by Sarah Craighead Dedmon
A shortage of available ambulances has caused longer ER wait times, caused patients to lose beds in other facilities, and created frustration in the community, said Down East Community Hospital and Calais Regional Hospital CEO Steve Lail, speaking from Machias Friday.
Following news that the Petit Manan Ambulance Corps could soon close its service primarily due to a lack of funding, Lail said the loss of even one local EMS service would have a serious impact on the two Washington County hospitals.
“The staffing issues that all of the services are experiencing right now are already having a significant effect. We have long-term care patients that need transfers, behavioral health patients that need transfers, and patients that need a higher level of care,” said Lail. “The reduction in [ambulance services’] ability to provide transfers means we wind up with ER beds filled with these patients, which backs up the rest of the ER, and patients have longer wait times.”
“It just backs up the entire system,” Lail said. “With Petit Manan potentially closing, it will make it even worse.”
Lail said his hospital has reached out to the state to try and learn about other models that might help DECH and CRH meet their transportation needs, possibly including the creation of a hospital-owned transport service.
“We haven’t been able to touch base about what that would look like and how that would work,” Lail said. “We plan to reach out to some of the local services to see if any of them would be interested in working in that model. At times it’s difficult to get information from the state or other places.”
Creating a transportation service from the ground up isn’t the hospitals’ first choice, said Lail, who believes the problem is acute enough and widespread enough that the state needs to step in and help.
“I think it is time for the legislature and DHHS to come up with some kind of plan to make sure that these organizations are funded properly. It needs to be on their radar,” he said. “It’s a significant issue for all of the hospitals in the state. In other states, sometimes the EMS service is subsidized by some kind of annual tax levy.”
Atlantic Partners EMS Advisor Rick Petrie says every ambulance in the state of Maine requires some kind of subsidy to stay solvent because EMS funding is based on a “pay for transport” model.
“Which means if you show up and transport the patient you can bill for it,” said Petrie. “The problem with that is it doesn’t take into account any other activities that go into a successful EMS service, like regulatory oversight, administration, and training.”
Another contributing factor to poor ambulance revenues is the fact that more than 70 percent of all ambulance runs in Maine are paid for by Medicare or Mainecare. Those services will only reimburse 85 percent of the cost.
"Right off the bat you lose money,” said Petrie. “So every single ambulance service in the state of Maine has to be subsidized, whether through tax subsidies or if they’re owned by a hospital, through the hospital’s finances.”
Petit Manan provides a relatively large number of transfers for its size. In 2022, out of 544 total runs, 143 were routine transfers and 37 were emergency transports.
Washington County’s wider EMS community has warned of critical staffing shortages for more than two years. To make sure the emergency calls are answered with reduced staff, all local services back each other up, and often must decline long-distance patient transfers which take an ambulance out of the area for a minimum of five to six hours, longer if the transfer is out of state.
Transportation is only one part of the state’s healthcare challenges, said Lail, noting that almost every facet of healthcare is experiencing a critical workforce shortage, which leads to a scarcity of beds available for transfers.
“I know there’s frustration in the community, and the frustrating thing for us is that it’s out of our control,” said Lail. “We can’t control the number of beds available, but the frustrating part is when there is a bed available, and you can’t get a person there because of the transportation issue.”
Petrie will lead a large meeting about the state of Downeast EMS next week from noon to 2 p.m. on Thursday, Jan. 12, at the Wreaths Across America gymnasium in Columbia Falls. EMS workers and town officials from Steuben to Machias are encouraged to attend.