Selectboard gets briefing on nonprofit ambulance service’s financial hassles

Rescue Inc. struggles with rising demand, falling reimbursements

DUMMERSTON — Rescue Inc. says it is looking forward to health care reform leading to a reduction in its percentage of uninsured patients. Meanwhile, its fees, unchanged since 2010, are set to rise somewhat.

Briefing the Selectboard at their regular meeting on Nov. 13, Drew Hazelton, Rescue's interim chief of operations, said the volunteer rural emergency medical service's call volume for ambulances is steadily increasing due to demand for transportation to large specialty hospitals.

“We're seeing a huge need from our community hospitals to move patients to higher levels of care, so you'll notice a lot of our ambulances moving up and down the interstate,” he said.

Hazelton noted that he had been to Dartmouth-Hitchcock Medical Center in Lebanon, N.H. on calls four times the day of the Selectboard meeting, “and this is a trend that we're working on staffing and making sure we have enough ambulances on the road to handle the hospitals' needs, as well as the increase in emergency volume.”

He explained that a patient with chest pains five or 10 years ago would come into a facility such as Townshend's Grace Cottage Hospital, “they'd get put upstairs on the ICU for two days, and they would either get better or they'd get worse.”

“Now,” he said, “quite often these patients come into the emergency room, they're identified has having some sort of cardiac incident, and we're loading them right back in the ambulance and taking them to the cardiac cath[eterization] lab where they're doing more-invasive procedures.”

Hazelton described the diversion of patients to better-equipped specialty hospitals as a national trend.

He said Rescue's executive pay summary, which covers everything from basic life support treat-and-release, to advanced life support, to event standby coverage, was being revised by Rescue's board of trustees and would be passed along to client towns.

He said the revised rates would be lower than most comparable services in Vermont.

Rescue's contract with Dummerston otherwise would be unchanged, he said. Selectmen had received a copy of the town's renewed contract with Rescue Inc. hours before.

Hazelton was introduced by Harold Newell, Dummerston's representative to Rescue Inc. Newell pointed out that Rescue serves 15 towns - 13 in Windham County and two in New Hampshire - across some 600 square miles.

For approximately 25 minutes, the two presented their update and fielded questions on demand for services, rates of reimbursement, and operational costs.

Rescue's website says the organization handles more than 5,000 emergency responses per year, trains approximately 1,000 people a year in first aid and CPR, promotes child safety through its Windham County Safe Kids Coalition, and operates a Technical Rescue Team that provides high-angle and swift-water rescue services.

It also has approximately 40 nationally certified EMTs working 12- and 24-hour shifts throughout each month.

Serving everybody, without question

Even though calls for emergency transports are increasing, Hazleton said, Rescue is dedicated to providing care for anyone, regardless of ability to pay.

“If you're having a heart attack in Brattleboro and you need to go to Dartmouth, it doesn't matter whether you can pay the bill or not, you need to go; we'll still take you to Dartmouth,” he said.

He explained that the percentage of patients receiving federally subsidized health insurance has increased, while the percentage of reimbursement for those programs has decreased.

Hazleton pointed to “another four-tenths of a percent reduction” in Medicare reimbursements this fiscal year, and said time would tell whether recently-enacted health care legislation would decrease the percentage of uninsured patients.

Overall, he said, Rescue is working as hard as it can to recover as much of its operating revenue through insurance and billing, with the rest made up in donations and grants.

That said, there is a shortfall of some 20 percent of its operating budget, he acknowledged, “which is why Rescue has for much of its existence come back to the towns for a subsidy.

This year the organization is trying to come up with those funds in other places. Its subscription campaign (see gives residents the ability to lock in services that existing insurance coverage don't meet, or in many cases aren't covered by insurance.

He and Newell said a car raffle also had helped raise funds.

“We are confident. We are working hard. We are hopeful that, under new legislation, the percentage of people who aren't paying anything will decrease. The idea of this health care reform is that everyone should have some sort of insurance coverage,” he told the board.

Responding to a question from Joe Cook, Hazelton said he could not readily say what the collection rate was on uninsured patients. He promised to return with that figure, but that it would be a low number.

He said that “some of the more interesting ways to look at billing and ambulance revenue” are:

• Under federal law, Medicaid pays 19 percent of its members' ambulance service, and ambulance companies must write off the remaining 81 percent of the receivables. “Anyone in business, if you have to write off 80 percent of your receivables, you're having a bad day,” Hazelton said.

• Medicare pays 40 percent of an ambulance bill. The rest must be written off.

• Under flat-rate billing, Rescue must bill the same cost whether technicians “use every supply in the ambulance or we use none of them,” Hazelton said, “so often the cost of disposable medical supplies and medications exceeds the allowable billing rates.”

Even if Rescue is paid $150 on a call, “the cost of the disposable medical supplies and medications will be $300 to $400. And none of that cost is actually recoverable,” he said.

• Rates for Rescue Inc. services are based on population as of 2010, with Brattleboro, at half the population, absorbing half the cost.

• “People don't realize how many ambulance runs we do. We wear out an ambulance every 18 months. Our fleet mileage is 180,000 miles a year. You guys keep us busy,” Hazelton said.

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