BRATTLEBORO — Regional and state leaders are voicing concern about Brattleboro's surprise last-minute severing of ties with Windham County's largest emergency medical services provider, Rescue Inc. [“Brattleboro breaks ties with Rescue,” News, April 20].
“I think it's a given that there will be some bumps in the road,” Putney Fire Chief Tom Goddard, newly elected chair of the state's southeastern EMS district board, told his peers at a meeting after the action. “This is a pretty significant, huge change.”
The Brattleboro Selectboard voted last week to end the town's nearly 60-year association with the private nonprofit Rescue Inc. in hopes of transitioning to a local fire department takeover of EMS calls.
A resulting wake of questions about the decision, which came with little notice or public debate, has rippled as far as the State House in Montpelier.
“The town of Brattleboro just pulled out from Rescue, which is one of the worst decisions ever made,” Sen. Jeanette White, D-Windham, told her chamber's Economic Development, Housing and General Affairs Committee during a discussion about state EMS concerns last Friday.
'Things will certainly be different'
Many locals are asking in meetings and on social media why Brattleboro dropped Rescue before conducting a full economic feasibility study of running its own fire/EMS unit and calculating how the move would impact the rest of Windham County and its mutual aid system.
Rescue, whose Brattleboro contract ends June 30, is aiming to reconfigure its operating plan before a meeting next month with its more than a dozen remaining member communities in southern Vermont and neighboring New Hampshire.
“From our perspective, things will certainly be different as we reallocate our resources and reshape our response model,” Rescue's chief of operations, Drew Hazelton, told the southeastern EMS district board last week. “That's certainly going to have an effect on everybody.”
Rescue will focus on providing “the same level and quality of service” to member communities but no longer will be able to answer calls in Brattleboro and other places outside its coverage area.
“Rescue has played a huge part for a long time in the greater regional response,” Hazelton said. “For example, a homicide or motor vehicle accident that calls for five ambulances, we've been able to usually take that pretty well in stride. That may not be the case moving forward. As far as mass casualty and large incident planning, there's going to need to be some significant discussion as to what that looks like.”
The Brattleboro Selectboard said it decided to drop Rescue based in part on claims the provider wouldn't share financial information and was opposing the fire department's EMS expansion plans.
“Despite the quite fair assessment that this is happening too quickly, this is what I feel is right for Brattleboro, for our safety, for our pocketbooks,” said Selectboard member Tim Wessel, who's running for one of Windham County's two state Senate seats this fall.
Newly hired Brattleboro Town Manager Yoshi Manale has estimated the municipality could make upward of $700,000 annually by taking over EMS delivery and billing.
But since the Selectboard voted last Tuesday, regional and state officials have refuted many of local leaders' assertions.
Manale said he had asked Hazelton for the private nonprofit's administrative costs and local insurance compensation at a meeting Feb. 9, only to be rebuffed.
In response, Rescue trustee Kathy Hege said that's because only the board that she chairs is authorized to release such information (which isn't broken down by community) and the town manager never followed up after the initial meeting to learn that - or anything else.
“I truly believe that, had the town manager taken the time to understand the 56-year relationship between the town and Rescue, we wouldn't be where we are,” Hege said. “If Mr. Manale had requested to meet with the officers of the board, at least he would have been talking to the individuals that had the power to make decisions on the agency's behalf.”
In response, Manale said the two sides “have different recollections of that meeting” and “I'm not going to continue a back-and-forth with them.”
Municipal leaders went on to write Rescue a letter this month charging Rescue with not only a lack of transparency but also “disturbing and highly inappropriate” behavior by its operations chief for opposing the local fire department's EMS expansion plans.
Until this month, Hazelton was chair of the southeastern EMS district board that oversees such applications. But state EMS Chief Will Moran said the Rescue administrator had nothing to do with reviewing the Brattleboro request, as Hazelton had abstained from leading and voting on the matter.
“The license application was still pending,” said Moran, an official with the Vermont Department of Health, “because it was not complete.”
The EMS district board, in fact, has since approved Brattleboro's application, even though the town has yet to receive all of the equipment required by the state.
Reconciling the numbers
During several public meetings last week, local residents and state leaders questioned the Brattleboro town manager's assertion that the municipality could reap up to $700,000 in revenue annually by charging for EMS calls.
Brattleboro could send out bills, officials say, but that doesn't mean private insurers and federal health care programs such as Medicare and Medicaid will pay those rates.
Ambulance operating costs have risen 22 percent between 2017 and 2020, according to a recent national FAIR Health study of 36 billion claims records, while average Medicare reimbursement has increased by just 5 percent.
Rescue was set to charge Brattleboro $285,600 in the coming 2022-23 fiscal year because that's how much would be needed on a per capita basis for the nonprofit to meet expenses after receiving what private and public insurers pay for reimbursement.
“As a nonprofit, we ask communities to kick in what amounts to about 18 percent of our operating budget every year to make us break even,” Hazelton said.
Hazelton knows the challenge both locally and statewide. He's chair of the Vermont EMS Advisory Committee that has studied the financial issue for the past five years.
“It's universally accepted that the current reimbursement system in Vermont, which is very heavily designed by the federal government because of the Medicare and Medicaid programs, does not cover the costs to deliver service,” he said.
White and other state legislators agree. They've been exploring not only funding problems but also the resulting effect on recruiting and retaining EMS workers.
“If Rescue has to have bake sales in order to fund themselves,” White told her Senate colleagues, “I don't know how the town of Brattleboro thinks that it's going to get an extra $700,000.”
Town leaders say they plan on commissioning a feasibility study for a joint fire/EMS unit. But longtime locals point to similar assessments dating back to 1983, when then–Town Manager Corwin “Corky” Elwell - father of Peter Elwell, who retired in December from the same position - determined the community would end up with more expenses than revenue if it went into the ambulance business.
The Brattleboro fire chief at the time, the now-late T. Howard Mattison, recommended the town contract with Rescue - whose $76,000 request in 1983 would be about $220,000 in today's dollars - to curb budget bickering.
“Everybody gets all heated up and mad at everybody,” Mattison said at Brattleboro's 1983 Town Meeting, “and I think it's about time we stop it.”