It’s more important than ever for local governments to step up and help emergency medical services remain viable, Lancaster EMS Executive Director Bob May told Lancaster City Council Tuesday evening.
Under current payment models, “EMS is not sustainable,” he said.
Every year, May makes the rounds of Lancaster EMS’ core footprint — the 18 municipalities where it provides basic life support services — to ask for funding. (It provides advanced life support in three more municipalities, for a total of 21.) Each community is asked for a contribution based on its share of 911 runs; added up, the requests total $695,903, or about 3.7% of the nonprofit’s $19 million budget.
For 2025, May is asking Lancaster for $327,052, the same amount requested since 2022. The city last raised its contribution in 2017, increasing it from $65,000 to $150,000, where it has remained for eight years.
The bulk of Lancaster EMS’ revenue, about 82%, comes from payment for ambulance runs and other services. The problem is that those reimbursements don’t cover the full cost of operations. A typical ambulance run costs about $600, but Medicare pays about $450 and Medicaid pays just over half, May said.
In some cases, no money can be recovered. Add it all up, and Lancaster EMS recovers just 39 cents for every dollar it bills for its city runs. Overall, the organization expects to write off $1.4 million in bad debt this year.
The same fundamental imbalance is driving an EMS crisis regionally and nationwide, he said. Providers are in “dire straits,” he said, and many are closing their doors.
Many, like Lancaster EMS, are seeking more financial support. In June, representatives of the nonprofit Manheim Township Ambulance Association asked township officials to begin providing $250,000 annually toward its operations, starting in 2025.
“Costs are going up and funding is going down,” the association’s treasurer, Kathy Barone, said. The association responds to 7,000 emergency calls a year on a budget of $2 million and recovers about 40 cents of every $1 it bills.
Others are reinventing themselves. In northwest Lancaster County, six municipalities set up the Municipal Emergency Services Authority, which has the ability to assess annual fees on properties in its service area.
Refresh Lancaster scales back
Among Lancaster EMS’ services is its Community Paramedicine program, which provides on-site checkups and preventive care to medically vulnerable populations.
The program includes the Refresh Lancaster shower trailer, which offers hygiene and basic medical care to homeless individuals. It is funded through the Lancaster County Homelessness Coalition and is believed to be the only shower trailer currently operating in Pennsylvania.
The trailer had been making weekly stops in Elizabethtown, Ephrata and Columbia. Due to reduced funding, however, those deployments have been scaled back to every other week, Community Paramedicine Director Carli Bechtold said.
It continues to make three stops a week in Lancaster: Tuesday and Thursday afternoons at the Lancaster County Food Hub and Friday mornings at Union Community Care’s “downtown” location on North Water Street.
At Lancaster EMS, “we’re doing OK,” May said. That said, the organization is keeping a cautious eye on its financial position as it proceeds with the remodeling of the former AmVets building at 715 Fairview Ave., Lancaster, for its new headquarters.
Current projections indicate it will need to draw down its reserves to complete the funding for the $6.2 million project, May said, leaving it with 80 days’ cash on hand, down from 180 days now.
After Lancaster, the next largest municipal contributor to Lancaster EMS is West Lampeter Township, which in 2024 is providing its full share of $58,690. Others contribute less, with one, Conestoga Township, contributing $0 of the $6,246 requested.
Overall, municipal support in 2024 totaled $354,175, 51% of Lancaster EMS’ request.
Support from county government is not in the cards. Lancaster EMS has asked, but in Pennsylvania, as Commissioner Josh Parsons noted last fall, it is local governments that are tasked with providing for EMS and counties have no direct responsibility.
Emergency medicine is an underappreciated service, May said. Incident scenes can be high risk — Lancaster EMS has seen some career-ending injuries, he said — and while wages have improved, they remain far below those earned by police and firefighters.
“What we do needs support,” he said.
