By Michelle Lynch
Reading Eagle
BERKS COUNTY, Pa. 鈥� Emergency medical services in Berks County are in crisis, a new study shows.
The study, begun in 2023 by the Albright College鈥檚 Center for Excellence in Local Government in partnership with Berks County Department of Emergency Services, reveals a sobering reality, said Paul Janssen, director of the center.
Janssen presented the findings to City Council on Monday during a committee of the whole meeting.
The study, he said, outlines a cascade of challenges that include insufficient funding, inadequate insurance reimbursement, paramedic shortages and aging equipment, all of which jeopardize emergency response across much of the county.
鈥淲hat really got us looking at this issue was the fact that we have had a number of EMS providers that have become insolvent over the last 10 years,鈥� Janssen said.
One of these, Kutztown Ambulance, ceased operations in 2023 after 37 years of service.
The private company, which had 29 employees, served the borough as well as Maxatawny, Greenwich and Richmond townships.
鈥淲hen we saw the failure of the Kutztown ambulance service, which happened overnight, we began to send out alarms,鈥� Janssen said.
Though Reading fully supports and operates a professionally staffed EMS service through its fire department, it is the only Berks municipality to do so, he explained.
Most of the 18 ambulance providers serving Berks are private nonprofit organizations, Janssen said, and many of them are in trouble. Two may not have the resources to survive the rest of the year, he said, emphasizing the need for municipalities to properly fund and support EMS services. Janssen did not identify those two providers, citing the anonymity promised to those who participated in the study.
What happens to services elsewhere in the county ultimately affects the city, Janssen said. This is due to a system known as mutual aid, an agreement among fire departments and ambulance services to help each other across jurisdictional lines.
When services outside Reading fail, mutual aid provided by the city and other services must fill in, he said.
鈥淚t becomes a case where we鈥檙e stretching the rubber band more and more and more,鈥� he said, 鈥渁nd it鈥檚 pretty taut right now.鈥�
The study showed that contrary to a common misconception, the city鈥檚 EMS service provides as much mutual aid as it receives, he noted.
鈥淚n reality, the city runs out of the city as much as others run into it,鈥� he said. 鈥淭hat鈥檚 how mutual aid is supposed to work. And for Reading, it is working.鈥�
Areas of concern
One of the most pressing issues highlighted in the report is the broken reimbursement model, Janssen said.
Medicare pays directly, albeit inadequately, he noted. Medicaid and private insurers, on the other hand, often pay less than 30% of what providers bill, and payers often send those reimbursements directly to patients rather than to EMS agencies.
鈥淚f you bill $1,700, the insurance company may pay $499, but they pay it to the individual,鈥� Janssen said. 鈥淎nd the individual doesn鈥檛 end up paying the (ambulance) company. So now the company is out $1,700.鈥�
That not only shortchanges providers but amounts to a misuse of public funds, he said.
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Recommendations
A key recommendation, he said, is that the state Legislature mandate direct and reasonable payments to EMS agencies rather than to patients.
Personnel shortages are another critical concern, Janssen said, noting the collapse of the volunteer model that once sustained many services.
鈥淲e used to have volunteers,鈥� he said. 鈥淣ow it鈥檚 all paid.鈥�
Top-level paramedics at some Berks nonprofit agencies earn only about $60,000 a year with limited or no benefits and often must work for multiple agencies to make ends meet, the study found.
Unlike firefighters or police, EMS workers typically don鈥檛 receive public safety pensions or health benefits unless they work for a municipal service like Reading鈥檚, Janssen said.
A study of emergency medical services in Berks County found that Reading鈥檚 EMS service provides as much mutual aid as it receives from county units. ( READING EAGLE )
鈥淭his is emergency response, just like police or fire,鈥� he said. 鈥淵et most of these providers offer very little in the way of benefits. It鈥檚 a huge issue.鈥�
Reading鈥檚 EMS, which runs paramedic-level services with full-time staff and union support, is an outlier, he noted. In contrast, many other providers in the county rely on underpaid and overstretched personnel who lack the support of municipal structures.
Just to stay afloat, many EMS providers are using capital reserves meant for long-term investments, the study revealed. This means when equipment breaks down, they may not have the money to replace it, Janssen said.
鈥淲e鈥檙e going to get to a point where someone goes to pull out their ambulance and it doesn鈥檛 run,鈥� he said.
This short-term financial scrambling is particularly dangerous given the cost and necessity of EMS equipment, he noted. A new ambulance can cost well over $250,000, not including the lifesaving gear inside.
Many calls are for non-transport services, such as administering insulin during a diabetic episode, he noted. Such responses are costly but often go unreimbursed if the patient is not transported to the hospital, he said.
Some providers serve multiple municipalities, but funding arrangements are inconsistent, and communication is often poor.
鈥淭oo often, the EMS agency only contacts the township in October during budget season and says, 鈥榃e need $40 per household instead of $30,鈥欌�� he said. 鈥淏ut there鈥檚 been no reporting all year. That has to change.鈥�
The study urges municipalities to stop assuming that another service will pick up the slack, he said, because that service may soon disappear.
鈥淚f one agency fails, the others may try to cover their territory,鈥� Janssen said. 鈥淏ut that weakens everyone. It鈥檚 not sustainable.鈥�
Consolidation could help create stronger providers with better business leadership, he noted.
鈥淭he question is, 鈥楥an we do a better job if we have fewer providers who are better led by people who understand the business part of being a provider?鈥欌�� he said.
Some may wonder why the county cannot simply take over services, Janssen said, explaining that is not permitted under Pennsylvania鈥檚 third-class county code. The same restriction also applies to police and fire departments. This structure dates to the founding of Pennsylvania.
Janssen was careful not to share identifiable details about specific agencies other than the city. This approach, he said, is intended to maintain confidentiality while conveying the severity of the situation and generating support for broader solutions.
County officials are seeking funding for an extensive regional study that would help address the systemic issues facing EMS providers throughout Berks, Janssen said.
But time is running out, and some areas of Berks may soon be without adequate emergency coverage, he said.
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