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Federal restrictions, Lack of COVID-19 Relief Funding Force Rural Ambulance Services to Close

Press Release, Pafford Medical Services

HOPE, ARK. – Ambulance providers are seeking a legislative fix in the 117th Congress for the problems created by combatting the COVID-19 public health emergency without proper reimbursement for their services. Providers are requesting such changes as many rural ambulance services are being forced to shut down operations due to a lack of adequate funding and a model of reimbursement which does not address the realities of a pandemic.

In approximately 30 percent of calls, an ambulance crew will respond and treat patients on scene without a subsequent transport to a local hospital, a practice known as “treatment in place.” While such protocols are meant to decrease the spread of COVID-19 to hospitals and medical personnel, they often place a financial burden upon ambulance services who are not reimbursed for treatment if their patient is not transported to a local facility. Despite pleas to Congress for $2.7 billion in aid from resource-strapped ambulance services across the country, EMTs and paramedics who provide skilled care did not receive additional funding to cover PPE, training and staffing costs related to COVID-19.

This issue hits close to home in Arkansas. An ambulance provider in England, Ark. announced earlier this week that they will be forced to cease operations effective March 1, 2021. In Southwest Arkansas, two local services were forced to sell their businesses to keep their communities served during the public health emergency.

Owners of these companies had previously received Paycheck Protection Program loans from initial CARES Act funding, but resources were drained within the first few months of the pandemic. They were often required to put forward personal funds to combat the loss of revenue, and local government organizations were unable to provide the necessary dollars to assist. These two Southwest Arkansas operations, one serving Nevada and Little River Counties for 17 years and another serving Lafayette County for over 50 years, sold to Pafford Medical Services of Hope, Ark.

According to Jamie Pafford-Gresham, CEO of Pafford Medical Services and Secretary of the American Ambulance Association, these financial burdens are exacerbated by the lack of federal funding provided to ground ambulance services during COVID-19. While the Department of Health and Human Services (HHS) was directed to disperse funding through the Provider Relief Funds, only a fraction of a $1.48 billion pool of funding was directed toward ground 911 and interfacility mobile healthcare. This is compared to nearly $7.4 billion granted to skilled nursing facilities and nursing homes, $11 billion to rural hospitals, and $14.4 billion to safety net hospitals. American Ambulance Association member agencies nationwide have experienced an average 16.7 percent decrease in volume of transports and a nearly 15 percent loss in revenue.

“HHS is failing to see the direct relationship that ambulance providers have with combatting COVID-19,” said Pafford-Gresham. She went on to describe the nearly $70 billion in the Provider Relief Funds directed to hospitals while EMS remains underfunded in its own frontline response. Additional Provider Relief Funds, Pafford-Gresham argued, could be used to reimburse the costs of additional PPE, treatment in place practices and COVID-19 presumptive patient care for the ambulance provider community.

Lawmakers in the Senate have attempted to combat this issue by submitting Senate Bill 149, a bipartisan piece of legislation which would provide ambulance services with a waiver to be reimbursed through Medicare for non-transported patients during a public health emergency. Pafford-Gresham said that this action, while helpful and fully supported by ambulance providers, is not sufficient to address the greater concern faced by ground ambulances in a time like COVID-19. Therefore, she and others are seeking a more immediate approach in the Provider Relief Funds to continue serving their communities in a time of increased need.

“I am humbled that they came to me and trusted Pafford to take care of their communities,” Pafford-Gresham said of the Southwest Arkansas companies forced to sell. “I respect both of these providers immensely for doing everything in their power to care for their citizens.” Detailing these companies’ exemplary service, she noted their undying commitment to quality medical care in rural Arkansas during a public health emergency. Since the transfer of contract ownership to Pafford Medical Services, Pafford-Gresham said she has focused her efforts on sharing necessary resources and protecting existing jobs. But this nationwide issue is not sustainable for long without adequate federal relief.

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