BILLINGS — Ambulance providers are suffering in Montana.
Rising care needs and rising living costs are putting a pinch on emergency medical services and providers are taking more calls than ever while seeing fewer applicants to keep up.
Industry leaders started a conversation during a Monday meeting on how to handle the crisis.
"This child restraint system so we can safely restrain a child while riding in the ambulance is $1,000. It's just webbing and hooks," said Beartooth EMS Joel Kelm, demonstrating just how expensive operating an ambulance is.
Kelm then showed off his vehicles' new self-propeled gurney lifts, which can safely hold up to 760 pounds on the back of the ambulance. The price tag?
"About $41,000," Kelm said. "It's very hard to make that up."
It’s hard because the U.S. government’s two primary healthcare systems — Medicare and Medicaid — usually don’t come close to covering a patient call, often paying more than 30 percent below operating costs. And that’s only if the critical care providers actually transport the patient somewhere.
"Let's say out of 100 people there are 25 people we didn’t transport - they just needed some first aid or basic services," said Lyndy Gurchiek, director of the Laurel ambulance service. "We don’t get any money back from those calls."
Some may think, hey that’s great, a way to game the system: get licensed care without paying for anything. But now the ambulance service eats that cost, which means they can’t afford to pay their workers as much.
"An EMT starting wage in this area is anywhere from $12-16 an hour," Gurchieck said. "And literally you can go to Taco Bell right now and make more money. Every manager I talk to wants to pay more to these people that deserve more, but there’s no funding."
And that was the real reason for Monday’s meeting at the Beartooth offices. Ambulance directors and related officials across Montana gathered in person or on Zoom - Senators Jon Tester and Steve Daines even sent representatives. Unbeknownst to most, EMS services are not considered essential in Montana.
"Ultimately, that means that when someone calls 911, or calls for a transport, someone may not show up," Kelm said, "and subsequently, it means we don’t get the grants, we don’t get the funding."
The group’s main goal is to craft a white paper, an explainer document often used to start legislation. They hope to develop the framework at meeting No. 2 on Nov. 15. In the meantime, their leftover expenses are getting paid two ways: by you...
"If I bill $1,000 to Medicaid, and all I get as a reimbursement is $260, and I need $1000 to operate, I have to get the $700 someplace else," said Bir Horn Country ambulance director Daniele O'Banion.
..or by themselves. “I give up my paycheck a lot," Kelm said, "to make sure staff are paid and to keep the doors open, keep serving our hospitals."
But when that runs out, the much bigger problems start.