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Mississippi ambulance providers anticipate downfall of services amid hospital crisis

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Mississippi ambulance providers fear a collapse of emergency medical services is on the horizon, partly as a result of hospitals discontinuing services and, in some cases, closing.

The crisis has caused a decline in worker availability for ambulance providers and an increase in emergency service wait times, those in the field say. And with the rise of medical costs and stagnant reimbursement rates, finances are also a challenge.

“Everything is working together and is causing this downward spiral of the whole system,” Clyde Deschamp, emergency medical service director for Mississippi Health Care Alliance, an organization aimed at coordinating medical activities within the state’s EMS districts, said. “It’s one big cycle.”

Hospital closures across the state are not only jeopardizing residents’ access to medical care but increasing interfacility transports – the transport of patients between two health care facilities.

Emergency services personnel are transporting patients longer distances due to rural hospitals no longer offering as many services. Patients now have to travel farther to get the care they need.

He said to make matters worse, once the ambulance arrives at the receiving hospital, the crew may be required to wait up to six hours in the emergency room due to bed shortages before transferring care to the hospital.

This “wall time” – the length of time emergency medical technicians and paramedics are waiting with patients before admission – prevents ambulance crews from responding to additional 911 calls, sometimes leaving a county area undercovered and residents with no assistance.

“Some of the more complicated transports won’t take just one paramedic but two. So, the problem with being stuck on the wall now is you have two people stuck waiting instead of one,” Deschamp said.

Clyde Deschamp, emergency medical service director for Mississippi Health Care Alliance Credit: Courtesy of Clyde Deschamp

Despite the demand for workers, fewer people are pursuing this career.

According to a recent National Association of Emergency Medical Technicians report, most agencies nationwide reported increasing turnover rates on average from 8% in 2019 to 11% in 2022. 

In addition, the report found from 2019 to 2022, nearly 66% of agencies experienced a decrease in job applications.

Deschamp said existing paramedics have stepped up as much as they can to fill staffing gaps, making it common for paramedics to work 80-plus hours per week.

“Unfortunately, resource management – no matter how good – simply cannot compensate for a lack of paramedics to staff ambulances and a growing demand for interfacility transports,” Deschamp told Mississippi Today. “Regrettably, the situation may get worse before it gets better.”

Gregory M. Cole, EMS advisory committee member to the Mississippi Board of Health and former chief compliance officer at Covington County Hospital, said working with limited resources to provide service in an adverse environment “is killing the morale of EMS workers.”

Cole said paramedics are burning out.

“They are exhausted,” Cole explained. “If you take a man or woman that has worked a 16-hour shift after running 12 calls, then at midnight have them take a patient six hours away. That is not safe for the patient nor is it healthy for the crew.”

At Covington County Ambulance Service, there are currently 70 employed medics and nine ambulances covering Covington, Simpson and Magee County, a roughly 1,010-square-mile area.

The ambulance service received a total of 10,000 calls last year – 90% were non-emergency and less than 10% were emergency calls. Non-emergencies included sprains and noise complaints, while emergencies included falls, motor vehicle accidents and respiratory disorders.

The number of hospital-to-hospital transfers this year for Covington County Ambulance Service as of Sept. 7 was 1,214, an increase from 714 in 2021 and 1,261 in 2022.

The rate of patient transfers spiked for two reasons, said Todd Jones, director of EMS at Covington County Hospital. The first is staff shortages at the hospitals it serves; the second is the service added Magee General Hospital and Simpson General Hospital.

In addition, the reimbursement model for EMS services is a problem, Cole said.

Cole told Mississippi Today that EMS is reimbursed at a bundled rate – it is paid an overall sum for treating a patient instead of an individualized amount for different patients.

He explained that even if he spends 12 hours taking care of a patient and $1,300 worth of medication to treat them, he is still provided one amount by the Centers for Medicare & Medicaid Services (CMS). And it usually doesn’t cover the expenses to provide emergency medical services, he said.

Gregory M. Cole, EMS advisory committee member to the board of health and former chief compliance officer at Covington County Hospital Credit: Courtesy of Gregory Cole

Cole said the uninsured, underinsured and private insurances cover only a portion of cost.

“This is equivalent to someone going into Walmart, getting $100 worth of groceries, deciding to only pay for $25 of it but still walking out with the rest of the groceries,” Cole explained. “Walmart wouldn’t allow you to do that, but somehow it’s okay to do that in ambulance services.”

Cole said without adequate reimbursement, EMS providers cannot stay response ready, attract the amount of workers they want and retain employees.

David Grayson, president of Mississippians for Emergency Medical Services, the state’s largest trade organization for ambulance personnel in Mississippi, said health insurers reimbursement rates vary by insurance type.

Nationwide, almost half of EMS patients are covered by Medicare, according to a 2008 American Ambulance Association study. The study found Medicare reimbursement rates for ambulance services are six percent less than the national average cost per ambulance transport.

In addition, uninsured patients make up an average of 14 percent of ambulance transports. Ambulance services experience almost double the uncompensated care burden as US hospitals and physicians, the study said.

Twenty to 40 percent of EMS patients are covered by Medicaid, which pays “universally low” rates.

“The concern I have is, if our reimbursements continue to stay flat or have a slow increase while our costs are obviously going up at a steeper level, then there’s going to come a time where ambulances are not going to be available,” Grayson told Mississippi Today.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

Mississippi Today

An ad supporting Jenifer Branning finds imaginary liberals on the Mississippi Supreme Court

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mississippitoday.org – Bobby Harrison – 2024-11-24 06:00:00

The Improve Mississippi PAC claims in advertising that the state Supreme Court “is in danger of being dominated by liberal justices” unless Jenifer Branning is elected in Tuesday’s runoff.

Improve Mississippi made the almost laughable claim in both radio commercials and mailers that were sent to homes in the court’s central district, where a runoff election will be held on Tuesday.

Improve Mississippi is an independent, third party political action committee created to aid state Sen. Jenifer Branning of Neshoba County in her efforts to defeat longtime Central District Supreme Court Justice Jim Kitchens of Copiah County.

The PAC should receive an award or at least be considered for an honor for best fiction writing.

At least seven current members of the nine-member Supreme Court would be shocked to know anyone considered them liberal.

It is telling that the ads do not offer any examples of “liberal” Supreme Court opinions issued by the current majority. It is even more telling that there have been no ads by Improve Mississippi or any other group citing the liberal dissenting opinions written or joined by Kitchens.

Granted, it is fair and likely accurate to point out that Branning is more conservative than Kitchens. After all, Branning is considered one of the more conservative members of a supermajority Republican Mississippi Senate.

As a member of the Senate, for example, she voted against removing the Confederate battle emblem from the Mississippi state flag, opposed Medicaid expansion and an equal pay bill for women.

And if she is elected to the state Supreme Court in Tuesday’s runoff election, she might be one of the panel’s more conservative members. But she will be surrounded by a Supreme Court bench full of conservatives.

A look at the history of the members of the Supreme Court might be helpful.

Chief Justice Michael Randolph originally was appointed to the court by Republican Gov. Haley Barbour, who is credited with leading the effort to make the Republican Party dominant in Mississippi. Before Randolph was appointed by Barbour, he served a stint on the National Coal Council — appointed to the post by President Ronald Reagan who is considered an icon in the conservative movement.

Justices James Maxwell, Dawn Beam, David Ishee and Kenneth Griffis were appointed by Republican Gov. Phil Bryant.

Only three members of the current court were not initially appointed to the Supreme Court by conservative Republican governors: Kitchens, Josiah Coleman and Robert Chamberlin. All three got their initial posts on the court by winning elections for full eight-year terms.

But Chamberlin, once a Republican state senator from Southaven, was appointed as a circuit court judge by Barbour before winning his Supreme Court post. And Coleman was endorsed in his election effort by both the Republican Party and by current Republican Gov. Tate Reeves, who also contributed to his campaign.

Only Kitchens earned a spot on the court without either being appointed by a Republican governor or being endorsed by the state Republican Party.

The ninth member of the court is Leslie King, who, like Kitchens, is viewed as not as conservative as the other seven justices. King, former chief judge on the Mississippi Court of Appeals, was originally appointed to the Supreme Court by Barbour, who to his credit made the appointment at least in part to ensure that a Black Mississippian remained on the nine-member court.

It should be noted that Beam was defeated on Nov. 5 by David Sullivan, a Gulf Coast municipal judge who has a local reputation for leaning conservative. Even if Sullivan is less conservative when he takes his new post in January, there still be six justices on the Supreme Court with strong conservative bonafides, not counting what happens in the Branning-Kitchens runoff.

Granted, Kitchens is next in line to serve as chief justice should Randolph, who has been on the court since 2004, step down. The longest tenured justice serves as the chief justice.

But to think that Kitchens as chief justice would be able to exert enough influence to force the other longtime conservative members of the court to start voting as liberals is even more fiction.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1968

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mississippitoday.org – Jerry Mitchell – 2024-11-24 07:00:00

Nov. 24, 1968

Credit: Wikipedia

Black Panther leader Eldridge Cleaver fled the U.S. to avoid imprisonment on a parole violation. He wrote in “Soul on Ice”: “If a man like Malcolm X could change and repudiate racism, if I myself and other former Muslims can change, if young whites can change, then there is hope for America.” 

The Arkansas native began to be incarcerated when he was still in junior high and soon read about Malcolm X. He began writing his own essays, drawing the praise of Norman Mailer and others. That work helped him win parole in 1966. His “Soul on Ice” memoir, written from Folsom state prison, described his journey from selling marijuana to following Malcolm X. The book he wrote became a seminal work in Black literature, and he became a national figure. 

Cleaver soon joined the Black Panther Party, serving as the minister of information. After a Panther shootout with police that left him injured, one Panther dead and two officers wounded, he jumped bail and fled the U.S. In 1977, after an unsuccessful suicide attempt, he returned to the U.S. pleaded guilty to a reduced charge of assault and served 1,200 hours of community service. 

From that point forward, “Mr. Cleaver metamorphosed into variously a born-again Christian, a follower of the Rev. Sun Myung Moon, a Mormon, a crack cocaine addict, a designer of men’s trousers featuring a codpiece and even, finally, a Republican,” The New York Times wrote in his 1998 obituary. His wife said he was suffering from mental illness and never recovered.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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Mississippi Today

On this day in 1867

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mississippitoday.org – Jerry Mitchell – 2024-11-23 07:00:00

Nov. 23, 1867

Extract from the Reconstructed Constitution of the State of Louisiana, 1868. Credit: Library of Congress

The Louisiana Constitutional Convention, composed of 49 White delegates and 49 Black delegates, met in New Orleans. The new constitution became the first in the state’s history to include a bill of rights. 

The document gave property rights to married women, funded public education without segregated schools, provided full citizenship for Black Americans, and eliminated the Black Codes of 1865 and property qualifications for officeholders. 

The voters ratified the constitution months later. Despite the document, prejudice and corruption continued to reign in Louisiana, and when Reconstruction ended, the constitution was replaced with one that helped restore the rule of white supremacy.

This article first appeared on Mississippi Today and is republished here under a Creative Commons license.

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