AUSTIN (Nexstar) — A new $50 billion federal program is giving states the chance to share and develop new strategies to transform rural healthcare across the country. Emergency medical service providers in rural Texas counties have some ideas to help address unique challenges they face everyday.
The new program, called the Rural Health Transformation program, was created by the enactment of the One Big Beautiful Bill that Congress passed this summer. All 50 states have been asked to apply for a share of the $50 billion program to help address each state’s rural health challenges.
The Texas Health and Human Services Commission (THHSC) is working on the state’s application to the federal government, and has asked different stakeholders to submit ideas and concepts on what they think should be included in the application.
Half of the money will be split evenly among each state, but the additional $25 billion will be paid out “based on individual state metrics and applications that reflect the greatest potential for and scale of impact on the health of rural communities,” according to the Centers for Medicare and Medicaid Services (CMS). The money will be paid out over the next five years, starting in 2026.
A spokesperson for THHSC said the agency received 303 submissions from the public and is in the process of reviewing each one. CMS has set Nov. 5 as the deadline for state application submissions.
Challenges facing rural EMS providers
Michael Furrh is the EMS Chief for both Lavaca and Colorado counties. He oversees a team of about 95 personnel and eight ambulances between the two counties. Located in a rural area between Houston and Austin, the two EMS departments combine to serve an area about the size of 2,000 square miles with roughly 40,000 people.
One of the challenges Furrh’s team faces, similar to many rural EMS teams, is not the volume of calls they receive, but the amount of time each call takes. They are tasked with covering 911 calls on top of transferring patients from local hospitals to higher levels of care in bigger cities. For Furrh’s team, that could be Houston, Austin or San Antonio.
“That’ll take an ambulance out of service for four to five hours, even up six to seven, depending on what time of day it is,” Furrh explained.
It’s not just interfacility transfers adding time and miles to ambulances, but also the type of injuries in the 911 calls. Casey Ebrom, the EMS Chief for Karnes County, estimates about 40% of the 911 calls his team responds to go directly to hospitals in San Antonio.
The average time on a call for Karnes County EMS is between 3.5 to 4 hours, according to Ebrom. He oversees a team of 24 personnel that keep three ambulances fully staffed 24/7. He keeps track of data when there is zero ambulances, a term known as “status zero.”
In 2023, Ebrom said his service area was at status zero for 86 hours out of the entire year. Although that number seems very little for an entire year, Ebrom puts it into perspective for his bosses on the commissioners court by saying it’s like if there was no ambulance available for Christmas Eve, Christmas Day, New Year’s Eve, and a portion of New Year’s Day.
Both Ebrom and Furrh said they have mutual aide requests with nearby agencies to help them when they are experiencing a high volume of calls or are at status zero.
“We have a bad wreck that has three or four injury trauma patients that are severe, we’re not coming locally, we’re going to San Antonio, and so we can very quickly exhaust our resources by one call,” Ebrom said as an example.
Another issue is the cost of staffing enough paramedics and EMTs. Carly French, the EMS Chief in Seminole, TX, a panhandle Texas town near the border of New Mexico, said she has to rely on a team of volunteers to help staff trucks during a high volume of calls. She has 12 full time employees and is looking to grow that number as a higher demand grows in her area.
It’s part of a transition in rural Texas where volunteers are aging out and the cost of becoming a paramedic is not worth being a volunteer, where you are only paid if you get called out, French explained.
“In rural America, we’re transitioning from a volunteer type agency to a paid type agency, and because of the lack of funding, you know, it’s hard to pay our staff,” French said.
She also said the reimbursements from Medicaid and Medicare services are falling short of the costs it takes provide EMS services. She said of the millions of dollars she bills for services, she is only receiving about 30% in reimbursements.
“Reimbursement rates are are not increasing, and we are going to rely heavily on financial support from our local governments, the taxpayers, in order to sustain our operations,” French said.
What’s the future of EMS services in rural Texas?
Ebrom said he believes the future of rural health services will be mobile integrated health. Put simply, it would utilize emergency medical services to integrate care at home rather than taking someone to a hospital.
Ebrom explained the concept by using a fake patient known as Miss Smith. She’s a frequent caller needed a lift assist because she fell in her house and she’s feeling weak because she’s not taking her medication. In this example, Ebrom said EMS will go out to her house and usually take her to an ER if she wants to go. He calls it a vicious cycle. He explained what a new model could do to end the cycle.
“It’s going back to like a root cause analysis right of utilizing EMS, a trained provider that is not just focused on emergency medicine, but also focused on long term care and disease management, that can go into those spaces in our homes and say, ‘Miss Smith, let’s have a conversation,'” Ebrom explained.
Furrh also said the use of technology will be important in transforming rural healthcare. Things like telehealth could prevent a trip to the hospital for certain patients. “I can take an iPad while I’m there with them, or my paramedics and EMTs are there with the patient, and I can connect that patient immediately on the iPad with the physician,” Furrh said.
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