A United Ambulance worker closes the door Monday afternoon after loading a patient into an ambulance at 76 High St. in Lewiston. Russ Dillingham/Sun Journal

AUGUSTA — The high cost of providing services, low reimbursement rates and poor recruitment and retention are contributing factors in bringing Maine’s emergency medical services to a “breaking point,” the commission studying state EMS said in its final report.

Members of the 17-person commission, established by a bill passed earlier this year, met Monday to review and approve its final report.

With only a few minor adjustments to some language, the members at Monday’s meeting approved the report.

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

The most pressing concern that Maine’s 272 service providers are facing is inadequate funding, driven largely by “antiquated and woefully inadequate” Medicare and Medicaid reimbursements, coupled with the high — and increasing — cost of providing services.

This is especially damaging for small, rural service providers who do not respond to high call volumes every year. Not only are these providers saddled with general operating costs, such as salaries, supplies, equipment and maintenance and fuel costs, but they also have the “cost of readiness.”

That means that even if he call volume is low, a service provider must be ready to provide “a continuous, 24/7 ambulance response and services must be geographically dispersed so as to be able to respond to those calls in a timely manner,” the report reads.

The cost of readiness then increases for smaller agencies that respond to a low call volume, according to estimates from member Joe Kellner, vice president of finance and business operations for Northern Light Health’s Home Care & Hospice division and chief financial officer for LifeFlight of Maine. And Medicare and Medicaid only reimburse for calls that end in a transport, and the rate is the same regardless of the agency.

According to Kellner’s estimates, the cost per call for agencies answering an average of 1,800 calls per year is about $800. With only about $490 reimbursed, they lose about $320 per call, or nearly $560,000 per year.

For smaller agencies answering about 300 calls per year, the cost per call is more than $2,500. Only about a fifth of that is reimbursed, meaning they lose nearly $610,000 annually.

More than half the EMS agencies in Maine are transporting services, meaning they take patients from a scene to a hospital, from hospital to hospital or to another location. The majority answer fewer than 500 calls annually. About a third answer fewer than 99 calls a year, according to data provided by Maine EMS, the state board overseeing the regulation and licensing of service providers.

To combat this, the commission recommended the Maine Legislature approve an infusion of $70 million per year for the next five years for transporting services. That funding should be in addition to current subsidies, such municipal contributions and grants.

The commission also recommended that direct funding from the state be “reduced to the maximum extent possible through the utilization of public and private Medicaid match programs.”

It also recommended that for at least the first two years, $25 million of that funding go to agencies that are at an “immediate risk of failing,” which would leave their service areas without adequate EMS coverage.

There should also be an additional $6 million a year for the next five years for nontransporting agencies, according to the commission. There are slightly more than 100 nontransporting agencies in Maine, meaning they provide services at a scene, but do not transport patients.

Member Rick Petrie, a paramedic and executive director of Atlantic Partners EMS, said he hopes the commission’s report will encourage people to reach out to their local legislators so they know “just exactly what the extend of the problem is.”

“There is plenty of need out there in the state of Maine, and everybody is making their case,” he said. “We’ve always been good about, in EMS, about kind of just quietly going about our job, no matter the toll it took and we need to stop that.”

The commission also said the state must address the poor recruitment and retention driven primarily by a dependence on dwindling volunteerism, low wages, inadequate benefits and insufficient training programs. It recommended staff members at nonmunicipal, nonprofit agencies qualify for state of Maine health care benefits and the Maine Public Employees Retirement System, among other recommendations.

Members of the commission said the Legislature should also look at the statutory language and licensure requirements for home health care providers and community paramedicine. Paramedicine is the branch of medicine dealing with emergency medical care given to those who are injured or ill, typically at a setting outside a hospital.

Finally, the commission noted in its report that its study of EMS in Maine was nowhere near complete, and recommended another blue ribbon commission be established for the 131st Legislature, which convenes Wednesday.

“My path into this world came from town leaders and directors of EMS that were ringing the alarm bell saying, ‘We’re in a whole world of trouble,'” Sen. Chip Curry, D-Belfast, co-chair of the commission, said at the close of the meeting. “We’re saying this is a crisis so that motivates people. It motivated me.”

Staff members from the Office of Policy and Legal Analysis have about 48 hours from the close of Monday’s meeting to make the final changes and get votes from the absent members before the report must be provided later this week to the Legislature’s Joint Standing Committee on Criminal Justice and Public Safety.