Emergency Care Services In Rural Idaho

Idahoans’ health and safety are impacted by location and distance because it is a huge and primarily rural western state. In comparison to their urban counterparts, people of Idaho’s rural regions are older, have greater rates of poverty and lower per capita income, and have higher rates of being uninsured.

Communities with a scarcity of primary care, urgent care resources, or mental health providers are designated as Health Professional Shortage Areas by the federal government. Geographic areas, demographic groupings, and facilities may all be designated as being in short supply.

EMS responded to 146,000 emergency calls in Idaho alone in 2020.

The Bureau of EMS and Preparedness of the Department of Health and Welfare claims it has little power and capacity to support local EMS services.

Role of Volunteers Providing EMS in Rural Idaho

Due to funding constraints, several agencies rely on volunteers to provide EMS. Patient care is harmed by insufficient staffing because of less advanced training and longer response times, especially in rural locations.

According to a new state oversight study, Idaho is failing to deliver emergency medical services, particularly in rural areas where volunteers are needed.

Most rural EMS services, according to the Office of Performance Evaluations (OPE), rely on volunteers to drive ambulances and serve as EMTs. This is also true in many urban locations.

The Idaho Legislature’s Office of Performance Evaluations investigated volunteer emergency medical service providers in a 92-page report. The findings demonstrate that EMS in Idaho is severely underfunded because the state does not consider EMS to be a vital government function and hence does not provide adequate funding.

According to OPE, Idaho has almost 2,000 EMS volunteers, accounting for more than 40% of all EMS providers. Volunteers make up 69 percent of EMS in rural Idaho.

Some volunteers are paid a small amount, but roughly 45 percent of volunteers are not paid at all, regardless of whether or not they are called out.

Staffing Challenge and Funding Challenges in Provision of EMS

Data from half of the state’s agencies are included in Idaho’s OPE Policy Report. Approximately 80% of EMS agency directors polled said they didn’t have enough staff or funding to meet community demands. One-third of respondents reported that staffing issues affect ambulance response times at least once a month.

According to a new report from the Office of Performance Evaluations, access to emergency medical services varies depending on where Idahoans live.

Because EMS is not designated as an essential service under Idaho law, the state is not obligated to finance it. Many EMS teams are entirely made up of volunteers, and finding money is a constant issue.

Patients in these areas suffer lengthier wait times and a worse standard of care due to a lack of manpower. The COVID-19 epidemic has become more severe.

Agencies are required to submit patient care records to the Department of Health and Welfare’s Bureau of EMS and Preparedness, although this data is often erroneous and incomplete due to a variety of issues.

Idaho is one of just three states where performance data from the National EMS Information System, a collaboration between the National Highway Traffic Safety Administration and the University of Utah, is not available, according to the report.

Because the Idaho EMS Bureau lacks accurate and full performance data, the state has little idea how much patient care is impacted.

Recommendations of the OPE Report and EMS Agency Directors

The OPE Report recommends that the bureau address data restrictions that impede its capacity to improve and focus evidence-based support for staffing difficulties. The Legislature could then consider giving cash pay, benefits, and training to aid agency recruiting and retention efforts.

The majority of Idaho agencies reported insufficient financing, with rural agencies suffering the most difficulties, according to the survey. The immediate cost of each emergency response is included in EMS expenses, as well as ongoing overhead to keep the organization ready to respond 24 hours a day, seven days a week.

More than half of agency directors who responded to a poll said they didn’t have enough money to address their community’s emergency medical care needs.

Agencies claimed that they are unable to cover their costs through billing in many situations due to low reimbursement rates, the fact that certain on-site treatment does not qualify for reimbursement, and the fact that some treated patients lack health insurance or financial resources.

To stay financially sustainable and provide services to their communities, EMS agencies must pay for unreimbursed care.

In 2010, OPE published a similar study on EMS, however, only a few of the suggestions given to the government were implemented. A suggestion was made to establish regional or county-level EMS services.

EMS is funded by certain municipal tax districts, such as ambulance districts or fire districts, however, the data is inconsistent. Property tax money can also be put into the general fund by counties, cities, and hospital districts.

According to the report, only 22% of EMS agency directors in Idaho believe they are adequately financed.

Due to minimal personnel and complicated medical billing, several agencies experienced difficulty recovering expenditures through billing. Patients who do not have private insurance have lower reimbursement rates.

OPE was given some background by larger agencies. “For example, in the county fiscal year 2020, Ada County paramedics reported losing $520 each Medicare patient and $550 per Medicaid patient treated and transferred to a hospital,” according to the report.

Because they have trouble receiving basic medical care, lower-income and uninsured people are more likely to use EMS, according to the survey.

Paid vs volunteer EMS

The licensing and training of paid EMS employees vs volunteer EMS workers is a key issue.

Federal statistics show that the most serious concern is the worsening of patient care and a lack of qualified EMS professionals.

This is especially true in Idaho, where volunteer agencies provide more than half of the services and nearly all rural communities rely on them for EMS.

The average salaries of volunteer fire department members are lower than that of paid firefighters, requiring volunteer EMS leaders to have other jobs outside the ambulance service. These individuals are encouraged by federal financial incentives to be part-time employees so their primary employment can qualify for public safety grants.

“It’s interesting because, in communities that are not as large or affluent, they need their volunteer base to continue to function,” said Sarah Evans, EMS state coordinator at the Idaho Office of Emergency Medical Services.

Volunteers have a lesser level of licensing than paid employees. A higher level of licensing allows a practitioner to deliver certain sorts of services and medications that lower-level licensees cannot lawfully supply.

According to the Office of Professional Ethics, paid providers are 3.6 times more likely to be licensed to give intermediate or advanced life support when treating a patient.

This also means that rural EMS professionals are about half as likely as urban EMS providers to be credentialed for intermediate or advanced life support.

Bill Spencer is the EMS manager at Grangeville’s Syringa Hospital. He’s been an EMT for 43 years and says recruiting new volunteers keeps getting harder.

He claims that only around 20% of those who attend his training seminars finish them, and even fewer stay with the department for more than a year.

Spencer’s crew is compensated for being on call and for going out on service calls. However, they must pay for their training, continuing education, uniforms, and other expenses. Almost everyone has a second job.

He suggested that the state assist with financial incentives for recruitment and retention. Spencer’s approach is echoed in the OPE policy recommendations for the legislature.

To encourage staff retention, OPE advised that the state consider paying full-time EMS in rural counties and providing perks such as health insurance and retirement.

To enhance retention efforts, the report also advised continued training and licensure. The state does not pay for volunteer EMS training, which is both costly and time-consuming.

OPE did submit a cost/analysis report as well as a study on how much it would cost to offer volunteer EMS retirement benefits.

House Bill 389

According to an OPE analysis released in November, agencies expect to receive less money than they would have otherwise since the Idaho Legislature passed HB 389, sponsored by Rep. Mike Moyle, with the goal of giving tax relief to Idahoans during the 2021 session. Due to new construction and annexation, the bill’s budget caps no longer adequately account for growth in service demand.

Before the passage of HB 389, funding was already a concern. The budget cap hampered 14 of 28 ambulance service districts and 90 of 158 fire protection districts in 2019, according to OPE.

The report was sent to the Joint Legislative Oversight Committee, and it is up to the members of the committee to decide whether or not to act on OPE’s recommendations.