Critical condition: The fight to fix EMS in Dutchess County

Story reprinted courtesy of The New Pine Plains Herald

POUGHKEEPSIE — “Over 400 times last year, an ambulance never got to the patient’s side; the patient had to get to the hospital another way,” said Dana Smith, commissioner of Dutchess County Department of Emergency Response (DCER). “What’s happening is unacceptable, and we need to do something about it.”

The critical state of Emergency Medical Services (EMS) in Dutchess County is sounding alarms among local and state officials. On March 7, Smith presented an eye-opening report before the county’s Public Safety Committee that indicated the crisis is part of a broader statewide issue. He reported that across New York, only half of the 70,000 certified EMS personnel are regularly available to answer calls, and that 30% of them plan to leave the force over the next three years due to the strenuous nature of the work and insufficient compensation.

County Legislator Chris Drago, who represents District 19 (Stanford, Pine Plains, Milan, Red Hook, North East and Millerton), is one of 12 members of the Public Safety Committee. Elected to his first term in November, he campaigned on EMS reform.

“Our EMS volunteers are doing incredible work; they’re asking for help, and that is hard for them to do,” said Drago. “We owe it to them to find solutions.”

A well-documented crisis

In his March 7 presentation titled “The EMS Crisis in Dutchess County,” Smith referred to three studies that analyzed EMS operations, documented failures and proposed fixes. “All the recommendations that we’re talking about, that we’ve done to date and our plans moving forward, come from these reports,” he said.

The 2017 Dutchess County EMS Task Forces, spearheaded by then-County Executive Marc Molinaro and a panel of 28 experts, produced a data-intensive report that established five benchmarks for the system: It must be “patient-centered, consistent, reliable, affordable and sustainable.” The task force recommended the formation of the Citizens Advisory Committee (CAC) on EMS to aid collaboration between towns and emergency service providers. The CAC, established in 2018, works closely with Smith, who said, “These are competent, capable people advising us; they know what they’re talking about.”

The 2021 Profile of Dutchess County EMS and Options for the Future is also rich with data, like 911 calls enumerated by town, season, month, week, day and hour. The study proposed incentives like tax credits and subsidized training to attract and keep EMS workers. It also advocated a regional approach to EMS in which towns would share costs of equipment and personnel, and the county — after obtaining a state-approved county Certificate of Need— would provide extra ambulances to fill in gaps.

The New York State 2023 Evidence Based EMS Agenda for Future made more than 20 key recommendations, including declaring EMS an essential service to assure dedicated state funding; adding 10,000 certified EMS providers in New York by 2025; and implementing measurable performance metrics that would be transparent to the public and standardized across the state.

“With the results of these studies and advice from the CAC, our plans are being made for the future,” Smith told the legislators. “The county has to come up with stopgap money right now. We’re looking at how to do that.”

Smith believes that the answer to fixing the county’s troubled EMS system lies in regional management. “It will help the taxpayer without putting small ambulance companies out of work and standardize the system so every town is doing the same thing,” Smith said. “It will give us time to figure out long-term funding.”

Two months ago, Smith distributed surveys to ambulance service providers in Dutchess County, seeking input about supplementing existing EMS coverage. “This way we’ll know where to place stopgap ambulances,” he said. Survey responses, due this month, will shape a formal proposal for extra ambulance service units under the direction of DCER.

“We’ve looked at Greene, Columbia and Montgomery counties,” said Smith, who is investigating different EMS models around New York. “We’ve seen Nassau County’s EMS: They spent a lot of money and they have a very fragmented system, I wouldn’t recommend it.”

Lawmakers beginning to act

With EMS stretched to its limits, elected officials, both at the county and state levels, are taking steps to help. The Public Safety Committee, DCER and Dutchess County Executive Sue Serino are working together on long-range regional EMS planning that would address each community’s needs.

Drago told the Herald, “In the short term, I’m advocating for county-staffed ambulances to be placed to supplement existing service, with one ideally placed in District 19. This will help alleviate the struggle that exists town by town and ensure we have a way of getting people to care faster.”

The 2024 Dutchess County budget includes a sales tax increase from 3.75% to 4%, in part to subsidize EMS. It has yet to be approved by the state.

Gov. Kathy Hochul signed legislation last year to make it easier for ambulance services to get paid: Reimbursement will go directly from the health insurance company to the EMS provider. Mark Browne, president and chief operating officer of Northern Dutchess Paramedics, said: “It used to be that payment went to the patient, making it more difficult for ambulance companies to get their money. It took a lot longer than it should have. Unfortunately, this change won’t even take effect until January of 2025.”

Hochul’s 2024-2025 proposed executive budget sets aside $8 million to revitalize the state’s EMS and $36 million toward improved Medicaid reimbursement for ambulance transport. It also grants Certificates of Need for county ambulance service, as recommended by the 2021 Dutchess County EMS study.

On Jan. 30, the New York state Legislature, in cooperation with EMS professionals and the New York State Association of Counties, released a package of bills called Rescue EMS, which contains seven proposals to revamp the system. “We are all aware that we need to help the emergency service [workers]” said Didi Barrett, assemblymember for New York’s 106th District, which includes parts of Dutchess and Columbia counties. “They put themselves in harm’s way every day. Finally, there’s enough critical mass in the legislature to get something done.”

Rescue EMS covers a wide variety of needs. The proposals are described by Barrett as “game changers.” One bill, if passed, would recognize EMS as an essential service, securing state and federal funding. It would also allow the creation of special tax districts to subsidize EMS services.

Barrett’s proposed legislation would allow volunteer firefighters and EMS workers to claim both state income and local property tax credits. “It will incentivize volunteer firefighter and EMS recruitment and retention,” Barrett said.

State Sen. Michelle Hinchey, who represents New York’s 41st District (which includes Northern Dutchess and Columbia counties, and portions of Ulster and Greene), is sponsoring a bill that provides Medicaid reimbursement for on-the-scene emergency care and ambulance transportation to non-hospital destinations, like urgent care centers and mental health facilities. It also would provide funding for telemedicine.

“Currently, EMS can only be reimbursed for treating Medicaid enrollees if they transport patients to a hospital ER, even if EMS has already provided the necessary care,” Hinchey told the Herald. “We cannot allow this status quo to continue.”

The remaining bills focus on funding and increasing the emergency workforce. Proposals include removing EMS from the property tax cap so towns can raise taxes more than 2% annually; increasing personal income tax credits for volunteer firefighters and ambulance workers from $200 to $800 for individuals and $400 to $1,600 for joint filers; creating a way to increase the amount of Medicaid ambulance reimbursements paid; and dispensing with tolls for emergency transport on New York thruways.

Lawmakers on both sides of the aisle are pushing for the Rescue EMS package to be included in the state budget, which is due April 1.

DCER supports the legislative package. “The bills address the major roadblocks faced by EMS; it’s a good start,” Smith said. “We still have a lot of asks, so we’ll just keep advocating. EMS needs recognition and support. We need to develop solutions that are patient-centered, consistent, reliable, affordable and sustainable for Dutchess County residents. It’s neighbors helping neighbors.”

This is the second article in The New Pine Plains Herald’s two-part exploration of the challenges facing local EMS systems, reprinted with permission of The New Pine Plains Herald. To see the first part in the series, visit www.newpineplainsherald.org