When an ambulance is dispatched in Illinois to help the victim of a car crash, shooting or heart attack, the paramedics who arrive don't ask — and are prohibited by law from considering — whether that person has a certain kind of health insurance or no coverage at all.
Ambulance services can't discriminate when it comes to relieving patients' suffering. But the state's ongoing backlog of bills is inflicting financial pain on ambulance providers if those patients are covered by Illinois' Medicaid program or the group health-insurance program for state employees, retirees and dependents.
"Nobody seems to care," said Andrew Thornton, the Illinois State Ambulance Association's chairman for governmental affairs.
Delays of six months to a year for Medicaid payments, and delays of more than a year for state employee insurance, have prompted ambulance services to borrow money to make payroll. The delays, on top of already inadequate Medicaid payments, also have depressed salaries for ambulance crew members and made it harder to replace aging equipment, emergency medical service officials say.
Though there's no hard data, there are anecdotal reports that the cash-flow problems have resulted in fewer ambulances on the road and longer response times, Thornton said. Delays in medical attention can result in death and in long-term health consequences for those who survive, he said. "
There is a human cost involved, but it's hard to quantify," said Thornton, a paramedic who lives in Springfield and directs the not-for-profit Fulton County Emergency Medical Association.
The 400 to 500 ambulance services in Illinois operate under a variety of structures. Some are part of city or village government, some are not-for-profit organizations that contract with local governments, and some are private companies that may be dispatched to "911" emergency calls by government-operated call centers. But when they bill for services, many are suffering because of payment delays.
"There are complaints everywhere," said Van Prater, chief paramedic for the Springfield division of LifeStar Ambulance Service Inc., one of three for-profit ambulance companies serving Sangamon County.
At LifeStar, where at least one-third of patients are covered by either Medicaid or state insurance, the state owes the company "a few hundred-thousand dollars," according to LifeStar billing manager Julia Pate.
Payment delays have prevented the company from purchasing the latest cardiac monitors, which automatically measure blood pressure rather than having a paramedic manually inflate an arm cuff, Prater said. And when an ambulance needs to be replaced, he said, "You go with a not-so-fancy unit."
At Springfield's America Ambulance, where the clientele covered by the state through private insurance or Medicaid is similar, the state owes more than $330,000 — some of it for services provided 14 months ago, office manager Carla Berg said. The oldest bills covered by the state's self-funded Quality Care plan, which is administered by Cigna, she said.
Page 2 of 3 - The late payments have resulted in America Ambulance replacing its ambulances less often, which costs the business more for repairs and fuel for older, less-efficient vehicles, America owner Susan Zappa said.
In 2012, the state paid America $7,000 just for interest on late payments. As a taxpayer, Zappa said she considers that a "sickening" waste of state revenues.
Delays in state payments began to get worse in 2009 and 2010 and are closely related to the economic downturn, Thornton said. The impact of the delays was magnified in July, when a 2.7 percent Medicaid rate cut imposed by Gov. Pat Quinn and the General Assembly took effect for most services provided by ambulance crews.
That cut, on top of a 6 percent Medicaid rate cut in 2002, rolled the rates back to levels paid in the 1990s, Thornton said.
An ambulance trip and aggressive medical services provided by paramedics might generate a $700 to $900 payment from private insurance but less than $300 from Medicaid, Berg said.
There's no end in sight to the payment delays. The legislature approved $550 million in spending for state employee health coverage this fiscal year, but the bills for that coverage are expected to total $2.65 billion. Underfunding of the employee health liability means bills get pushed into the next fiscal year before they can be paid.
The state paid $87 million in interest payments last year to medical providers owed money by the state insurance program, according to Scott Adams, director of research and employee benefits for Council 31 of the American Federation of State, County and Municipal Employees.
Illinois currently owes about $20 million statewide to medical transportation providers, with most of the money owed to ambulance providers, according to Kelly Jakubek, spokeswoman for the Illinois Department of Healthcare and Family Services. The state owes an estimated $9 billion to vendors of all types — an amount that hasn't changed much in the past two years, according to Bradley Hahn, spokesman for Illinois Comptroller Judy Baar Topinka.
No easy fix
State payment delays for ambulance providers haven't "materially worsened" in the current fiscal year compared with fiscal 2012, Jakubek said, but she added that HFS "cannot speculate as to when provider time frames will improve. It is, however, likely that similar delays will continue for the foreseeable future."
Until lawmakers and the governor can resolve funding issues involving state employee pensions, Jakubek said, "there will be many funding issues that will be very challenging for the state to deal with. This is across-the- board in terms of health care, education, public safety and many other vital state programs."
Lawmakers tell advocates for ambulance services that they care about the problem and how it can affect the lives of their constituents, but the problem persists, Thornton said.
Page 3 of 3 - State Rep. Donald Moffitt, R-Galesburg, who sat on a bipartisan Illinois House task force that held hearings throughout the state and produced a report in November on emergency medical service funding, said the payment delays "absolutely worry me. If it's your loved one suffering a cardiac arrest, you want a quick response and the best that there is." Moffitt, who co-chaired the task force with former Rep. Lisa Dugan, D-Bradley, said EMS service is "a very basic funding role of government and should be considered an essential service," regardless of whether the EMS provider is for-profit or not-for-profit. "They all need to be paid," he said.
Can't afford to wait
Moffitt said he will continue to advocate that EMS funding be given higher priority, and he plans to work with Lt. Gov. Sheila Simon, a Democrat, to push for legislation in the spring session that carries out the task force's The group's recommendations include establishment of zero-percentage interest loans to EMS providers, a boost in Medicaid rates, quicker state payments and a dedicated funding source for EMS equipment and training.
Charles Kelley, president of MedStar Ambulance Inc. in Sparta, said he doesn't know how long his business can wait for relief. MedStar handles 911 calls in many impoverished communities in the Metro East area, including East St. Louis, and at least half of the patients it serves are covered by Medicaid. Because of MedStar's high Medicaid load, the state used to make sure the company was paid within about 70 days, Kelley said.
But then, in December, the state notified MedStar that the accelerated payments were ending, he said.
MedStar can't afford to wait six months to a year for payment and can't borrow that much money to fill the gap, Kelley said.
"We may have to reduce services in some areas with high Medicaid numbers, and that would lengthen response times," he said.
Dean Olsen can be reached at 788-1543. Follow him at twitter.com/DeanOlsenSJR.
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