Emergency medical services (EMS) providers are continually challenged to maintain an adequate workforce. A survey of state EMS directors in 2004 suggests that volunteerism is declining in rural areas. Communities may respond to declining volunteerism in a variety of ways including conversion from a volunteer service to a paid service. Conversion to a paid service raises important policy questions relevant to not just the EMS services involved but also other rural health care providers including local hospitals, particularly for those services that provide patient transports. If a substantial number of volunteer EMS convert to paid services, there may also be a national effect on reimbursement because of global limits on ambulance payments. Based on a new fee schedule implemented in 2006, the Centers for Medicare and Medicaid (CMS) pays an additional rate for beneficiaries picked up in a rural area. CMS also pays a larger fee for beneficiaries who are transported by EMS that provide advanced life support if such services are medically necessary. To the extent that rural EMS are transforming to paid services, there will be a concurrent appearance of growth in the number of EMS billed services that reflects increased billing rather than increased provision of services and the proportional demand for CMS reimbursement may shift from hospital to EMS while the global limits do not change.

There are little data to describe volunteer EMS' conversion to paid services. A focused investigation of conversion and the issues considered by services considering this option could inform policies to support the provision of and reimbursement for prehospital emergency medical services in rural areas as well as other important patient transport services provided by rural EMS. For this project we will use a semi-structured telephone interview protocol to answer the following research questions:

• Has the ability to recruit and retain unpaid volunteers in rural areas changed in recent years?
• Have rural volunteer EMS converted to paid services or are they considering such conversion? If so, what factors played a role in their considerations regarding conversion?
• Has payment of emergency medical technicians (EMTs) improved recruitment and retention?
• How does their ability to pay their EMTs even in token ways such as end-of-year bonuses or recognitions relate to decisions about billing for services?
• How do relationships between the EMS and their local hospital or other agencies such as fire departments relate to their decision to convert or not to convert?
• In the face of declining volunteerism which other health care providers, if any, have been available to fill the need for EMS.

Publications

• Rural Volunteer EMS: Reports From the Field (Final Report)
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 08/2010
  This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.
• Rural Volunteer EMS: Reports From the Field (Findings Brief)
  North Carolina Rural Health Research and Policy Analysis Center
  Date: 09/2010
  This report explores the current state of rural EMS by interviewing 49 local directors from all-volunteer rural services in 23 states. Respondents were encouraged to speculate on the future viability of their local service, describe the challenges they face, and what they need to ensure continuance.