PITTSFIELD – The demand for emergency medical services has increased and ambulance companies are struggling to meet it.
Low reimbursement rates, more calls for service due to COVID-19 and the opioid crisis, staffing shortages and now record high gas prices. In order to survive in this climate, ambulance companies face a difficult balancing act.
One person who knows how this industry works is Brian Andrews. He is president of the County Ambulance Service in Pittsfield, a private, for-profit ambulance service his family founded in 1982. The county is the largest family-run ambulance service in western Massachusetts. (Andrews’ brother and father are on the company’s administrative staff.) Andrews also serves on the state ambulance board.
We recently spoke with Andrews about the challenges ambulance services are currently facing.
Q: There are many ambulance companies. How do you stay competitive in a market where there are so many choices?
A: I really think it’s all about quality and maintaining the latest and greatest training and equipment. I guess that’s where my satisfaction comes from now. Before, it was in the street to take care of patients. When you get as big as us, I can’t go out. But now my satisfaction comes from solving challenges.
Q: How has the company evolved over the past 40 years?
A: The technical aspect of this one is right through the roof. When we started it was basic EMT. But now, in the age of paramedics, we have so much at our disposal. I’ve been a paramedic since 1994 and even today the paramedics we hire are so much better trained than when I was. It is a profession in constant evolution. We are literally doing more for patients than we ever have.
As for the challenge, obviously there’s a lot in the media right now about [how] the payback picture just hasn’t kept pace. So it’s hard to try to keep up with what’s new while having little money to do so.
Q: So how does the refund process work in your business?
A: We provide service, and that’s also a struggle, because the definition of service is that we get that person to the hospital. We are not authorized to bill the insurance company or Medicare. They decide if it was medically necessary and if the patient’s insurance coverage was appropriate. They reimburse us at a much lower rate than what we charge. We really don’t have much bargaining power when it comes to reimbursement.
A: That is really, to put it bluntly, the power of lobbyists. You have hospitals that are represented by big lobby organizations that have a lot of power with lawmakers and can get a lot of what they need. We really are a fledgling industry, if you will. The ambulance industry really started to grow in the 1960s and early 1970s, so we’re relatively new and it took us a while to catch up. Right now, I think we’re doing a good job, but we’re still fighting this battle because especially today, post-COVID, everyone is fighting for money. So the biggest challenge with reimbursement is basically being told what you are being reimbursed for, but also the fact that they will only reimburse you if you transport that patient (to the hospital).
Q: How else has COVID affected your profession?
A: One of the biggest parts of our business was the chair car, the wheelchair van service where we could take people from their homes and nursing facilities to doctor’s appointments and medical tests. That went away during COVID because, as you know, nursing homes were doing their best to limit the spread of COVID in their homes. So they started doing a lot of telemedicine. They would send an x-ray company to the nursing home rather than have us bring the patient to the hospital. This business did not return after COVID. The number of transports we do in wheelchairs is almost nil at this point.
Q: Is it difficult to plan?
A: The ambulance is a tough beast to even put a pattern on. I’m kind of a data driven guy. I manage our numbers for everything from the time it takes to get a call to the number of heart attack patients we can see. You can never develop a very good model of the busiest days or the busiest months. I can tell you it’s a bit slower than before COVID.
Our biggest challenge right now, like all businesses, is staffing. We have the calls to make but we don’t have the people to make the calls.
Q: Are you having trouble recruiting people or finding qualified people?
A: Both. We always had a file full of requests. So if someone decided to retire, leave or move on, we could always look at the file and get requests. Right now, any application that comes through the door, we try to hire them. We also did an EMT course last fall where we actually waived the tuition and paid it to take the course in exchange for giving us two years of employment with us. The numbers haven’t been really good with the money invested. We only have a handful of trained people.
Q: Has giving Narcan to overdose patients changed the way paramedics work?
A: You can get instant results because you can administer Narcan and now the patient is awake. But the other thing we’re seeing in our industry is that it also makes us more aware of the danger we face. Sometimes we go into an environment that is not the safest, which puts our people at risk.
In the 1980s you came with an ambulance and you were like the cowboy in the white hat to save the day and make everyone better. Nowadays this is no longer the case. We are simply seen as part of the system. As you know, people are more angry and in some cases more violent, so we have more people wearing body armor at work. It certainly has an effect on how we operate.
The other thing, and it’s common, is that we come to an overdose and we find that one, two or three people have overdosed at the same time. We recently had one where three people had overdosed in the same place.
Q: This must be difficult to manage.
A: Another thing I try to fight against is what we call compassion fatigue. It’s very easy if you see the same person over and over and they don’t go through treatment and you don’t understand the whole opioid process to become hardened and worry less about those patients. We are working very hard to educate people about this so that they realize that [these patients] are no different from the person who has chest pains and may be having a heart attack. It’s a disease and as difficult as it can be, we need to be as compassionate to them as we are to all of our patients.
Q: How have high gas prices affected your bottom line?
A: We have vehicles that are not the most economical. If we go down the [Massachusetts] Turnpike to get someone to Baystate or Boston, it’s costing us a lot more than it used to. We’re talking about vehicles that go about 6 or 7 miles per gallon. Over the years there have been spikes in gas prices and we kind of held our breath hoping it would be over soon enough. But it doesn’t look like this one will end very quickly.