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Changing the EMS System

The Viewpoint from
the Ambulance
Driver's Seat

Mickey McCabe
By Mickey McCabe
President, Medical Transportation
Association of New Jersey

More than two years ago, the State of New Jersey set out to study, analyze and implement improvements to our EMS system that cares for hundreds of patients daily. The recommendations are far and wide but one thing is for certain: the work of the New Jersey Department of Health and Senior Services and the state Legislature to improve the EMS system is only the beginning. A level playing field for ambulance services providers must be created and protected. Reimbursements that do not come close to covering costs or are split between ALS and BLS providers need to be addressed. Certainly, detailed consideration must be given to any decision to legally mandate EMS services in all New Jersey communities.

The Medical Transportation Association of New Jersey has a diverse membership that includes private for profit and non-profit companies, as well as hospital based and municipal providers, which makes arriving at a consensus interesting on some issues. The mandate for ensuring EMS coverage in all communities is not one of those issues. In a survey of members, this is one recommendation of the 2007 EMS study about which the respondents were most strongly in agreement. But the devil is in the details.

EMS working on a person in a strecher

At any given moment across New Jersey when 9-1-1 is dialed for help in a medical emergency, ambulance providers, whether they are public or private or members of a volunteer or paid EMS Squad, arrive at the location of a patient in need. Despite the fact that EMS services are not mandated under state law, as are fire and police services, New Jersey residents expect to receive the EMS and medical transportation services they need.

This expectation does not take into account the realities facing the medical transportation system or the diversified providers who keep patients moving daily. Well before the financial market took a dive and the housing market crumbled, the medical transportation community was feeling the financial affects of higher costs and lagging reimbursement. Complex payment models for ALS and BLS combined services; Medicaid reimbursement rates that cover only a fraction of costs; and rising costs of gas and insurance coverage to operate an ambulance dominated the daily problems affecting the EMS community.

The costs incurred in our communities could fluctuate depending upon the patient community make-up. For example, a community with a higher Medicaid population would be at an inherent financial disadvantage as opposed to a community with a higher volume of patients with private insurance. Communities with more Medicaid patients would need to close the gap in payments for un-reimbursed care which is undoubtedly significant.

Private ambulance providers supplement or provide all EMS coverage for communities from Millville to Hammonton to Bayonne. The costs to each municipality using private or non-profit providers currently vary depending upon the volume of EMS calls and make-up of the EMS squad. For instance, many volunteer EMS companies do not bill private insurance companies for reimbursement whereas private EMS providers are more likely to seek compensation. Given the state of municipal finances, it is prudent to consider third-party reimbursement so as to not put additional cost burdens on residents.

The potential effects of legally mandating EMS are numerous and complicated. Multiple delivery options need to be weighed when moving toward mandating EMS in all communities and implementing other changes in the system. The EMS Council has worked to make legislative recommendations that will impact New Jersey’s diverse medical transportation industry.

Providers stand ready, willing, and able to work with their communities to make sure people receive the EMS help they need. And when we are done with our day’s work we are just as ready, willing, and able to answer the call to work to foster significant and needed improvements in the EMS system.


Mickey McCabe is President of the Medical Transportation Association of New Jersey and President of McCabe Ambulance Service of Bayonne. Mr. McCabe also serves as Hudson County EMS Coordinator and Vice-Chair of the NJ EMS Council.



This article was originally published in New Jersey Municipalities magazine. Vol. 86, No. 5, May 2009


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