The Syracuse Fire Department may start billing residents for ambulance calls they handle when private companies are overwhelmed.
Since November, the city’s fire department has been running a pilot ambulance service to fill in gaps for AMR and other ambulance services who have been stretched thin by the pandemic.
Residents always received a bill when AMR and other private services responded to ambulance calls in the city.
If the fire department wants to keep running the service, city officials say they need to contract with a medical billing service to recoup some of the costs of running the ambulance.
“There’s a crisis going on,” Syracuse Fire Chief Michael Monds said at a recent Syracuse Common Council meeting. “… This is going on in cities all over the state, small towns and villages. There’s just an ambulance crisis.”
Later today, the Common Council plans to vote on a proposal to pay a medical billing service $150,000 to handle the billing of residents.
In some cases, portions of the bill will go to insurance companies and the resident taken to the hospital will pay a co-pay.
Since Jan. 1, 2021, AMR has been unable to respond to more than 2,500 calls in the city, leading to ambulances from other towns and villages, like Fayetteville, to be called in.
Monds said on at least one occasion an ambulance from Oswego County had to respond to a call in Eastwood.
The total number of calls AMR could not respond to in the city in the last 15 months nearly matches the number of calls it could not respond to from 2017 through 2020, according to data presented by fire officials at meetings with the Common Council.
While AMR and the city do not have a contract for the company to provide service to the city, it is the main ambulance provider in the area.
The problem is clearest in the city, but it is also happening countywide. An increase in ambulance calls, an increase in hospital wait times for ambulances and a decrease in staff has stretched ambulance companies thin.
Fayetteville increased the staffing of its ambulance service and raised its fire department and emergency medical services budget by more than 20% for the next year because of it.
Mayor Mark Olson, who is also a county legislator and chair of the county’s public safety committee, plans to have the committee study the problem, he said.
It’s unclear how the strain is affecting service to residents. Neither the city nor the county has so far provided data on ambulance response times or about the types of calls being delayed despite multiple requests from Syracuse.com | The Post-Standard.
“II’ll be crystal clear: Our city is the major strain on the county’s problem,” Monds said.
More calls, fewer nurses and EMTs
Fire officials first began noticing the problem in May 2021. It’s being driven by lack of staffing at ambulance services and at hospitals.
During the first year of the pandemic, in 2020, ambulance call volume plummeted.
But call volume rebounded above pre-pandemic levels in early 2021, said AMR spokesman Nick Corbishley. Last year, AMR responded to about 5,000 more calls in Onondaga County than in 2019, an increase of about 8%.
During the pandemic, many EMTs and paramedics left the profession and fewer people signed up. That meant a smaller staff was left to deal with a higher call volume, Corbishley said.
Ambulances have increasingly been stuck at Syracuse-area hospitals, meaning fewer ambulances are on the road to take calls. Last summer, hospitals had to divert ambulances to other hospitals for more than 1,100 hours per month, the most in the last decade.
That jams up emergency rooms and makes ambulance trips to the ER longer.
When ambulances that service the city spend more time at the hospital, ambulances from other towns and villages have to be called in to cover for them.
That leaves those towns and villages short an ambulance and taxpayers from those areas paying for an ambulance to respond to the city.
According to data provided by AMR, it has also had to respond more frequently outside the city. Since Jan. 1, 2021, AMR has taken a call for another ambulance service more than 1,900 times.
Syracuse Mayor Ben Walsh approved the fire department to start its pilot program in November of last year.
Fixes
AMR has tried to fill in as many gaps as it can, Corbishley said.
It has been accepted into a new program called Emergency, Triage, Treat and Transport through Medicare. That allows EMTs to ask Medicare patients whether they would like to get a virtual meeting with a physician rather than be taken to a hospital, if the patient does not have a medical emergency that requires a hospital visit. That often allows an ambulance to move from call to call faster.
The ambulance service also has 19 people going through an “earn while you learn” program, meaning it could put 19 more EMTs in ambulances soon.
Syracuse budget director Tim Rudd said at a recent Common Council meeting that one long-term fix could involve the city signing a contract with an ambulance service like AMR.
Many contracts require an ambulance service to answer a certain percentage of calls, according to Rudd. If the service drops below a threshold of calls answered, the contract often includes a way to hold the ambulance service accountable. That’s something the city can’t currently do.
So far, the city has been paying for the ambulances in its pilot program out of the fire department budget, which didn’t account for having to run the program.
The department has been staffing two ambulances Sunday through Thursday, from 3 p.m. to 11 p.m., at its fire station on West Genesee Street.
The fire department pinpointed those times as times when AMR and other ambulance companies that service the city might need help covering calls, Monds said in a presentation to the council.
It has so far covered about 75 calls per month, said Syracuse Fire Department spokesman Deputy Chief John Kane.
In an initial common council meeting, pushback from councilors came from worries about billing. Several councilors expressed concern over billing residents for a service they may believe they’re already paying for.
“Right now, this is a stopgap measure,” said Frank Caliva, the city’s chief administrative officer. " … The long-term solution … is probably a countywide program. It’s not Syracuse fire expanding beyond the pilot. It’s probably the municipalities getting together and responding to it as a group.”
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