Over the years I've watched EMS leaders ask for, beg, or request funding only to be told either NO outright or watch their request get cut by 50% or more. A recent example was a service chief who told me he was asking for $300k so that he could get the $150k he actually needed. That is a rookie mistake – it perpetuates the problem and it breeds an adversarial relationship between the service and the local government officials. 

The typical result, the EMS agency licks its wounds and continues to operate with the amount provided, thereby 'proving', in the municipality's mind, that they didn't really need the amount requested.  This dance happens year after year until finally the EMS agency reaches a breaking point and their request now becomes an emergency. 

It is time that every EMS agency in this country break out of this cycle and systematically show their actual operating costs, billing revenue and identify any shortfalls so that proper funding of EMS can be addressed before it reaches a critical point of failure. 

This reporting should be done throughout the year, I recommend at least quarterly, so that there are no surprises at budget time. 

Any reports provided to municipal leaders should include at a minimum: 

• Number of EMS requests
• Number of completed transports (great discussion point)
• Response times (average is good, fractile is best) 
• Mutual aid given and received 
• Amounts billed and collected 
• Payer mix, showing the discounts and non-allowables 
• Community events covered 

Quite often I find myself explaining to municipal boards of selectmen, boards of finance, county commissioners or the public the realities of EMS Economics. 

Most have no idea how the finances really work, that almost every completed trip is done at a significant discount, that there is often a high bad debt component to the service and that there is little the EMS agency can do about it. 

When budget time comes and the justified amount of subsidy is put forward there needs to be explanation showing what the community gets for that money.  

More importantly, and this is where EMS fails, is to fully explain what happens to service if the subsidy amount is not provided. 

NOT as a threat but as an operational reality.  By doing it this way the community leaders and the public can decide if they want a cut in service, if they want to have fewer paramedics, if they want continued turnover because wages are under market, making recruitment and retention difficult, or if capital expenditures should be pushed off again potentially resulting in equipment failures and possible litigation from a bad outcome. 

EMS leaders need to hold firm if a decision is made not to fund the justified subsidy amount and actually cut units, explain extended response times and add downtime to the quarterly reports showing the results of their decisions. 

Sounds harsh right?  Spoiler alert, in our experience when the numbers are transparent and the subsidy request is fully explained and justified, we have been able to secure funding for our clients more than 90% of the time.   

If these issues sound like what you're facing, let's discuss your situation and see if we might be able to help.  Click the link to take the first step: https://www.holdsworth.com/contact/