Rural ambulance services left to fill gaps

When rural hospitals close, emergency medical services providers are left to carry the burden. With the majority of Iowa’s ambulance services run by volunteer departments, this can leave some rural patients without critical access to care.

According to a 2019 report by the Iowa Department of Public Health, 75 percent of Iowa’s emergency medical service providers are volunteers.

With Rural Emergency Hospital designations, Petersen said during floor debate on the bill in February that she worries patients who require a transfer to a larger facility might be stuck with a hefty ambulance bill, or the ambulance service might have to pick up the cost.

Petersen said Lee County’s ambulance service saw an increase of 60 minutes in average transport time and an increase of $750,000 in spending in the county’s general fund since the hospital in Keokuk closed its doors.

Low Medicaid reimbursement rates and lack of coverage for transfers from one hospital to another are to blame for the spike in spending because the ambulance service has had to make up the difference, Petersen said.

She introduced an amendment that would increase Medicaid reimbursement rates for ambulance providers transporting a patient from a rural facility to a larger inpatient facility. But the amendment failed on party lines, 15-33, with Democrats in favor.

“There are 17 to 21 rural hospitals [in Iowa] that could find themselves in the same circumstances that they’re facing in Lee County,” Petersen said. “If [a patient is] covered by Medicaid, Medicaid would pick up the cost of taking them by ambulance to a hospital where they can get the care they need and not have the cost of that hospital ride dumped on an Iowa family or dumped on property taxpayers.”