AUGUSTA — On Jan. 12 the Maine Legislature released the report of a Blue Ribbon Commission formed to study emergency medical services in the state and recommend improvements.

The commission, co-chaired by House Speaker Rachel Talbot Ross, D-Portland, and Sen. Chip Curry, D-Belfast, was formed in 2021 to examine and make recommendations on the structure, support and delivery of emergency medical services in the state. The commission held six meetings throughout 2022, issued its report last week, and recommended a second blue ribbon commission be formed this year to further study issues with EMS service delivery in Maine.

“We owe a huge debt of gratitude to the folks who respond when 911 is called,” Curry said in a press release announcing the final report. “Our first responders ought to be treated with respect and given the backing of a health care system that ensures they are paid fairly and have access to the education, equipment, and resources needed to deliver the vital services we depend on.”

The commission’s Jan. 12 report found Maine EMS woefully underfunded and in need of programs that develop, educate, train and retain EMS responders.

“From the very first meeting of the commission, members expressed grave concerns that EMS in the State is not only at the edge of a cliff,” the report states, “but that in many areas of the State, particularly rural areas, EMS is already over that cliff.”

The primary issue is funding. Deemed an “essential service” by a 2021 Maine public law, EMS services receive reimbursements from Medicare, Medicaid and private insurance companies. These funds are applied to EMS service delivery and readiness. With the reimbursements from those organizations lagging well behind the cost of service delivery and readiness, the commission recommends significant and consistent state funding to avoid EMS service closures.

The federal Centers for Medicare and Medicaid services is currently conducting a cost study on ground ambulance services and notes this study “is anticipated to more accurately identify how much it costs to actually deliver EMS and to result in a corresponding increase in reimbursement rates. The report notes, however, this study will take time and is unlikely to impact service reimbursement rates within the next five years.”

The report also states that defining the cost of actual EMS service in Maine is made more difficult by skewed data.

“That data is necessarily deficient,” the report states, “because it relies on the provision of EMS through volunteerism, low wages and donated labor.”

The commission found that reimbursement rates currently cover 60% to 80% of the cost of services and that the shortfall between the cost of service and revenue is “greater than $70 million each year.”

With that in mind, the commission recommends the state fund the delivery of EMS in Maine by appropriating $70 million per year for the next five years. The commission also recommends that $25 million of the recommended $70 million per year should specifically target transporting EMS services at “immediate risk of failing and leaving their service area without access to adequate EMS.”

Additionally, the commission recommends appropriating $6 million per year from the General Fund for non-transporting emergency medical services.

Much of the commission’s work was dedicated to identifying potential solutions to EMS workforce issues, which are significantly impacting the delivery of EMS service in Maine. These issues lead to delays in emergency response times and to an overworked and overstressed workforce.

The report states that the primary contributors to EMS employee recruitment and retention are the insufficient compensation and benefits offered to EMS employees. A majority of the commission members felt that access to Maine State Retirement System and State of Maine health care should be available to staff of non-governmental, nonprofit licensed services. Many of Maine’s 272 licensed EMS services are governmental services that already provide staff with such access. Boosting access to employees of non-governmental, nonprofit licensed services would help those services with recruitment and retention, according to the report.

The commission therefore recommends the Legislature explore options for providing staff of non-municipal, nonprofit licensed EMS services access to the Maine State Retirement System and to State of Maine health care benefits.

The commission also addressed the development, recruitment and retention of EMS providers by recommending a “work group” to explore career pathways and educational opportunities in the state. The work group would be composed of representatives from Maine EMS, the Community College System and the University of Maine. The commission also called for the growth of community paramedicine programs in Maine.

The final recommendation is that the Legislature appoint another blue-ribbon commission to continue the study of EMS in Maine during the upcoming legislative period.

Curry hopes that work continues and understands that solutions, while not immediate, are available.

“We heard from rural, urban, coastal and island communities struggling to provide this essential service,” Curry said in the press release. “We listened to the professionals, from EMTs treating patients daily to administrators with insight into the financial hurdles of our EMS departments.

“The commission’s recommendations are a result of the hard work and expertise of local EMS professionals and leaders who shared their experience and innovative ideas with us. I look forward to working with my fellow legislators to implement these recommendations and create a better path forward for Maine’s EMS system.”