GUILFORD — At the Dec. 12 regular Selectboard meeting, the Board unanimously approved Rescue, Inc.'s Fiscal Year 2018 contract to provide the town with ambulance service, but many board members questioned the cost - and one member questioned whether the town needed to support Rescue, Inc. at all.
Rescue, Inc., chartered in 1966, is the Brattleboro-based nonprofit providing emergency medical services to 15 towns in southern Vermont and southern New Hampshire, including Guilford. It is governed by a Board of Trustees composed of appointed representatives from each town. Dan Ingold is Guilford's representative.
Each member-town pays Rescue a per capita yearly assessment. Guilford, with a population of 2,121 as of the 2010 census, pays Rescue $22.63 per resident in the current contract.
The $47,998.23 fee that Rescue, Inc. seeks from the town hasn't changed in two years, according to Rescue, Inc. Chief Drew Hazleton.
At the Dec. 12 Selectboard meeting, Town Administrator Peder Rude provided some data on Rescue's work in Guilford in 2016.
Looking at the numbers
Rescue, Inc. responded to 150 calls in Guilford, including 26 motor vehicle accidents, six falls, seven mental health calls, and four cardiac arrests, among other incidents - but, Rude noted, “probably for privacy purposes,” the statistics didn't mention how many individuals were served per call.
In total, the service responded to “well over 5000 calls” in 2016, according to a Rescue, Inc. dispatcher.
Some board members expressed alarm at how much Rescue, Inc. charges the town considering how few calls involved Guilford.
Board member Gordon Little said, “we perhaps [should] talk to an attorney” about the fees, then questioned the need to pay them - although he noted, “they do a great job as an organization.”
Hazelton provided The Commons with an explanation of how the fees are assessed.
“The [Board of Trustees] representatives from the towns set [them],” he said.
The local delegation to the Vermont Legislature has worked hard to help keep Rescue, Inc.'s fees level-funded, Hazelton said, by securing better reimbursement rates from state insurance. “It is a huge help for us,” he said.
“There is a cost to being available. There's an infrastructure cost whether [the ambulances] go out or not,” Hazelton said, likening EMS to the Fire Department. “The fees aren't driven by the number of patients we serve,” he added.
Mandate question
“I thought the federal government [mandated] if a call goes into Rescue, they're going to respond, whether we're a charter member of a town that's affiliated with them or not,” said Little, who suggested Rescue, Inc. charge the afflicted individuals' insurance company.
Board Chair Sheila Morse pointed out the average price per call is below Rescue, Inc.'s cost of responding to emergencies.
Hazelton confirmed Morse's statement.
“The fees don't offset the cost of patient care,” he said, noting, “a lot of services we provide are nonreimbursable [from health insurance]. If we go to a person's home and we don't end up transporting them, insurance won't cover the call.”
Hazelton said that sometimes Rescue, Inc. can collect “a small charge” for in situ treatment. Rescue, Inc. provides fire scene standby for major incidents, but that's also not covered by insurance.
“This is really important: Vermont has many low-income and elderly residents, and the majority of our residents are on Medicare or Medicaid,” Hazelton said, noting state and federal health insurance reimbursement rates are “less than the cost of supplies,” but Rescue, Inc. is mandated to accept the assignments.
“Depending on the severity of the illness or injury, we often spend more on supplies than is covered,” he said.
Hazelton responded to Little's assertion about a federal mandate requiring Rescue, Inc. to show up to calls, even in a nonmember town.
“That's not the case. There's no guarantee of ambulance service in the state,” Hazelton said, noting, “towns without ambulance service don't get ambulance service.”
Few alternatives
EMS comes from nonprofits, for-profits, or municipal entities, Hazelton said, but there is no statutory guarantee.
“It's the public's expectation,” he said.
“We don't have many other options we can look into,” Rude said at the Dec. 12 meeting.
Morse agreed, reminding Little the Selectboard had explored alternatives to Rescue in the past, “but honestly, I don't think it's that high on our list of priorities in the coming year.”
Hazelton pointed out town officials' direct opportunities - beyond relying on the town's representative to the Board of Trustees - for airing their concerns about Rescue Inc.'s operations and fees.
“We had a meeting in late August or early September and all the Selectboards were invited to give input and ask questions,” Hazelton told The Commons. “I don't believe any representatives from Guilford's selectboard attended.”
“I encourage Guilford [Selectboard members] to come out and learn about emergency medicine. It's more complicated than people think,” Hazelton said. “[Ambulance service] is one of those things that's not important to you until you need it. We don't think about it until a family member struggles to breathe. Otherwise, it's the furthest thing from our minds.”