Ambulance

Angels in the Outfield

Angels in the Out Fields - February 3, 2019

State Representative David Perryman

The 1994 film, Angels in the Outfield featured Danny Glover, Tony Danza and Chistopher Lloyd in a family sports fantasy that provided the answer to a young boy’s prayer and along the way engaged the services of a group of angels who helped the California Angels win a pennant and gave him the family that he had so desperately longed for.

I was reminded of that storyline this weekend during a Super Bowl commercial. The ad was for a wireless phone company but it was centered around Major League Football coach Anthony Lynn who had been asked to give a motivational talk to a group of First Responders. As he spoke to the Police Officers, Paramedics and Firefighters who had been gathered, he confessed to them that fourteen years earlier he had nearly died when he was hit by a speeding car as he walked across a street.

Unknown to Coach Lynn, several of the men and women who had responded to his 2005 accident had been assembled in the group to which he was speaking. For the first time since he was injured, he and those who had rendered aid to him were reunited. The emotional coach told the First Responders that he had been told that angels had helped him survive. He surmised through tears that these men and women were indeed those angels.

Across Oklahoma’s 77 counties there are a lot of “out fields.” We call them rural communities and long stretches of highways that at a moment’s notice may need first responders, paramedics and other emergency personnel. The people who need those “angels” are not just the citizens of rural Oklahoma. Visitors to rural Oklahoma hail from all corners of the state and nation as they engage in recreational activities, enjoy nature and attend hundreds of festivals, fairs and other events that represent the true history and heritage of our great state.

While there has been much news coverage about hospitals and emergency rooms closing across the state, the rate of insolvency and closure of Oklahoma’s ambulance services exceeds that of Oklahoma hospitals. More than 50 rural Oklahoma ambulance services shut down between 2003 and 2015 and the rate of closure has not slowed. When an ambulance service closes, that simply means that the territory becomes absorbed in the next closest service. Consequently, distances between ambulance services increase. When Oklahoma ambulance services suffer, so do the people who need them. It is no wonder that life expectancies in some rural communities are as much as 20 years shorter than life expectancies in more urban areas.

A May 11, 2018 Policy Brief by the National Rural Health Association provided the most concise illustration on the challenges facing EMS Services in rural America. 1) The cost per transport is higher in rural areas because the base costs of “maintaining readiness” are sunk costs. 2) With lower volumes there is less of a funding stream to offset costs. 3) Reimbursement rates by Medicare, Medicaid and private insurance are often based on call volume and therefore, in a vicious cycle, studies have shown that over 60% of rural EMS providers rely on volunteers for EMT-Intermediate or EMT-Paramedic staffing and over 70% report having difficulty in recruiting volunteers.

The statistic that is most injurious to rural emergency medical services is the demographic of rural Oklahoma. Oklahoma’s rural population is older, poorer and less healthy than urban Oklahoma. Therefore, when an ambulance call is made in rural Oklahoma, it is less likely that the patient is privately insured or can afford to pay for the services rendered. That “uncompensated care” is often the straw that breaks the back of a rural ambulance service.

There is a solution. If Governor Stitt, in some form or fashion, would accept federal Medicaid funds, $2.3 Million PER DAY would go to Oklahoma hospitals and ambulance services, thus preventing hundreds of Oklahoma EMTs, nurses and medical personnel from losing their jobs. It would not only sustain medical care in rural areas but also roll those dollars many times over through Oklahoma’s economy.

Rural Oklahoma is important to our state and residents and visitors there need “angels” just as urgently as do urban areas.

            Questions or comments, contact David.Perryman@okhouse.gov or 405-557-7401.

Who You Gonna Call?

Who You Gonna Call? - October 25, 2015

State Representative David Perryman

                In the 1984 film, Ghostbusters, Dan Aykroyd introduced the world to the Ecto-1, a 1959 Cadillac “combination car” that was large enough to carry the ghostbusters and their “proton packs.”

                Ecto-1 was called a combination car because it and other like vehicles were long, high-roofed “professional cars” that doubled as hearses and ambulances. In fact, until about 45 years ago, many “ambulances” were operated by local funeral homes in communities where people would joke about the “conflict of interest” posed by an ambulance driving undertaker!

                With the advance of medical science and the recognition that minutes matter when patients are experiencing heart attacks and strokes, communities in all areas of the state focused on ways to couple qualified emergency medical personnel with well-equipped ambulances that would respond to a medical crisis on a moment’s notice.

It soon became apparent that while urban ambulance services readily cash-flowed, ambulance services in areas of sparse populations could not exist solely on ambulance service billings and receipts. Population was not the only problem, higher poverty rates in rural areas meant that a large number of users of rural ambulance services were Medicare and Medicaid patients and many could not pay at all even though the law required the services to be rendered.

In 1976, the citizens of Oklahoma passed State Question 522, by a vote of 54% to 46%, authorizing the creation of Ambulance Districts. The constitutional amendment allowed a community or a group of communities to levy a 3 mill AdValorem tax to help fund an ambulance service. The millage was never intended to provide enough money to equip, man and operate an ambulance service. Instead it was intended to subsidize the ambulance service billing revenues to keep the service in the black.

Today, the cost of operating an ambulance service continues to rise as equipment is more expensive and there is a shortage of trained EMTs. Also detrimental is the phenomenon of “uncompensated care” or that care that is provided to those persons who do not have insurance and are not covered by Medicare or Medicaid.

Rural ambulances are required to care for all patients in their times of crisis and therefore they encounter a few patients who can pay the full rate in cash; a few who are insured and the insurance company has negotiated a relatively low rate; a number of Medicare and Medicaid patients that are not liable for anything above the deeply discounted reimbursement rate set by the federal government; and those who have no insurance and cannot pay any amount.

Rural ambulance services that do not have dedicated sales taxes or other tax revenues to further subsidize the system are closing their ambulance services at an alarming rate. More than 50 rural ambulance services have shut down in the past 12 years, two as recently as this month.

Governor Henry’s 2007 Task Force recommended that the 3 mil cap on levies for ambulance operations be raised. No action has been taken on that or any of the other suggestions made by the task force.

Today, in the absence of help from the state, cash strapped communities that are already subsidizing ambulances are forced to increase sales taxes to keep ambulances rolling.

There is a solution. If Governor Fallin would accept federal Medicaid funds, $2.3 Million PER DAY would go to Oklahoma hospitals and ambulances and prevent hundreds of Oklahoma EMTs, nurses and medical personnel from losing their jobs. It would not only sustain medical care in rural areas but also roll those dollars many times over through Oklahoma’s depressed economy.

Without your ambulance service, it doesn’t matter who you’re gonna call. It matters how far they have to drive to get there.

Libraries, Fire Departments, etc.

Last Thursday, December 27, was the deadline for submitting substantive language on the bills that are to be introduced in January for the First Regular Session of the 54th Oklahoma Legislature.  Last week I discussed two education bills that I have been working on and this week I would like to discuss four bills that will provide enabling legislation to allow rural communities, municipalities, school districts and counties to address needs in their particular jurisdictions.