Ambulance company AMR halts an estimated 28,000 trips in Southern California – Orange County Register

For 23 years, California’s private ambulance industry had done without an increase in the base rate the state pays it to transport Medicaid applicants. Earlier in the year, it asked lawmakers to more than triple the rate, from about $110 to $350 per ride. The request went unheeded.

In September, American Medical Response, the largest US provider of ambulance services, announced that it had “made the difficult decision” to halt non-emergency transportation in Los Angeles County, accusing the state of having one of the lowest reimbursement rates for ambulances Having Medicaid in the country. “Additionally,” said the company, which was sold to private equity firm KKR for $2.4 billion in 2017, “we’re not subsidized by taxpayers’ money like government agencies, and nearly 80% of our patients pay for ours.” Services nothing or less.”

The company, which also cited high operating costs, said its non-emergency division in this area is on track to lose $3.5 million in 2022.

The California Department of Health Care Services, which administers the state’s Medicaid program for low-income people, known as Medi-Cal, didn’t dispute that the base rate hasn’t increased since 1999, but said supplement reimbursements have increased Payments for incidentals and emergency trips.

In its initial announcement, AMR mentioned phasing out non-emergency services only in LA County. However, the company told KHN it would stop servicing five Orange County hospitals in addition to seven LA County hospitals.

Jason Sorrick, vice president of government affairs at Global Medical Response owned by KKR, which is now AMR’s parent company, said AMR will phase out over the next six months and move vehicles and as many of the 170 crew members as possible to its core emergency services.

AMR’s withdrawal equates to a loss of 28,000 non-emergency transports per year and could create an awkward position for hospitals that have contracts with the company. LA County said it doesn’t track the total number of non-emergency trips provided by ambulances in the county, while Orange County couldn’t immediately share its number.

Although ambulances are typically associated with 911 calls, many are used to transport frail or vulnerable patients between healthcare facilities. A patient may need to go to a rehabilitation facility after hip replacement surgery, or someone who has attempted suicide may need to be transferred from an emergency room to a psychiatric facility. Such transfers, known as interfacility transports, allow hospitals to free up beds and maintain patient access.

In September, American Medical Response, the largest US provider of ambulance services, announced that it had “made the difficult decision” to halt non-emergency transportation in Los Angeles County, accusing the state of having one of the lowest reimbursement rates for ambulances Having Medicaid in the country. (File photo by Kurt Miller, The Press-Enterprise/SCNG

There is no consensus on what the impact of AMR’s withdrawal will be. The state told KHN that it would “target” and address access issues when they became aware of them. Patient advocates said it is too early to draw any conclusions about the effect on patients, particularly those covered by Medi-Cal. The California Ambulance Association has expressed concerns that businesses have already been thinned out by staff and vehicle shortages.

Although the two counties and the insurers that serve their Medi-Cal population did not express immediate concern about AMR’s decision, some hospitals may struggle to cope with the loss.

“The discontinuation of these services will undoubtedly impact hospitals’ ability to efficiently manage the flow of patients from arrival to discharge,” said Adam Blackstone, senior vice president of communications at the Hospital Association of Southern California.

AMR said its withdrawal will primarily affect Providence, a Catholic health-care system that operates in several states including California. It did not respond to a request for comment.

AMR now also attributes its exit to avoiding a labor dispute. Sorrick said that because of Medi-Cal’s rates, AMR cannot staff both emergency and non-emergency ambulances and can increase wages for unionized emergency workers who threatened to strike. So it closed its non-emergency, lower-priority department that wasn’t unionized. The plan was to use the savings to increase rescue workers’ wages.

Michael Diaz, a paramedic and president of the International Association of EMTs and Paramedics Local 77, which represents 350 EMTs and paramedics for AMR emergency services in LA County, confirmed that AMR’s announcement came a day before the union’s planned protest march for higher wages .

Diaz, whose national union joined the industry to lobby the California legislature for higher rates, said AMR’s announcement may also have been politically motivated. “You’re sending a message,” he said.

So far, it’s unclear whether elected officials have noticed the retreat. The chairs of the Legislative Budget Committees declined to comment or did not respond to inquiries.

Medi-Cal’s spending on all medical transportation services totaled approximately $975 million in fiscal 2021-22, according to the Department of Health Care Services.

The department said that Medi-Cal’s insurers are ultimately responsible for maintaining an adequate network of medical transportation providers, noting that insurers are entitled to pay above the base rate. The ambulance industry said it was unusual for insurers to pay more.

Jimmy Pierson, president of the California Ambulance Association, said other ambulance companies typically pick up the slack when one exits a market. However, he warned that competitors might not be able to cover all of AMR’s ambulance runs this time around due to unprecedented labor and supply shortages — including two-year waits for new ambulances — and rising Medi-Cal enrollments and inflation. A recent national survey found that EMTs have an annual turnover rate of 36%.

“How are you going to find 170 employees in a labor shortage?” Pierson asked. “How do you like these ambulances?”

Ambulance companies said hiring and retention have been impacted by low wages, burnout and the lingering impact of EMT school closures during the pandemic — and that low Medi-Cal reimbursements are making it harder for EMTs to pay competitive salaries.

Some other companies in the state have already suspended or scaled back services, Pierson added. In 2016, AMR terminated emergency medical services in Tulare County, a Central Valley region with one of Medi-Cal’s highest population percentages.

Sorrick said AMR believes there are enough companies offering non-emergency transport to absorb the volume.

Chad Druten, president of the Los Angeles County Ambulance Association, said the county has about 1,200 licensed private ambulances operated by about 35 companies, most of which are small to medium-sized and focused on non-emergency transport. Some large companies, including AMR, cover emergency calls.

Melissa Harris, owner of LA County’s AmbuServe Ambulance Service, said she plans to compete for small portions of AMR’s contracts and focus on those with fewer Medi-Cal patients. Harris said she loses money on every Medi-Cal-covered transport and can’t just buy and staff new ambulances. If she wins any contracts, she will likely have to “swap” her existing contracts, which serve most Medi-Cal patients.

The consequences of this, Harris said, would hit underserved patients hardest.

KHN (Kaiser Health News) is a national newsroom that produces in-depth journalism on health issues. Along with Policy Analysis and Polling, KHN is one of the three major operational programs of the KFF (Kaiser Family Foundation). KFF is a donated non-profit organization that provides information on health issues to the nation. Ambulance company AMR halts an estimated 28,000 trips in Southern California – Orange County Register

Dais Johnston

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