Turnover Costs in Rural Emergency Medical Services

Funders:	North Central EMS Institute Office of Rural Health Policy (ORHP)
Research center:	ORHP-funded Individual Grantees
Research staff:	P. Daniel Patterson, PhD, MPH, EMT-B
Project funded:	September 2007
Project completed:	August 2009
Topics:	Emergency medical services (EMS) Workforce

Costs associated with providing Emergency Medical Services (EMS) transportation in rural areas are much higher than in urban communities. Turnover is a nationwide, but mostly rural problem for EMS systems that can result in significant increases in operating costs. A rural EMS system that can control or reduce operating costs can improve margins and retain differences between costs and payments for transports as revenue. Because of a lack of research focused on identifying actual turnover in EMS, there are no turnover benchmarks. Additionally, there exists no recognized approach for calculating turnover costs in EMS. Using a random sample of 50 rural EMS systems from across the U.S., our study will identify the annual rate of turnover and associated costs for rural EMS. Over a 6 month period, we will use telephone, mail, and web-based tools to collect system staffing and budget data from a minimum of 25 EMS systems.

Our long-term goals are to spur the development of cost-effective programs for reducing turnover in EMS, identify the impacts turnover may have on quality of care and patient safety, and improve the sustainability of rural EMS systems for rural America. The objectives of this application, which are logical first steps in the pursuit of our long-term goals, are to (1) measure the annual rate of turnover among rural EMS systems, (2) identify costs associated with turnover, and (3) create a budgeting tool for calculating the costs of turnover.

• Hypothesis 1: Among rural EMS systems employing a mix of paid and volunteer staff, greater than 25% of staff turnover annually.
• Hypothesis 2: Annual turnover of full-time and part-time paid personnel increases with decreasing workload, and turnover of volunteer staff increases with increased workload.
• Hypothesis 3: On average, a rural EMS system must spend 1.25 times an employee's annual salary and benefits to replace one paid (part-time or full-time) employee. Costs associated with replacing a volunteer EMS professional are hypothesized to be substantially less than costs required to replace paid personnel.
• Hypothesis 4: Costs associated with turnover are responsible for 20% of the average cost of an EMS transport and consumes greater than 20% of the average per transport payments from Medicare.

The federal government spends billions of dollars every year on ambulance services, and over the past 10 years, millions of dollars have targeted rural EMS infrastructure and workforce conditions. Examination of the impact these programs have had on turnover or associated costs is limited due to a lack of research. As the Office of Rural Health Policy, National Highway Traffic and Safety Administration, and state governments address EMS workforce issues, there must be benchmarks and tools for evaluating their impact. Additionally, local EMS systems need tools for budgeting that have been proven in research. The project outlined in this application can fill gaps in knowledge and provide a tool useful to all of rural EMS.

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