Many emergency medical service agencies in Wyoming are struggling financially. Most have found ways to make ends meet despite rising costs and more complex expectations. But communities may have some difficult conversations ahead about how to pay for what many consider a necessary service. Madelyn Beck, a health and public safety reporter for WyoFile, just published a three part series called “A Critical Call,” looking into the state of EMS agencies in Wyoming.
One way Beck says the public can help is to learn CPR, and stock public spaces with defibrillator machines. Or, if you’re able, consider volunteering for your local EMS agency.
Editor’s note: This transcript has been lightly edited for brevity and clarity.
Nicky Ouellet: Right now, is there anywhere in Wyoming where if I were to call 911 because I had a medical emergency, nobody would respond?
Madelyn Beck: Hard to say. Right now, there are so many areas that are so far out there, I'm not aware of any pocket of the state where just nobody would respond ever. But what we're seeing is increasingly strapped EMS agencies, so it's becoming increasingly hard to respond to certain areas.
There are plenty of locations where it would be expected that an ambulance on the road would take 20, 30, 40 minutes to get out to these rural locations. The vast majority of the state is outside of the 30 minute response time.
NO: And that's a time when every minute counts. Taking that ambulance ride typically comes with a pretty hefty bill. But at the same time, these ambulance services are struggling financially. Can you kind of break down that math?
MB: The problems come from multiple different directions. We're seeing ambulance costs go up, gas costs go up, costs of living going up. Trying to pay someone who's an EMT in Cody, it's gonna start costing more. And then you have health insurance costs going up, you have medical supply costs going up, all of these costs going up. While at the same time, you see major payers like Medicare and Medicaid, their reimbursement rates have largely stagnated. And that is for, of course, the patients who even have insurance.
The problem is in rural Wyoming, there's simply not enough people who have reimbursable rides, or reimburse enough money for those rides, to pay for your 24/7 crew or your ambulance.
NO: One of the stats in your story, it would take 600 trips a year to break even for an ambulance with basic life support.
MB: Yeah, more than 600. It's about 650 for a basic life support ambulance. We're not talking about the advanced life support ambulance that you might need for that older patient who has critical care issues.
So you have all these different challenges. And at the same time, you have decreasing volunteerism. If you have fewer volunteers, obviously you're going to have to hire people if you want a 24/7 crew to respond when you call 911. So it's complicated math. And I should say, EMS agencies run out of a variety of systems. They run out of hospitals. Some of them are private. Some of them are funded by local government, or partially funded by local government.
The way EMS has formed across the country is a relatively new idea. We're talking late ‘60s, early ‘70s when we started to see any sort of formalization of these systems. We really only started funding them as a transport service to a hospital.
NO: An expensive taxi.
MB: Yeah, it's a hospital Uber. The initial idea was these should be self-sustaining. But we as a society have collectively asked them to step up what they are able to do for us. And by doing so, we have saved more lives. Major incidents have become more survivable. That said, while we've asked them to step up, funding for them has not stepped up.
NO: You looked at a bunch of different ways that we could address this. One way is for the state to declare EMS an essential service. Lawmakers considered this back in 2023, but they nixed the idea. What would that designation mean?
MB: This is the idea that we should tell counties or towns that they have to provide EMS. The challenge there is a lot of people see it as a potential unfunded mandate. So if I come in and say, ‘Hey, Albany County, hey, Laramie County, you now have to provide EMS service.’ If they hadn't been putting in that money before, now that money comes out of something else. And so what ends up getting cut to make room for EMS? And a lot of people say, ‘You know what? It's necessary. EMS is life saving.’
NO: Yeah, I think that there's a real expectation that this is a service that will be available to you if you call.
MB: Right, and I think a lot of people still expect that, even if it's becoming increasingly challenging to provide that. AARP just recently released a survey of adults around Wyoming, and two-thirds reported that they are not very, or not at all, concerned about their ability to access emergency medical services. So it's how do you convince people to even want to support it more if they don't think there's a problem?
NO: One of the other strategies is consolidation. That's something that towns in eastern Carbon County have been trying out since 2009.
MB: Regionalization is another sticky topic because, one, you can have consolidated billing, right? You can bill out of one office and have one person doing that for an entire area. You can have some economy of scale there. The concern then comes if, for example, up in Star Valley, there are communities that benefit from their regional EMS now that it's consolidated, that not all communities that they serve pay into it an equal amount. Then you have, okay, I've taken up a larger area. Now, more areas may or may not pay. And then you have a larger area that if that now larger EMS agency fails, that's more communities at risk. So consolidation has worked for a lot of communities and has a lot of benefits if it can be worked out given certain community dynamics, but there's challenges with it too.
NO: The governor's office has suggested a different tack: community EMS, basically allowing home visits from an EMS agency that would be reimbursed similarly to how an ambulance ride is.
MB: The challenge with a lot of it is that you may be able to convince some insurances to pay for this, but when you look at federal reimbursement levels from federal insurances, they often are not reimbursing for that service. If I just go to your home because you fell, and were scared and had a panic attack, and I'm in an ambulance and I respond and we sit with you and make sure you're okay, and you are able to get back down and feel better and don't need to go to the hospital. All of that time that I spent with you, the miles that I put on the ambulance, that is all unreimbursable.
I think you see the Centers for Medicare and Medicaid Services are looking at that as a potential solution, but some of their trial runs have been unsuccessful. It hasn't raised enough money.
NO: What surprised you or stuck with you the most from reporting this series?
MB: I think what's stuck with me the most has been how precarious of a situation we currently find ourselves in. I think it's hard to know when you only call 911 for an emergency that that system is struggling. How would you know? You just expect them to get there as quickly as possible. So I think seeing the challenges that are so widespread and there are so many of them that are impacting EMS, and how few people understand the challenges they're facing. I think those are the things that stand out for me.
