GREENVILLE — Ambulance services are facing difficult decisions with the ever-rising costs of healthcare. Among them is Spirit Medical Transport of Greenville.
Spirit Owner/Operator Brian Hathaway invited State Representative Keith Faber (R-Celina) to tour his facilities Friday to discuss the challenges his business is seeing. Joining Rep. Faber on the tour was his nephew, Travis Faber, who is seeking to be elected to his uncle’s seat in 2018 as the elder Faber seeks election to the office of Ohio Auditor.
Much of the difficulty for ambulance services revolves around bureaucratic red tape and insufficient Medicaid payments for services. For Spirit, the biggest hit financially is the lack of reimbursement from Medicaid.
On a transport of a Medicaid patient covering only three miles, Hathaway said Spirit is losing approximately $64 per run. As the distance of the runs increase, so too does the loss. A Spirit transport to Dayton of 35 miles loses the company $96. A trip of 100 miles to Cincinnati or Columbus means Spirit is out $162.
“This doesn’t even factor in my overhead costs,” said Hathaway, who noted the company lost approximately $5,000 last month providing the service to local nursing homes.
The result is Spirit may be forced ultimately to stop providing its service to Medicaid patients, and may also drop wheelchair van service in its entirety.
“We do make money if we were to transport a [wheelchair] patient. We make $6.14 if we were to transport a patient to Cincinnati or Columbus, a hundred miles, but again we’re only able to take care of two or three people a day,” said Hathaway.
Another problem is hiring potential employees. Hathaway said it takes two years for an individual to obtain his or her paramedic certification at significant cost, but the resulting pay is not attractive. Currently, he says his business is understaffed to handle the number of patients in the area and paying overtime to those already employed because of staff shortages further cuts into profitability.
“$30,000 every two weeks for overtime right now is very, very expensive, especially at the losses we’re taking on 30 percent of our business,” said Hathaway.
Rep. Faber said that while legislative solutions in the near term are now hard to come by with passage of the state’s bi-annual budget, he, if elected state auditor, would work administratively to ease red tape and concentrate on rooting out fraudulent businesses which further tax an already strained Medicaid system.
“My approach is to look more systemically about what we can do to improve the quality of transport at a lower baseline cost,” said Faber.
“From our perspective, we’re trying not to curb the quality side,” added Hathaway. “At the same time, there’s a push to do more with less. What we’re trying to do is lower those costs so it’s not as impactful as the loss we’re already taking.”
Also in attendance Friday was Lauren Huddleston, executive director of the Ohio Ambulance and Medical Transportation Association, who says since 2011, 29 medical transport providers licensed in that year are no longer operating in the state.
While she wouldn’t speculate on the number of providers that may be forced out of business in the near future due to unreasonably low Medicaid reimbursement, she said service “deserts” have already developed where providers have closed their doors or are no longer able to provide transports to certain facilities due to the losses incurred.
Huddleston also pointed to vetoes by Governor John Kasich of certain items in the 2015 bi-annual budget which might have provided some relief. These include a 10-percent ambulette medicaid reimbursement increase, a fuel surcharge, and a single form denial for dual (Medicare and Medicaid) eligible patients.
“While the provisions vetoed by the governor certainly would not have made these medical transportation providers whole, they would have been a positive step in the right direction and acknowledgement of the difficulties faced by our industry,” she said. “Our members are realistic that after over a decade of stagnant Medicaid reimbursement rates and an ever increasing regulatory burden, improvements in the health of the industry will not happen overnight and will require a long term strategy and years of gradual improvement.”
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