Sign up to save your podcasts
Or
Share Discussion: Part 4 — The Architecture No One Chose
Share to email
Share to Facebook
Share to X
Share to email
Share to Facebook
Share to X
Or
Discussion: Part 4 — The Architecture No One Chose
In our last episode, we heard Chapter 6 from Donnie Woodyard's book, The Dark Ages of Emergency Medical Services — the chapter that reframes the entire CMS debate by asking whether the profession has spent decades fighting the wrong fight.
In this discussion episode, two colleagues sit down to work through an argument that, if it's right, changes everything about how EMS advocates for itself.
The conversation starts with the number that stops you cold: eighty-five percent. That's the share of EMS costs committed to readiness — personnel, vehicles, equipment, dispatch, training, insurance — before the first call of the day is ever dispatched. Only 15 to 20 percent of the total cost is the variable cost of the actual patient encounter. And Medicare's per-transport reimbursement may already approach that variable cost. The profession has spent decades fighting for a higher rate on the fifteen percent while no one funds the eighty-five.
They talk through the hospital comparison and why it's so damaging. Hill-Burton built a third of America's hospitals with federal grants. Tax-exempt bonds finance the majority of hospital construction. Facility fees exist specifically to cover twenty-four-hour readiness. Philanthropy adds billions. And even with all five mechanisms, hospitals still can't fund readiness through patient billing alone. EMS has zero of those mechanisms — and the profession's primary strategy has been to demand that CMS somehow cover everything.
The conversation gets into the police analogy — no one bills a crime victim for the responding officer — and why that framing makes the argument accessible to legislators who've never thought about EMS funding before. They wrestle with what it means for the profession's lobbying strategy if the real fight isn't in Baltimore but in state capitols and county courthouses. And they explore the uncomfortable flip side: if CMS isn't the villain, then who is?
The chapter's answer — the absence of a readiness funding architecture — is simple to state and enormously difficult to build. That's what makes this conversation worth having.
View all episodes
By Donnie Woodyard, Jr.In our last episode, we heard Chapter 6 from Donnie Woodyard's book, The Dark Ages of Emergency Medical Services — the chapter that reframes the entire CMS debate by asking whether the profession has spent decades fighting the wrong fight.
In this discussion episode, two colleagues sit down to work through an argument that, if it's right, changes everything about how EMS advocates for itself.
The conversation starts with the number that stops you cold: eighty-five percent. That's the share of EMS costs committed to readiness — personnel, vehicles, equipment, dispatch, training, insurance — before the first call of the day is ever dispatched. Only 15 to 20 percent of the total cost is the variable cost of the actual patient encounter. And Medicare's per-transport reimbursement may already approach that variable cost. The profession has spent decades fighting for a higher rate on the fifteen percent while no one funds the eighty-five.
They talk through the hospital comparison and why it's so damaging. Hill-Burton built a third of America's hospitals with federal grants. Tax-exempt bonds finance the majority of hospital construction. Facility fees exist specifically to cover twenty-four-hour readiness. Philanthropy adds billions. And even with all five mechanisms, hospitals still can't fund readiness through patient billing alone. EMS has zero of those mechanisms — and the profession's primary strategy has been to demand that CMS somehow cover everything.
The conversation gets into the police analogy — no one bills a crime victim for the responding officer — and why that framing makes the argument accessible to legislators who've never thought about EMS funding before. They wrestle with what it means for the profession's lobbying strategy if the real fight isn't in Baltimore but in state capitols and county courthouses. And they explore the uncomfortable flip side: if CMS isn't the villain, then who is?
The chapter's answer — the absence of a readiness funding architecture — is simple to state and enormously difficult to build. That's what makes this conversation worth having.