State taskforce looking to solve EMS staffing and funding crisis

[GUITAR MUSIC] CATHY WURZER: In other news, a new state legislative task force is meeting today to address a crisis facing emergency medical response in rural Minnesota. Ambulance services in Minnesota respond to nearly 715,000 calls for service every year, and that is rising.

Since COVID, demand for emergency medical workers is way up when a workforce shortage is becoming dire. The state legislature is intervening with the emergency medical services task force, established late last year. The legislature wants to hear from both the EMS and the public, holding hearings across the state, including one today in Elbow Lake, Minnesota. That's where Dylan Ferguson, the executive director of Minnesota Emergency Medical Services Regulatory Board is joining us today. Dylan, thanks for the time.

DYLAN FERGUSON: Absolutely. Good afternoon, Cathy.

CATHY WURZER: Tell us about what's happening in Elbow Lake today.

DYLAN FERGUSON: So here in Elbow Lake today is actually the third meeting of the legislative EMS task force. This particular task force is made up of representatives and senators from both parties and from both chambers of the House and Senate. And throughout this process, they have been gathering information, taking public testimony, hearing from ambulance service managers and directors directly, in addition to hearing from local officials, as was a really key tenant of the task force meeting that was held up on the Iron Range just before the holiday.

CATHY WURZER: Give us a sense of some of the issues that EMS services are facing in rural Minnesota.

DYLAN FERGUSON: So in terms of rural Minnesota, and to a lesser extent but still important in the Metropolitan area, ambulance services are facing a double challenge related to available workforce and available funding.

So specifically with workforce, we see that when we compared certification numbers for calendar year 2023 versus 2022, we found that the number of people who are leaving the EMS field by their certifications expiring is up 21%. The problem that goes along with that is that the number of new EMS providers that were bringing into the system for the first time is down almost 26%.

If those numbers weren't concerning enough, when we take a look at our emergency medical technicians, which are truly the backbone of our statewide EMS system, we saw 1,360 of them hang up their certifications in 2023. Half of those were under the age of 30 years old. And 68% of those were under the age of 40. So we're running into challenges in being able to retain our newest and our youngest future prehospital professionals.

CATHY WURZER: What do you think's going on? We have to say, of course, that EMS is one of the toughest jobs, right? You see all manner of terrible things. You're always dealing with death and suffering. I can imagine the burnout rate is probably pretty high.

DYLAN FERGUSON: So that is a common misconception as it relates to EMS. Certainly, there are components of that to the job, absolutely without question. But really, EMS providers have an opportunity to be able to interact and to be able to serve the public on a daily basis. And it's not always life and death emergencies. That's why one of the things that EMS educators often say is that EMS providers are trained for what they may need to do, not necessarily what they do on a daily basis.

Certainly, it could be a traumatic accident. But also, sometimes it's holding someone's hand and getting them to the hospital and getting them to that next chain of health care. But in terms of what we see driving this, at the EMSRB, we actually conducted a survey of individuals who had let their certifications expire. And we surveyed almost 21,000 EMS providers who had left.

And we found that the top issues that influenced their decision to depart the field, number one, related to low pay and compensation. But the other influencers that we saw really related to the culture and the leadership of the organization that they work for. But also, that mental health and that burnout component that you had mentioned, Cathy.

CATHY WURZER: So let's talk about funding here for just a minute, Dylan, because I think many people figure, well, EMS, paramedics, they're paid for by the local fire department perhaps or the local hospital system. Is there something about the reimbursement system that's just not working anymore?

DYLAN FERGUSON: I think that that's a fair question, and I think that's one of the questions that the legislative task force that's being led by Representative John Huot and Senator Judy Seeburger are really taking a look at. But when we take a look at the funding mechanisms, 93% of the revenue that a Minnesota ambulance service relies on is coming from health insurance payments, whether that's a third-party insurer, like Blue Cross Blue Shield, or Medicare from the Federal government or Medicaid from the State of Minnesota.

So when we take a look at that 93%, we saw that in an analysis and a survey of all the state's ambulance services that health insurers were billed a collective $1.2 billion in calendar year 2022. Yet, ambulance services only collected about 50% of that at about $450 million.

So that means that 72% of Minnesota ambulance services reported some level of financial loss. And this comes at a time where we're seeing escalating operational costs for EMS services, not only across the state, but across the country, with having seen those costs increase anywhere from 55% to over 150% since 2010. So those are some of the financial challenges that ambulance services across the state are facing.

CATHY WURZER: So you have increased costs and your client base, the population is aging. So there are more health problems you're probably called to assist with. And as you know, when someone calls 911, you expect someone's going to be sent out to help you. Are you comfortable saying, are there enough EMS personnel to cover service areas, or not?

DYLAN FERGUSON: No, I absolutely think that there is a marked need for lots of individuals who have an interest in health care and who have an interest in serving their communities and making a difference. And the Minnesota legislature in the last term, recognizing the need to support EMS workforce, did pass a couple of initiatives that are just starting to get off the ground that we're really excited about and happy to be working in partnership.

There was funding that was allocated to the Minnesota Department of Education to help fund emergency medical technician and first responder courses in Minnesota high schools. And in addition, there was funding appropriated to support 400 scholarships to the Office of Higher Education to support existing EMTs who wanted to upgrade to our highest level of prehospital care paramedic. And those programs are just getting underway, and we're excited to see what type of impact those can have as we work to try to use levers at all levels of government to increase that EMS workforce.

CATHY WURZER: So those are those efforts, and then, as you say, there's obviously this funding piece that needs to be looked at, which sounds like that is another story for another time. Dylan, I appreciate your time here this morning from Elbow Lake, Minnesota. Take care of yourself.

DYLAN FERGUSON: Thank you, Cathy.

CATHY WURZER: We've been talking to Dylan Ferguson, who's the executive director of the Minnesota Emergency Medical Services Regulatory Board.