Stefan Hofer’s ambulance company, West Traill EMS, in Mayville, North Dakota, has received only one or two calls that weren’t related to Covid-19 over the past two months. But he said the case count has ballooned by 20 to 30 percent because of the pandemic. At the same time, the company’s expenses have mounted, its revenue has cratered and its workforce is being decimated by the virus.
The company — which is private and supported by volunteers, a few employees and four trucks — covers more than 1,500 miles of North Dakota prairie and serves about 10,000 people on the far east side of the state.
Private EMS services, both in urban and rural centers across the country, collectively received $350 million in Covid-19 relief funds in April, but those companies said that money ran out within weeks. Months later, the need remains great as they face another coronavirus surge.
40 Under 40 nominees were selected based on their contributions to the American Ambulance Association, their employer, state ambulance association, other professional associations, and/or the EMS profession.
Adam Parker Operations Manager Sanford Health Bismarck, ND
Linked In Nominated By: Kelly Dollinger (North Dakota EMS Association – Bismarck, ND)
Adam Parker has been involved in North Dakota EMS for over 15 years working for volunteer, private, and hospital-based EMS services. Adam is currently employed by Sanford Health as an Operations Manager overseeing AirMed operations, EMS education and outreach, and a Community Paramedic program. Adam is also a Board Member for the North Dakota EMS Association and serves as Chairman of the Advocacy Committee and Co-chair of the Service Leaders Committee. Adam lives in Bismarck, ND with his wife, Jessica, and two children.
Reason for Nomination:
As President of the North Dakota EMS Association – I am thrilled to have the opportunity to nominate Adam Parker for consideration in the AAA’s Inaugural Mobile Healthcare 40 Under 40 – due in part to his exceptional and continued rise through the leadership of North Dakota EMS.
Adam’s full-time position is with Sanford Health as the Operations Manager for the Bismarck and Dickinson AirMed bases, as well as the Sanford EMS Department. In his position, Adam oversees the daily and strategic operations for two air medical bases, as well as EMS outreach and education. Adam also spearheaded the creation of the newly developed Community Paramedic program. Currently, Adam supervises over 50 mobile health care professionals including Paramedics, Community Paramedics, Critical Care Paramedics, and Advanced Certified Registered Nurses.
Adam has successfully obtained his Master’s Degree in Business Administration and also completed the Certified Medical Transport Executive course. Adam is always learning and applying what he learns to better himself and the EMS industry.
On top of his busy schedule, Adam serves on the North Dakota EMS Association Board of Directors. Adam serves as the Co-chair of the Service Leader Committee and is currently the Chairperson for the Advocacy Committee. It is in this capacity where Adam has contributed greatly to our EMS Association and the agencies throughout North Dakota. Adam has been instrumental in obtaining Legislative Grant Funding for North Dakota EMS agencies and assisted in developing a formula to determine funding that would allow for as many ambulance services as possible throughout the state. This proved highly contentious, and risked the loss of all state grant funding, but Adam developed a successful strategy and managed the situation extremely well by negotiating with legislators to find a workable agreement. Adam also serves as our State Advocacy Coordinator and Affiliate Advisory Council representative for the NAEMT.
Adam was also instrumental in advancing the Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA) legislation. This bill successfully passed and North Dakota became the 17th State to be recognized as a REPLICA state.
Adam is very knowledgeable in various aspects of state and local politics, policies, and procedures. Adam is the go-to expert on establishing local taxing districts and he advocates heavily for every ambulance service to establish themselves as a political subdivision, since this is the best way to ensure sustainability in rural areas. Adam freely donates time to meet with and assist ambulance services going through this process as it is very complex and daunting for most rural agencies.
Most recently, Adam has taken it upon himself to educate himself on the inner workings of the Medicare cost data collection process and has contacted every ambulance service selected in the state to ensure they understand what they need to do and has helped them organize themselves to collect the necessary information. Despite Adam’s employer not being selected to submit cost data this year, Adam still gives a lot of his time to ensure that rural ambulance services in North Dakota are successful with this important requirement.
Adam is very generous with this time and freely gives out his phone number and encourages anyone to call if they need help – with anything. There is no doubt that Adam would be of the finest selections for the Inaugural Mobile Healthcare 40 Under 40 in recognition of his contributions to the entire state of North Dakota and the mobile healthcare profession.
A top priority of President Trump and congressional Republicans is to repeal and replace the Affordable Care Act (ACA). Since Republicans retook control of Congress in 2012 after passage of the ACA in 2010, they have sought to repeal the ACA. However, they had not developed a consensus on a replacement package, as they knew then-President Obama would veto the repeal bill. Now with President Trump in the White House and Republicans controlling the House and Senate, Republicans in the House have agreed upon a package and moved it through three Committees of jurisdiction: the Ways and Means Committee, the Energy and Commerce Committee, and the Budget Committee. Republicans in the Senate are less aligned and are said to be working on their own package, which is likely to differ in important ways from the House version.
For ambulance services, there are several key components to watch. These are:
Coverage for ambulance services. Expressed in terms of providing more flexibility, there is concern that some insurers are pushing and some Republicans agree that the concept of a minimum set of covered services (essential health benefits (EHB)) should be narrowed or even eliminated. Currently, only emergency services are included as an EHB, but through the designation of benchmark plans, non-emergency services have also been covered. If the benchmark plans requirements are modified, coverage for non-emergency services could become an issue.
Medicaid expansion. The Administration has sent a clear signal that it plans to roll back the expansion of Medicaid, which provide coverage to many Americans who had signed up under the ACA. For ambulance services in expansion States, the elimination of this program could result in more uncompensated care problems.
Coverage more generally. Republicans have clearly indicated a desire to eliminate the individual mandate. This could have two effects that may impact ambulance services. First, if people are not required to have coverage there are many who will not have it. It is not certain whether without coverage these individuals will be able to pay for the services they receive, which could lead to more uncompensated care. Second, individuals who do not purchase health insurance often are younger and healthier. Without such individuals in the risk pool, it is possible that premiums and other cost-sharing requirements will increase making it more likely for sicker individuals who cannot afford care becoming uninsured.
Employer costs and obligations. The House Republican legislation includes several provisions that relax the obligations and/or provide tax relief to employers providing health insurance. Such provisions could be beneficial to ambulance services in terms of providing health care coverage for their employees.
In addition, there are a few other provisions that the current bills being considered do not modify, but potential could be part of the discussions at some point or in subsequent Medicare legislation. Of these, there are three that would directly impact ambulance services.
Productivity Adjustment. As part of the ACA, the annual inflation updates for the Medicare ambulance fee schedule rates are now subject to a productivity adjustment, which reduces the amount of the update. CMS subtracts a projection of the non-farm business multi-factor productivity adjustment (MFP) from the Consumer Price Index – Urban to determine the update amount.
Inflation Index Below Zero. Prior to the ACA, the Medicare inflation update for ambulance rates could not be a negative percentage. Under ACA policies, the update may be a negative percentage. For example, in 2011, the CPI-U was 1.1 percent and the productivity adjustment was 1.2 percent, which resulted in a cut to the rates of 0.1 percent. In 2016, the CPI-U was 0.1 percent and the productivity adjustment was 0.5 percent, which resulted in a cut of 0.4 percent.
GPCI Increases. The ACA made a temporary change to the practice expense component of the physician geographical price cost index (GPCI), which is the entire GPCI for reimbursement under the Medicare ambulance fee schedule. The change established a minimum 1.0 GPCI for ambulance payments from January 1, 2010, to December 31, 2010. As a result of these changes, rates under the Medicare ambulance fee schedule for localities with a GPCI of less than 1.0 saw an additional temporary increase in reimbursement rates. Localities with a GPCI of 1.0 or higher were not be affected by the provision. The provision was retroactive to January 1, 2010 and the increases escalated for 2011 before expiring on December 31, 2011.
The ACA also established a permanent GPCI floor of 1.0 for “frontier” States which took effect in 2011. The designation of a “frontier” applies to those states in which 50 percent of the counties are frontier which have less than 6 people per square mile. The designation is updated with the original frontier states consisting of Montana, North Dakota, South Dakota, Utah and Wyoming. Utah is no longer deemed frontier and Nevada has been added to the list. While a complete repeal of the ACA would not impact the temporary GPCI increases as the provisions were temporary, it would eliminate frontier status.