An Interview With O.J. Doyle on EMS and the Political Process

The political process—whether it is at the local, state or federal level—is a part of the day-to-day life of EMS. Politicians, and the legislative initiatives they endorse and vote on, impact issues important to EMS. This occurs through processes like budgeting and other governmental policy rulings that can exert pressure, positive and negative, on all levels of EMS systems.

Unfortunately, most EMS providers are not, or choose not to be, aware of what is going on in the political arena. This often-willful ignorance prevents prehospital concerns from being fully represented when important discussions are being held and funding decided on. Being out of touch with the political process also prevents providers and administrators from being recognized as a resource for emergency medical system data when new legislative bills are being considered that affect EMS.

For this column, I spoke with O.J. Doyle, one of the few lobbyists who represent clients involved in the EMS delivery system. O.J. is a lobbyist for the Minnesota Ambulance Association and the American College of Emergency Physicians. In addition to his clinical experience as a former paramedic, O.J. has been both an operations director and the owner of an ambulance service. He is also a frequent speaker and author on legislative advocacy.

How well is EMS represented at the state and federal levels in regard to legislative initiatives?

It is difficult to make general statements about how well EMS is represented at the state and federal levels because it varies so greatly. At the federal level, there are many different organizations lobbying on behalf of the diverse types of EMS providers and personnel. There are at least a dozen organizations representing different provider types with competing agendas. Some individual states lobby Congress for state-specific legislation. From a distance, it seems that there is little organization or co­operation among the groups, and some of the associations appear to work against each other. This can be confusing for elected officials.

Similarly, state lobbying on behalf of EMS runs from very effective to nonexistent. Some states have no formal advocacy at their state legislatures. From my experience, those that do tend to have organizations that represent only a specific type of provider, or even a small group of providers serving a portion of their state, such as private, hospital-based, fire-based or some other parochial group. As is the case with Congress, I am aware of very few state multirepresentational advocacy organizations.

Minnesota is somewhat unique with its broad-based cooperative effort through the Minnesota Ambulance Association. Its membership is diverse and includes volunteer and paid services, hospitals, municipalities, fire departments, private individuals and American Indian tribes. We try to work with related advocacy groups such as firefighter and paramedic unions.

What can EMS agencies and providers do to remedy the situation you described?

If EMS providers would join together at the state level through some type of broad-based organization, we would be much more effective as an industry. Then, the state organizations could form a national advocacy group to approach Congress.

The recipe for self-advocacy and effective promotion of our industry is simple to outline, but problematic when it comes to implementation. Some fundamentals of a straightforward approach include forming a broad-based EMS organization with membership that includes all types of providers and focusing on what those providers have in common, not their differences. Educate your members about how the legislative process works and how to establish relationships with elected officials. Create a calling tree so threats to the industry can be responded to with significant numbers of calls or letters on short notice.

Educate your state officials about EMS. Get on the agendas of appropriate legislative committees to inform officials and staff about the health of your state’s industry and lay out your legislative agenda for the year. Establish a permanent EMS presence at your state legislature.

To form a cohesive statewide political advocacy organization, it is important to have some means of communicating with the membership. A newsletter or widely distributed open memo makes providers feel as if they are involved in the lobbying process. It is also a good way to alert providers in specific areas of your state that they need to contact their legislators to either support or oppose some legislative initiative. In my experience, most EMS providers have no idea what goes on in their state legislature that directly affects their jobs.

What sort of EMS-specific legislation have you been able to help implement?

In Minnesota, we have enjoyed incredible bipartisan support for the two decades that I have been involved. I don’t recall EMS-related programmatic funding ever being cut.

Due to a long-term cooperative effort of EMS providers and organizations, we have accomplished a lot through legislation.

We created the EMS Regulatory Board (EMSRB)—an independent state agency whose members are appointed by the governor. The board is given a budget, employees and enforcement authority. It administers most of the EMS program funding in the state, licenses ambulance services and training institutions, and regulates ambulance personnel.

All ambulance services—public or private, ground or air—are exempt from the state fuel tax; state sales tax on all ambulance equipment, vehicles, communications equipment, repairs and replacement parts; and annual license plate fees or registration.

All ambulance and first responder/rescue squad personnel are eligible for the state’s “Peace Officer Death Benefits” program, which delivers a one-time payment of approximately $110,000 and offers free college education at a state institution to the dependents of an EMS provider killed in the line of duty.

Ambulance services, including air ambulances, must now be reimbursed by health insurance companies for all emergency calls, regardless of whether or not the call is deemed “medically necessary.” In addition, ambulance bills that are “clean claims” must be paid within 30 days or the insurance company must pay 1.5% interest per month on the outstanding balance.

We have created a volunteer ambulance recruitment/retention plan for which a standing appropriation of $1 million/year is deposited in a state fund. Volunteer ambulance personnel receive credit for years of service and receive a one-time payment when they “retire.” Initial training and recertification for volunteer ambulance personnel is also paid for by the state.

Enacted legislation requires medical assistance reimbursement for ambulance services to be the same as Medicare. This represents a two- to three-fold increase in payment rates.

How do you feel about establishment of a lead federal EMS agency and its potential impact on EMS?

Establishing a lead EMS agency at the federal level is an excellent idea. All aspects of the EMS delivery system and the public would be better served. Coordinating all of the federal entities and nongovernmental advocacy organizations that have some degree of EMS involvement could do nothing but benefit EMS and our patients. It could also perhaps do a better job with programs like homeland security grants. But, will it ever happen? I seriously doubt it.