Lanc. Co. EMS faces funding deficit, the latest in a trend of statewide EMS funding woes

‘We are in the crosshairs of no one wanting to own the problem,’ one local leader said, as he scrambles to close a funding gap

By: - September 23, 2021 7:44 am

(l-r): Kerilee Shuey, Katie Miller-Amick, Dan Richards, Bob May (Capital-Star photo by Lauren Manelius).

Correction: A previous version of this story incorrectly stated that none of the workers received raises. 

LANCASTER, Pa. –  Bob May attended Lancaster City Council’s finance committee meeting on Sept. 7 amid his annual quest to fund Lancaster EMS (LEMSA), the primary provider of emergency response services for Lancaster County, for 2022. It’s mostly a solo effort; he serves as LEMSA’s executive director. 

It is not going well, which has been the case for the past 20 years, May told the Capital-Star. 

The same goes for others in charge of emergency medical service (EMS) organizations throughout the commonwealth, as evidenced by local news: for example, the shuttering of small EMS companies in rural western Pennsylvania, a dearth of applicants for open paramedic positions in Dauphin County, and the shuttering of 70-year-old Newberry Township EMS in York County, due to lack of funding, and more calls than its staff can handle. 

Circumstances in Lancaster County can serve as a case study of this pattern across the state. May shared the figures he presented to Lancaster City Council with the Capital-Star.

LEMSA’s annual budget is $12.4 million. To close next year’s budget gap, LEMSA needs the 21 municipalities it serves to pledge a total of $700,000. He has only been able to secure around $228,000 so far. He has until the end of 2021 to make up the balance.

He asked for $327,000 from the city of Lancaster, from which LEMSA typically receives $150,000. 

May’s appeal to Lancaster is for only 47 percent of what his formula stipulates he should request. 

Pennsylvania’s EMS leaders use various methodologies to determine funding requests for municipalities, taking into account such factors as population density, the number of households, and proximity to dangerous areas such as rail lines, highways, and farms.

Lancaster EMS asks municipalities to boost their contributions (One United Lancaster)

May keeps it simple, basing his requests on the total number of calls the EMS made over the previous year. For example, if LEMSA ran 10,000 trips in a given year, and 1,000 of them were for residents of City A, the next year he’ll request 10 percent of LEMSA’s municipal support budget from City A. 

The money is needed to hire new employees — 30 of the positions at LEMSA are currently unfilled — and to provide wage increases to its 155 workers. Ultimately, however, it’s to prevent LEMSA from having to reduce its service area for the first time in its history.

The annual ask

During this annual quest, May writes to, calls, or visits each of the 21 municipalities LEMSA serves, a total population of about 260,000 people. Usually it’s via their city councils, where he’s granted several minutes during public comment periods.

After he makes his plea for funding, although the wording varies, the response from elected officials is typically an iteration of: “We appreciate you, but we can’t make any guarantees — we’ve also got x, y, and z to fund,” May told the Capital-Star.

Each year, he invites policymakers to accompany paramedics on a ride-along for a day to witness the level of care they provide, and the daily hurdles they face. These officials almost always decline, but following last week’s presentation in Lancaster, City Council President Ismail Smith-Wade El took him up on the offer on September 17.

“County commissioners and state government need to take this up. This is a public good that crosses municipal boundaries, which is exactly the type of effort they’re supposed to be supporting,” Smith-Wade El told the Capital-Star. 

“If we can get the word out, we can show our county officials and state legislators that they need to take action, because this is what the community wants. When you call 911, you want someone to show up,” Smith-Wade El continued. “Everyone deserves to feel safe in their community, and EMS helps make that happen, regardless of how wealthy the person on the other end of the phone is. Every municipality should be contributing to EMS. It’s frankly irresponsible for our elected officials, at any level, to see the current situation and say, ‘That’s not my problem.’”

Funding limitations defined by law

May focuses on local governments because of the Emergency Services provision of Pennsylvania statute, which stipulates that it is up to cities (which include municipalities and boroughs) to “be responsible for ensuring that fire and emergency medical services are provided within the city by the means and to the extent determined by the city.”

In other words, May told the Capital-Star, “The power is at the local level.” 

County leaders traditionally have cited this statute when May approaches them for help, so he doesn’t focus on them much anymore. 

Many municipal leaders, however, are unaware of it, and contribute nominal amounts in the four digits, while supporting their own local fire companies with appropriations that run to the six digits — and assume the county will help fill in the gaps for EMS.   

“We are in the crosshairs of no one wanting to own the problem,” May told the Capital-Star, and explained additional misconceptions among the public and local government leaders that lend to the struggle to fund local EMS.

While it’s true that LEMSA is a fee-for-service organization that bills patients’ insurance companies, that doesn’t always result in reimbursement — it ultimately collects an average of only 50 cents  for every dollar billed. Within the city of Lancaster, it’s about 35 cents. LEMSA is prohibited by law from billing patients for what the insurance companies, Medicare, and Medicaid don’t pay out, May said. 

Others assume that LEMSA is for-profit, but it’s been a 501(c)3 nonprofit organization since its founding in 1996. 

Still others think EMS transport is paid for by local hospitals. But as of 1988, hospitals and health systems are prohibited by a federal provision known as the Stark Law from funding ambulance services, because of past instances where they established fraudulent relationships for their mutual benefit.

History of EMS in Lancaster County

May began his career in emergency medicine in 1976, as a volunteer emergency medical technician (EMT). Lancaster Osteopathic Hospital, which later became Community Hospital of Lancaster, recruited him to manage its Emergency Department in the early 1990s., 

At the time, individual hospitals were responsible for providing their own ambulance service, relying on volunteer drivers who did not perform any medical support. When volunteers dwindled in the 1980s, ambulance drivers started getting paid. 

Hospital leaders selected May to guide the formation of LEMSA in 1996, when both Community Hospital and the former St. Joseph’s Hospital came to the conclusion that they were losing too much money on ambulance services. 

It was the first time two regional hospitals partnered together on such an effort, and they were later joined by Lancaster General Hospital. Today, LEMSA is one of only 190 nationally accredited EMS organizations in the country, May told the Capital-Star

By then, ambulance workers were called paramedics, and it quickly took off as a career with promise. The applicant waitlist was often 20 people long, so the standards were high. 

Only those with strong recommendations and educational/background credentials made it in, May told the Capital-Star.

But starting in the 2000s, conditions began to creep toward what May is experiencing now: municipalities reducing funding, coupled with steadily increasing call volume, has resulted in shifts with zero downtime. 

May attributes rising call volume to several factors. 

Pennsylvania’s senior population is growing. The opioid epidemic continues to rage on. They have more paperwork than ever, due to insurance company red tape and new regulations handed down from the state legislature. More and more people are encountering financial insecurity, which historically indicates an increase in violence. Smaller EMS companies are shutting down from lack of funding, and others have to pick up the slack, creating a ripple effect of understaffing.

Effects of the COVID-19 pandemic

The pandemic continues to exacerbate the stressors of life as a paramedic, May told the Capital-Star. They’re running more calls than ever, and before the COVID-19 vaccine became available, many were afraid to go home to their families, he said. 

Some of his staff admitted to sleeping in their cars after being exposed to COVID-19 patients, doing everything they could to avoid infecting their family members.

While the risks about providing emergency medicine during a pandemic are widely acknowledged, he has received only two phone calls from elected officials in LEMSA’s coverage area thanking its staff for their service,  May told the Capital-Star,. 

This stands in contrast to the public accolades given to other types of health workers during the pandemic, as well as police and firefighters.

Pennsylvania is one of only a handful of states that doesn’t define EMS as an “essential service,” May said, adding that he believes this lends to the disconnect in funding made available to EMS versus fire and police. 

Fire companies also have the historical benefit of being “the fabric of the community,” May said, serving as a social meeting place and maintaining connections with local elected officials.

The growing collapse

LEMSA is now — for the first time in its history — forced to consider a policy change that reduces services, which may include ceasing coverage of certain areas, May told the Capital-Star. 

But nobody at LEMSA wants it to come to that. The answer, May said, is that, “We need all of the municipalities to have skin in the game.”

Without wage increases, LEMSA and other EMS organizations won’t be able to hold onto employees.

Sep 22, 10-20

“Being a paramedic is no longer considered a career track for most,” May said. “It’s low wages, high stress, high risk, and underappreciated. There’s no concept of keeping an EMS worker until they retire.” 

Workers are fleeing to jobs at companies like Rutters and Amazon, according to May, because they’re less stressful, require less training (LEMSA’s application asks about eight types of certification), and are able to pay better wages.

“It’s a collapse,” May told the Capital-Star. 

The quest continues

After visiting Lancaster City Council, May’s next stop came on September 13, when he presented during the public commentary period of the Quarryville Borough Council’s work session meeting. Quarryville relies on LEMSA for EMS — its residents comprised nearly 10 percent of trips in 2019 — but has never contributed to its budget.

They listened patiently, May told the Capital-Star, and responded that they would consider his request — just like Lancaster City Council did. 

But if history is any indication, May said, that response is usually given to soften the no that’s coming later.

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