HUDSON - Last week, the Greenport Rescue Squad in Columbia County rushed to a diabetic's home after his family called to report that he had lost consciousness.
EMS personnel obtained a blood sample showing the man's blood sugar was "dangerously low," according to Greenport Rescue Squad Executive Director Aidan O'Connor. They started an IV and the patient regained consciousness, but the rescue squad was not done.
"We were there for nearly one hour assessing the patient, answering questions, making a peanut butter sandwich, calling the doctor and making sure the patient is safe and healthy," O'Connor said.
However, the patient, who was on Medicaid, did not want to go to the hospital. Therefore, everything about the response - the IV fluids, the gas for the ambulance, EMS personnel's time - was not reimbursed.
About 30% of all EMS responses in New York do not result in a patient being transported to the hospital, according to Jeffrey Call, the former chair of the United New York Ambulance Network. Since about 43% of all New Yorkers are on Medicaid, this punches a significant hole in rescue squads' budgets.
On Friday, EMS leaders gathered in Columbia County to advocate for a bill that would end this practice. The bill unanimously passed the state Senate and Assembly earlier this year, and its sponsors, state Sen. Michelle Hinchey and Assemblywoman Anna Kelles, are pressing Gov. Kathy Hochul to sign it by Sept. 30 so the law will take effect this year. If Hochul signs it after the 30th, the law will not take effect until Oct. 1, 2025.
Call said ambulance services could have more breathing room if they received reimbursements from Medicaid calls where there was no hospital transport, freeing up money for more equipment, and to recruit and retain staff. The average EMS technician in New York state makes $22.23 an hour, according to Indeed.
County and municipal governments, who must make up part of the revenue lost from Medicaid calls, would also benefit from the bill, according to Call.
The bill would also provide more options for EMS crews trying to help patients. Some patients need to go to a mental health facility or an emergency clinic, and the bill would allow Medicaid reimbursement for these transports. The bill would allow EMS crews to keep patients at facilities in their communities.
"Not everyone needs to go to the ER," Hinchey said.
The best place to take a patient "might not be the hospital" because of increasing wait times at emergency rooms, O'Connor said.
Extended wait times at emergency rooms are a national problem felt particularly strongly in the Capital Region. The average wait time at Albany Medical Center is the longest in the state and is two hours and 22 minutes longer than in 2016. Paramedics must wait with patients at ERs until they are seen, making them unable to respond to other calls. EMS crews must also sometimes transport patients long distances to be seen when local ERs are full: Hall said patients sometimes had to be transported from Watertown to Westchester Medical Center, a distance of more than 300 miles, "because hospitals are so overtaxed."
The opioid crisis has also taxed EMS services. When a crew receives a call for a suspected overdose - calls that rarely come from the person overdosing - the crew responds and administers the overdose reversal drug Narcan, according to Call. When the patient is revived, they almost always refuse to be transported to a hospital. If the patient is on Medicaid, there is no reimbursement for the call.
The bill's sponsors represent mostly rural areas of upstate New York. Kelles said EMS services were especially critical in these areas, since hospitals can be more than an hour away, and patients sometimes have to be cared for in place.
O'Connor told a second story at Friday's news conference: a 13-year-old fell off a swing set at a rural playground. When the EMS crew arrived, it was obvious the child needed stitches, but the mother, with tears on her face, had to tell paramedics she did not have enough gas to follow the ambulance to the hospital, nor enough money to afford the parking fee there.
The hospital was 50 minutes away, while an emergency clinic was 15 minutes, O'Connor said. With the new bill, EMS crews would not have to take into consideration reimbursements when making this decision.