sounding the alarm about a system in a financial and worker crisis that can lead — and in some cases has already led — to increased response times for Minnesotans in a medical emergency.

“This has not been a trend that has really surprised people that have been paying attention,” said Becca Huebsch, director of Emergency Medical Services and Emergency Preparedness for Perham Health in western Minnesota. “But now it’s really coming to a breaking point where systems have been underpaid for so long, now they’ve used up their cash stores and they put off big purchases.”

For the seven ambulance services that cover Otter Tail County, where Perham is located, ambulance providers are losing $181 per call, according to Huebsch.

“Every time the pager goes off and we respond to an emergency, we’re digging ourselves deeper into the hole,” Huebsch said. “We don’t want to stop responding but we do need to address this because there’s only so long that we can sustain that.”

In response to this call, legislators have set up an Emergency Medical Service Task Force to address the state of EMS services in Minnesota. Legislators plan to travel around the state to hear from the public about what is needed to keep the system afloat.

In addition to the cash-flow issues, the state is currently facing a shortage of almost 3,000 EMS workers, which is impacting greater Minnesota at higher rates due to lack of pay, leadership and culture issues, job burnout and time commitments in outstate Minnesota, Dylan Ferguson, executive director for the Emergency Medical Services Regulatory Board, told the task force during its first meeting in early December.

In addition to the shortage of EMS workers, there is a particular shortage of emergency medical technicians because they are often assigned to do hospital work as opposed to running an ambulance, Ferguson said.

EMS is largely financed through billing to patient insurance or the patients themselves. This type of funding model no longer works, Huebsch said, and even when it did, it has been just enough to cover costs.

“The challenge is, as our costs have increased, reimbursement has not changed or not kept up,” she said.

Even if an EMS increases its charges, it doesn’t matter, according to Huebsch, because the insurance rates are set by the insurance providers. For example, Medicare and Medicaid only pay about 35% of the cost when it comes to ambulance transportation.

In Perham, a town about 25 minutes from Detroit Lakes with a population of just slightly over 3,500, a projected $200,000 loss for 2023 is expected, according to Huebsch.

Response times

Beyond further stretching medical personnel in an already strained system that largely relies on volunteers outside metro areas, the cash and worker shortage has led to response times that lie entirely outside the bounds required for effective medical care.

In Mountain Iron, a town of fewer than 3,000 people in St. Louis County, EMS response times have extended to up to 90 minutes.

Thankfully, these lengthy response times haven’t hit Perham EMS, but if something doesn’t change soon, the possibility is there.

“It’s not a problem. It’s not a challenge. It’s a crisis,” Sen. Grant Hauschild, DFL-Hermantown, told the task force during its meeting.

Hauschild, who represents Minnesota Senate District 3, which covers most of northern and northeast Minnesota, including Mountain Iron, said towns are going bankrupt trying to provide these services.

“Your health care, your livelihood shouldn’t be determined by your ZIP code,” he said.

Ely, an Iron Range town with a population of around 3,200, has about two months of money available before they have to shut down, Hauschild said.

“It is multiple communities, it’s everybody, and we are acutely hit by it on the Range and northern Minnesota because of the rural isolation we have and the distances it takes to transport,” he said. “The reimbursement rates are so out of whack at the federal level and are just not keeping up with the services that we need to provide.”

The task force was formed following an Office of Legislative Auditor report that highlighted issues with a system that has not changed since the 1980s despite changes in demographics and health care in general.

“The increasing cost of medical supplies, labor and equipment has greatly outpaced reimbursement from state, federal and commercial payers,” Huebsch wrote the task force in a submitted statement. “This comes at a time when we are seeing an aging and medically needy population and increasing requests for ambulance services.”

The task force is slated to visit areas outside the metro area to receive testimony from the public and stakeholders about the state of EMS in Minnesota’s more rural regions.

A report that includes recommendations is expected to be submitted by the task force by Aug. 15.

“We’re an action-oriented unit of government,” task force member Sen. Andrew Lang, R-Olivia, told the group during their initial meeting. “Hopefully, in not too long of time, this task force will have a plan in place that will keep those small ambulances in rural Minnesota functioning.”

Several task force members are employed in the health care field, including co-chairs Rep. John Huot, DFL-Rosemount, and Sen. Judy Seeberger, DFL-Afton. Both serve as emergency medical technicians.

“This is overdue,” Sen. Tina Liebling, DFL-Rochester, said, adding that while Rochester may not face these issues because Mayo Clinic runs emergency services in the city, everyone deserves medical care. “When you make that call, the need is great and you need somebody to respond.”

Lack of staffing

Rural EMS services largely rely on volunteers, and those are getting harder to come by.

Altura, in southeastern Minnesota, may have an ambulance service that dates back to the 1960s, but they’re in danger of losing their basic lifesaver license because they have been unable to staff on-call shifts for more than 12 consecutive hours on several occasions in recent months.

Jason Passow, a volunteer EMT in Altura, said he joined because he wanted to help his neighbors, and if the service goes away, that’s akin to telling people in the community they need to wait for lifesaving medical response care.

Because the service area only generates about 80 to 90 calls a year, Passow said it would not be financially feasible to hire a full-time EMT to cover shifts.

A solution put forward during an October public meeting at Altura City Hall suggested recruiting more emergency medical responders, though those are in short supply as well.

During a similar October meeting in Baxter, near Brainerd, stakeholders pointed to outdated thinking from policymakers.

“Our current reality is that we lack people, not jobs, yet our current policies, still, I think, favor 1970s thinking,” Kelly Asche, senior researcher at the Center for Rural Policy and Development said during the meeting. “Policies are still developed around the idea that we should build more jobs, not (find) more people. … We still have politicians or policymakers, doing their campaigning on, ‘I’m gonna bring good jobs to the region.’ That’s really the last thing we need. And it’s that old style of thinking that’s going to keep us stuck.”

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