BOISE, Idaho (CBS2) — Every day, local paramedics and EMTs work tirelessly, responding to a growing number of emergencies in our communities. These EMS agencies are there in our worst moments, and sometimes their response can mean the difference between life and death.

But behind the scenes, many of Idaho's Emergency Medical Services (EMS) agencies are struggling to keep up themselves.

Statistics that tell a story

In November 2021, the Office of Performance Evaluations conducted a report focused on the efficiency of Idaho Emergency Medical Services (EMS) agencies. Idaho Code does not designate EMS as an essential government service, meaning it does not guarantee access for all Idahoans.

The report found, (among other things), that the number of EMS providers in Idaho has not kept up with population growth, and that most EMS agencies don't have sufficient funding for personnel. As a result, response times and standards of care can vary widely across the state.

A couple of other highlights:

  • Just 18 percent of EMS directors say their agency can maintain a sufficient staff
  • Of the 82 percent that are short-staffed, 65 percent of EMS directors say their staffing issues have impacted response times.
  • Nearly all (88%) of Idaho's EMS agencies think it will be harder to recruit and retain EMS volunteers in the future

Ada County's challenges

While there are more challenges in rural areas, EMS agencies right here in the Treasure Valley are also feeling the strain.

Ada County Paramedics has several vacant positions on staff right now, and the agency is having a hard time recruiting people to fill those spots.

"We just can't attract people," said Ada County chief of paramedics Shawn Rayne. "That's a national issue. It's not just an Ada County issue. Across the country, people are having a hard time attracting paramedics and EMTs."

Ada County Paramedics has just over 140 paramedics and EMTs on staff right now -- many of who the chief says are overworked and underpaid.

"It has gotten more and more expensive to live here," he said. "It makes me sad that my employees that work here in Ada County likely can't live in Ada County."

On top of that, the county also needs to hire more EMS workers to keep up with the demands of this growing valley.

"We're busier than we've ever been out there right now," Rayne said. "Our call volume in 2020 was 31,000 calls. We jumped up to just shy of 36,000 calls last year. That wasn't just the pandemic either, a lot of that has to do with growth.

In theory, growth also requires more infrastructure, but the chief says those needs are being put on the back burner to focus on more pressing challenges.

"We have plans for additional stations, but the people are expensive to be able to staff those stations," he said. "Unless we have revenue coming through the door, we just can't hire more people."

Without more revenue to support more staff, the chief warns response times could get longer.

Where's the money?

Fixing any of these problems requires more funding. But the fix isn't simple. In fact, the chief says it continues to be his agency's biggest challenge.

Ada County Paramedics is working with a $20.2 million dollar budget for FY 2022. More than 75 percent of that ($15.5 million) goes toward paying employees and providers, while the rest goes toward things like equipment, units, and training. That funding comes from a combination of taxes and fees for service (billing).

Taxes

Chief Rayne says $7.6 million of the agency's $20.2 million budget comes from taxes.

"Our tax levy in Ada County is the lowest tax levy in the state of Idaho," chief Rayne said. "That affects our funding."

In order to get more revenue from taxes, the agency would have to put a levy on the ballot and get a two-thirds majority approval vote from taxpayers.

"It's something we've definitely talked about, but we haven't made a firm decision on if or when that would happen," Rayne said.

Fees for service

The rest of the agency's funding comes from fees for service -- or billing. While some of the costs fall on patients, most of them come from programs like Medicare and Medicaid.

The problem: the payments from those programs don't typically cover the entire cost of a service.

As an example, Rayne says the average cost of a Basic Life Support bill is $800. (That type of response doesn't include more advanced care like IVs, cardiac monitoring, or ventilators). But Medicare only covers $300 of a bill -- no matter how much money is leftover.

"The patient isn't responsible for the other portion of it," Rayne said. "We have to write the rest of that off."

At the end of the day, it just doesn't add up.

Doing more with less

Because the agency can't get as much money as it needs, Ada County Paramedics is being forced to do more with less. As hiring challenges become more pronounced, the agency has proposed a new schedule that requires its employees to work more overtime to compensate.

Currently, paramedics and EMTs work 48 hours per week. Under the new proposed schedule, they'd work 56 hours per week (an additional 8 hours each week). Do the math, and it adds up to 416 hours of overtime per year.

Chief Rayne says this schedule isn't uncommon among EMS agencies -- in fact, it's the schedule many of our local fire departments follow. But not everyone is happy about the idea of working extra hours -- especially after challenging times during the pandemic.

"Some employees certainly don't want to work the additional hours, and I totally understand that," Rayne said. "But it all comes back down to that idea that right now we have to do more with what we currently have and the revenue that we currently get."

If approved, the new schedule could kick in as soon as 2023, but the chief knows it wouldn't be a feasible long-term solution. Instead, most of those would require a complete overhaul of the agency's funding model. (More on that below).

In need of a lifeline

One potential funding lifeline could come from the Idaho Statehouse soon. Lawmakers passed a bill during the 2022 legislative session that will give our state's EMS agencies more money from Medicare or Medicaid patients who need transport.

"That bill actually allows us to capture another federal share of money...that pays for half of the actual cost responding to the call, as opposed to just the sum that we get now which is around $300," Rayne said.

The chief says that change should bring in some additional funding, but not enough to fix all of the staffing problems at Ada County Paramedics. As previously noted, any long-term, sustainable solutions will require a new levy, and ultimately an overhaul of the agency's funding model.

"If we were ever able to adjust the levy and convince voters to do that, then we could look at you know, doing something different with our staffing model and that kind of thing," the chief said.

Looking to the future

Looking ahead, chief Rayne admits there are a lot of unknowns. The only certainty, he says, is that something has to change.

"I wouldn't say the system's on the verge of collapse, but we know that we have to do something different," he said. "We have to act now to be able to serve the citizens of the county in a better way than we currently are today."

Until then, Ada County Paramedics will keep doing more with less. They don't have a choice not to -- because our growing community depends on them.

"We're still out there responding to every call," Rayne said. "And we don't have any intention of going away. We just need to be able to keep serving the citizens of Ada County in a very impactful way."

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