Expert EMS Billing

Advocacy in EMS: What Does Engagement Look Like?

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In today’s fast-moving world, it can seem daunting to get actively engaged in the political process. Many EMS leaders avoid it completely, whether locally, statewide or nationally. However, allowing policy decisions to happen to us is never a good strategy. The reality of the current EMS environment is that we cannot afford to ignore the opportunity to advocate for our profession and the communities and patients we serve.

Impact on EMS

EMS professionals face a variety of challenges to sustainably provide high-quality, pre-hospital care services. Personnel shortages, drug and supply shortages, funding challenges and a myriad of regulatory expectations make delivering services more complicated than it was 20 years ago. The reality is that government policy is evolving every day, with both direct and indirect impacts on our ability to serve our communities. Changes to Medicare and Medicaid policies, an evolving global geopolitical environment, and many other policy matters are impacting EMS agencies, both in the near term and over the long term.

Key Elements of a Strong Advocacy Effort

Despite these challenges, there are some fundamental elements of an advocacy strategy that can help EMS leaders meaningfully impact the political process.

Get Educated

There are plenty of resources to help EMS leaders understand the policy issues that are impacting our profession. A great place to start is by joining one of the many national and regional professional associations that represent our community. The American Ambulance Association, the National Association of EMTs, the International Association of Fire Chiefs and many others have highly active advocacy programs and tools available to their members. Many of these organizations provide a wealth of information about the legislative and regulatory issues that impact, or have the potential to impact, the EMS world.

Another resource is your vendors and partners; check with them to assess their engagement in advocacy. In our case, both Bound Tree and Digitech have regularly active advocacy teams, working each day to raise awareness and educate lawmakers and regulators about the challenges we face.

Build Relationships

There is a common misperception that those who make policy have their minds made up. The reality is that those who govern are often very open to learning. Take the time to introduce yourself and your organization. Educate those who set policy about the services you provide and the challenges you face. Remember that the people you employ, and the people you serve, are also constituents of your elected officials; a powerful connection that can influence a legislator’s approach to policy decisions.

Build Coalitions

There is value in numbers and consensus. Advocacy isn’t something that succeeds in isolation. Any effort to impact policy is often strengthened by presenting a strong coalition of stakeholders who support an idea or solution. Connect with other organizations, related disciplines and geographically connected groups with which you share common ground. Work together, where possible, to craft and advance your message.

Have an Elevator Pitch Ready

There is always a great deal of noise in the political process, where success is often determined by how simple and memorable the message is. Presenting a 42-point plan to improve the delivery of EMS will not likely get much traction. However, delivering a consistent message regarding the top 3 challenges your organization faces, and 3 “asks” that will help you address these challenges, is something that can build census and momentum. Before you engage with government officials, develop and hone your elevator pitch to tell the story in 10 minutes or less.

Practical Efforts

Whether it’s your town council, state representatives or the U.S. House of Representatives, lawmakers face elections on a regular basis. They are motivated to stay connected to those they represent—and that creates opportunities to interact with them directly.

Hold an Open House

The services you provide, and the way your organization provides them, may not be familiar to lawmakers. Invite them to visit your facility. Scheduling may take some time but get something on the books for when the representative is in town. In some cases, a ride along may be possible. Organize the opportunity around the availability of the official.

Panel Discussions

Ask an elected official to participate in a discussion about EMS. This can be a very valuable experience, as well as a solid relationship-building exercise. Assemble a group of stakeholders, including the representative, to participate on site. This two-way dialogue can both educate the representative about EMS and allow them to help EMS leaders understand the challenges and processes they face.

Photo Opportunities and Remembrances

If you can arrange a visit to your agency, be sure to create a photo opportunity to memorialize the event. A team photo of the representative with your staff, a photo with your equipment in the background, or an action photo with the representative observing a training exercise are examples of compelling images. If you have ever visited a government official’s office, you’ll almost always notice awards and memorabilia the representative has received. The importance of such items cannot be overstated.

Aides are an Important Audience

Most elected officials have staff that assist them in performing their duties and carrying out their service. These individuals tend to be trusted advisors and in many cases are the first step in evaluating whether a specific policy decision is made. Meeting with staff and investing time into building relationships with key staffers is an important part of the process.

Never Too Late to Take the First Step

As you ponder some of these ideas, please don’t allow historical inertia to keep you from moving forward. Start by setting aside some time to get educated, hone your message, seek out and build relationships with key decision makers, and dive in. There is a plethora of policy matters unfolding in the halls of Congress, State Houses, and Governors’ Mansions that will impact how we deliver EMS today and in the future. Don’t let the past limit the future for you and your organization. Now is the time!

For additional insights and ideas, please join us for our Advocacy in EMS Webinar on May 19, 2026. Register here.

What Lies Ahead for Prehospital Care Finances

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From the operational challenges associated with a global pandemic, to staffing difficulties, to ongoing reimbursement shortfalls, it seems as if the Prehospital Care Community in the United States has been under siege for years. And now, as the budget reconciliation process continues in Washington and the Federal Government recalibrates in the post-DOGE era, there are both risks and opportunities for healthcare providers and suppliers.  

Headwinds Ahead

In an ever-shifting landscape, uncertainty has become the norm. Here are some of the challenges that lie before the pre-hospital care community:

Cost Pressures

The cost pressure is no surprise to anyone who follows our industry. However, what does the future hold on this front? It stands to reason that labor costs will continue to rise as certain members of our teams catch up from historically low wages. Shortages of key professionals are expected to continue and, in some cases, accelerate in the years ahead. In addition, the cost of equipment, supplies and technology continues to rise at alarming rates—if you can even get the medications and/or ambulances to put them in.

Government Budget Challenges

As the saga of the Federal budget process plays out in our nation’s capital, we should note there are challenges in State and Local municipal budgets as well. The projected cuts in Federal spending are destined to impact Medicaid, Medicare, and many other healthcare programs. To compound the issue, many State and Local agencies are seeing federal dollars that they relied on for other key programs to cut. Likewise, changes in funding for education are likely to impact the institutions that offer the majority of the training required to develop new EMTs, Paramedics, and Nurses.

Balanced Billing Challenges

The EMS community is entering an era of uncertainty as States continue to address the impact of balance bills to patients. Those of you in the air medical services portion of our community are several years into what we know as the No Surprises Act (NSA). While many states are taking a slightly different approach to addressing this issue on the ground side, the reality remains the same, and our ability to cost shift (make up the shortfall from inadequate government payments, uncompensated and undercompensated care) will be significantly diminished.

Tariffs

While we are still relatively early in the “tariff era,” economists believe the near-term impact will be higher prices for many goods used in healthcare delivery. Some remain hopeful there will be a more positive long-term impact as domestic production of many of these items ramps up. Only time will tell, but it seems logical to assume the current tariff related cost pressures will evolve into significant cost increases for healthcare supplies for the next 1-4 years.

VA Reimbursement Cuts

The stay of execution on VA payment cuts was issued last year. It was a huge relief for agencies that operate in areas with large Veteran populations. However, there is still a need for VA leadership to address the findings of the Government Accountability Office (GAO) study and develop a more balanced payment mechanism for medical transport services to avoid reduced payments from the VA.

Opportunity on the Horizon

At the same time, there are doors that can open even in times of uncertainty. Here are some of the opportunities that may present to the pre-hospital care community:

Market Rationalization

Our organizations operate with very high fixed costs (what we call readiness costs). This means that the ultimate performance metric, cost per transport, is tied tightly to the volume of episodes of care we provide. As economics become more challenging, there are often reductions in the number of suppliers. That reduction creates an opportunity for the remaining organizations to reduce their cost per transport by increasing volumes and getting economies of scale. Of course, expansion of services and/or service areas must be carefully evaluated and implemented.

Medicare Payment Reform

Compiled data from the Ground Ambulance Data Collection System (GADCS) shows that there will now be relatively objective data on the operation of prehospital care organizations. Likewise, the NSA prescribes a similar data collection process for air ambulance service. The air ambulance process should commence with the publication of the final NSA rule. The industry is hopeful this data may be applied to a comprehensive effort to reform the current Medicare payment system. Anyone who has been around the EMS community for more than a few years understands that Medicare reimbursement is less than adequate. For the first time in many years, we may actually have the data to support a rational calibration of the Medicare Ambulance Fee Schedule.

Readiness Movement

In many areas of the country, community leaders have come to grips with the concept of readiness costs. Some communities are making efforts to compensate prehospital care organizations accordingly. While a great deal of work is left to be done in this area, there are certainly models to build upon. This is an area that has the potential to change the economic landscape of EMS in many portions of the country.

VA Payment Reform

While there is still risk the reimbursement payment system will result in dramatic reductions in payment for prehospital care providers, there is also an opportunity for the emergence of a rational system of compensation for the prehospital care of VA patients. EMS leaders need to continue to track this matter and pursue policy change that is balanced and rational.

There is Hope…

As you weigh these many factors that will impact prehospital economics in your own organization and in the years ahead, recognize there is hope and opportunity. There is more movement toward true financial reform than we have encountered in recent years. More data is now available to us. There appear to be emerging champions for EMS payment and financing reform. The industry seems to be more engaged and united in its commitment to achieve rational reforms.

While headwinds are inevitable—and EMS leaders must and prepare their organizations for the storm—we must never lose focus on the opportunities that lay before us.

How EMS Leaders Build Cultures That Drive Performance

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Creating a culture of excellence requires EMS and Fire Service leaders to take an intentional approach to blending optimal clinical outcomes, meaningful continuing education, consistent compliance, and thoughtful organizational management.  

In our recent webinar, More Than Mandatory: How EMS Leaders Are Building Cultures That Drive Performance, we asked a panel of experts to share how they guide their teams to balance everyday challenges with building a culture that can sustain a thriving agency. 

Across three very different organizations—Area Ambulance Service in Iowa, Plum EMS in Pennsylvania, and the Oklahoma City Fire Department—these leaders described culture not as a side initiative, but as a core operational strategy. Their message was consistent: Strong culture doesn’t happen by accident. It is built deliberately, reinforced daily, and led from the top. 

Leadership Sets the Tone 

The conversation opened with a reality familiar to EMS leaders everywhere: The job has never been more complex. Agencies are navigating workforce shortages, financial pressures, evolving clinical demands, shifting regulations, and the cumulative mental strain placed on providers. 

Our panelists agreed that in a constantly shifting landscape, culture is a vital stabilizing force, shaping how EMS teams respond to challenges. Across the board, it was agreed that leadership needs to set the tone to ensure a culture in which employees feel supported rather than burned out.  

“We can talk about culture all day,” said Jennifer Zahrt, CEO of Area Ambulance Service, “but if we’re not out front setting the example, it’s just not going to take root.” 

Oklahoma City Fire Department Chief Richard Kelley emphasized the importance of authenticity in leadership, as culture shows in how leaders communicate, how they handle challenges, and how visible they are to their teams.  

“People don’t care how much you know until they know how much you care,” Kelley said, underscoring a philosophy that prioritizes trust and connection as the foundation of performance. 

All three panelists emphasized the role of transparency in building that trust. Rather than limiting access to information, the leaders described a deliberate effort to share everything from financial data and operational performance to areas where leadership needed to improve. At Area Ambulance, regular town halls provide a forum for employees to ask questions directly, with no topics off-limits. At the Oklahoma City Fire Department, engagement surveys and open communication channels allow leaders to identify employee concerns and respond in real time. Ultimately, the goal is not just to inform, but to align with those they are leading. 

Defining Standards and Holding to Them 

While culture is often discussed in broad terms, the panelists emphasized the importance of making it concrete through clear expectations. 

At Area Ambulance, that clarity is distilled into a simple but powerful mindset designed to avoid fruitless venting and promote action: “Fix it or forget it.” Team members are encouraged to either take ownership of a problem by finding a solution or to let it go, eliminating the kind of subtle negativity that can quietly erode culture over time. 

More broadly, Zahrt framed accountability not as a punitive measure but as a cultural strength—a call to the standard. In EMS environments, where much of the work happens without direct supervision, that distinction matters. Adhering to a cultural standard becomes the guide that informs decision-making, reinforces expectations, and shapes how individuals respond under pressure. 

Or, as Zahrt put it: “What happens when nobody’s watching is what determines your outcomes.” 

Plum EMS Director of Operations Brian Maloney says his agency puts focus on collaboration and continuous learning to create a culture where employees take initiative and pursue excellence together.  

“We try to create an environment where people feel supported rather than scrutinized,” he said, adding that the result has been improvements in clinical performance, documentation, and patient satisfaction. 

Measuring Culture Like Any Other Priority 

Another key theme of the discussion was measurement. Culture, the panelists agreed, should be evaluated with the same rigor as clinical or operational performance. Chief Kelley said Oklahoma City Fire leverages engagement surveys to track employee sentiment and identify areas for improvement. At Area Ambulance, Zahrt’s team uses structured “people metrics” to assess trust, accountability, and leadership effectiveness. Low scores in areas like trust or accountability are treated as signals, prompting conversations, guiding training, and informing leadership decisions.  

Over time, data measurement and tangible responsiveness reinforce credibility and demonstrate that feedback leads to change. It can also create a culture that people want to be a part of, according to Maloney. 

“In the history of Plum EMS, we’ve only posted to hire for a position once. We’re lucky to have always been fully staffed and if or when someone does resign, we have good quality people in the pipeline,” he said. “It’s one of the things the culture and the people here have created, and I can’t give them enough credit for it.” 

A Continuous Commitment 

Finally, all three panelists agreed that building agency culture isn’t a one-time initiative. It requires ongoing attention, focused on finding ways to connect leadership, teams, operations, and outcomes. 

“There’s no magic recipe,” Zahrt said. “If you’re not proactively driving your culture, you’re going to fall behind.” 

To catch the full panel discussion, you can watch the webinar on demand.  

Advocacy in Action: EMS Day on the Hill 2026

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On March 26, 2026, more than 350 EMS leaders, advocates, and supporters gathered in Washington, DC for EMS on the Hill Day, an annual advocacy event. Members of the Digitech team accompanied agency representatives, spending the day meeting with Senators and House Representatives to garner support for current legislative bills that impact our industry.  

Together, we brought a unified message to Capitol Hill, advocating a slate of legislative priorities designed to modernize care delivery, strengthen the workforce, and ensure the long-term sustainability of emergency medical services. Among the top priorities this year were legislative bills focused on Treatment in Place (TIP), Mobile Integrated Health (MIH) and Community Paramedicine (CP) programs, as well as rural EMS agencies.  

Here are a few highlights of the legislative priorities: 

Treatment In Place and Mobile Integrated Health 

At the forefront of proposed legislation is the Comprehensive Alternative Response for Emergencies (CARE) Act, which would allow EMS providers to be reimbursed for treating patients in place; an important shift toward more flexible, patient-centered care that reduces unnecessary hospital transports while still supporting agency revenue. Despite the demonstrated benefits of such methods, funding remains a roadblock for agencies. One National Association of Emergency Medical Technicians (NAEMT) study found that 38% of MIH-CP programs across the country that had ceased operations over a three-year period attributed their closure to funding, staffing, or resource shortages. In addition to the CARE Act, however, the complementary Community Paramedicine Act would expand Mobile Integrated Healthcare (MIH) programs through federal grants, enabling EMS agencies to play a larger role in preventive and community-based care, particularly in underserved areas. 

Rural EMS Support 

Sustainable funding remains a critical concern for rural providers, particularly in the face of rising costs and increasing hospital closures. According to the National Rural Health Association, nearly 50% of rural hospitals in the United States are operating with negative margins, leaving them vulnerable to closure. When a rural hospital closes, the surrounding communities lose access to vital care, often leaving EMS agencies to fill the gap. Continued investment through Supporting and Improving Rural EMS Needs (SIREN) Act grants would deliver essential resources for training, equipment, and operations to agencies that often serve as the only healthcare access point in their communities. 

Prehospital Blood Transfusion 

Another focus was the ability to administer blood in the field; an increasingly vital practice in rural and outlying communities where transport times to the hospital can stretch or that represent logistical challenges. The improved outcomes and real-life examples of such practices are clear. According to the National Highway Traffic Safety Administration (NHTSA), severe bleeding is the primary cause of preventable fatalities in trauma patients, but with the prompt delivery of prehospital blood, it’s estimated that 37% of trauma patients with severe bleeding could be saved; and that for every minute of delay in administering blood, the risk of death increases by 11%. Yet despite the documented benefits of administering blood in the field, the EMS reimbursement structure hasn’t been updated. The proposed Reimbursing Emergency Services for Critical Use of Emergency Blood (RESCUE) Act addresses this financial gap by ensuring EMS agencies are reimbursed for administering blood in the field, helping expand access to lifesaving prehospital interventions. 

National Recognition and Support 

Finally, EMS leaders emphasized the importance of recognition and advocacy at the national level, first with the Honor Our Emergency Medical Services bill which seeks funds and backing to establish a National EMS Memorial. Similar to our national fire and police memorials, the new memorial would honor those EMS personnel who have died in the line of duty. Continued support for the Congressional EMS Caucus was also emphasized, ensuring these and other industry priorities have a strong, bipartisan voice in Washington to help promote, educate, and increase awareness among decision-makers on the federal EMS policy. 

Together, the initiatives at the center of EMS Day on the Hill 2026 reflected a comprehensive approach to advancing EMS, addressing some of our industry’s key challenges, and laying the groundwork for a more resilient, responsive system of care.