Rural Ambulance Services in Oklahoma Say They Face Crisis

Financial hardships have led 50 rural ambulance services to shut down in Oklahoma since 2000, including three that closed this year alone.

“The model we set up is collapsing,” said Shawn Rogers, the state Department of Health’s emergency services director.

Shrinking tax bases, low Medicare and insurance reimbursements, and a state law requiring the closest ambulance to respond to an emergency have hurt these businesses.

Counties and municipalities in Oklahoma are not required to provide emergency medical response. Oklahoma law requires that the nearest ambulance respond to a call if a neighboring area does not have one to dispatch.

Bob Hawley, EMS director for LeFlore County, said his ambulance service often responds to calls outside his county in communities that have no emergency medical service. Recouping the money lost is difficult if not impossible, he said.

“Nothing is going to change in rural Oklahoma as long as communities can hide behind this rule,” Hawley said.

Hawley said Medicare reimburses about 27 percent less than what it costs him to make a run. He must make $624 per ambulance call to break even.

Oklahoma EMS Coalition Chairman Ron Feller said many take ambulance service for granted and some don’t know whether their area has service.

“Do you really want to carry around a map so you know where you have ambulance service?” he asked.

Last year the state Legislature approved a bill to create a revolving yearly fund with up to $2.5 million per year for emergency medical services development. The money could help some rural ambulance providers restructure their services and train professionals. But this money may not be enough to help other services on the brink of collapse, Rogers said.

At Parkview Hospital in El Reno, the cost of ambulance services has created major budget problems.

Several top executives of the hospital have resigned and Quorum Health Resources Management Company has been retained at $30,000 per month to sort out the problems.

“We’re unique because … the ambulance service is run out of the hospital, and that’s kind of a dying breed,” El Reno Mayor Matt White said. About 40 ambulance services in the state, or 25 percent, are operated by hospitals.

The problems started in 2006, when hospital officials asked the city of El Reno for a $250,000 subsidy to continue operating three ambulances, Parkview chief executive officer Lex Smith said. That jumped to $300,000 for 2007 and 2008. The service still costs the hospital up to half a million dollars in annual losses.