Brattleboro crunches EMS numbers in look to future

Other towns around Vermont warn that providing EMS services is not a revenue producer

BRATTLEBORO — When municipal leaders abruptly ended a nearly 60-year relationship with Rescue Inc. in 2022 and proposed a town takeover of emergency medical services which they claimed would reap up to $700,000 in annual insurance profit, residents weren't the only ones surprised.

So were officials of the 13 Vermont communities that operate their own emergency medical services.

“That whole decision by Brattleboro sent shock waves through Vermont EMS,” said Bill Mapes, chief of the Morristown EMS Department. “Insurance doesn't cover EMS costs. Never has, never will.”

Mapes points to Morristown's yearly ambulance budget of about $800,000. Public and private insurers reimburse his local government some $300,000. That leaves taxpayers to pick up the remaining $500,000.

“Municipalities sometimes think they're going to have this windfall of cash,” said Mapes, a paramedic in the business for 42 years. “Reimbursement is never going to match what it actually costs you.”

Brattleboro leaders revealed their latest revenue projections on May 16 as part of a public process called for at this year's Town Meeting. The new numbers estimate $975,000 in annual EMS reimbursement, with expense figures yet to be finalized.

But Vermont communities that run their own ambulances warn that taxpayers must subsidize as much as two-thirds of spending after insurance collection.

“In a perfect world, funding would not be an issue,” Barre Town EMS Director Paul Ginther said. “The realities are that insurance reimbursements are lacking and tax dollars are finite.”

Seven municipalities in state operate EMS

It's rare for a Vermont community to operate its own ambulances, according to rosters from the state Department of Health's EMS Office.

Some 95% of the state's 247 cities and towns are served by regional outfits such as Brattleboro's former provider, the private nonprofit Rescue Inc.

Seven municipalities offer EMS through their fire departments: Barre City, Burlington, Hartford, Montpelier, South Burlington, Springfield, and Williston. None report an ambulance profit, although it's difficult to determine their exact reimbursement rates, as most of their budgets include unrelated fire costs.

Burlington, for example, can report that it receives about $1.5 million annually through ambulance billing. But without a breakdown of EMS versus fire costs - in part because the two utilize the same staff and facilities - the city can only say reimbursements cover some 10% of its nearly $14 million combined fire/EMS budget.

Six communities run stand-alone municipal rescue squads: Barre Town, Colchester, Milton, Morristown, Northfield, and Stowe. All are more easily able to calculate their reimbursement rates, which show none of them breaking even, let alone banking a surplus.

At first glance, the best-case scenario is Northfield, where up to 90% of its $450,000 annual EMS budget is covered by insurance payments. But that's because the town has only one full-time paid EMS position, with a majority of the work done by part-timers and Norwich University volunteers.

“Wage and benefit costs aren't there, so that's a big savings,” Northfield Town Manager Jeff Schulz said. “Where we come up short is when you throw in the capital budget to replace things.”

Colchester reaps about 70% of its $827,000 EMS budget through billing, leaving taxpayers to pick up the remaining $230,000 this year. But leaders there caution about judging their community against others, as numbers vary based on staffing, call volumes, and whether and how clients are insured.

“It's very hard to compare all this, as it's extremely complicated,” Colchester Rescue Chief Scott Crady said. “It's always such a hard-moving target, so when we do budgeting, it's a guess. But to think it's going to make money? It's not going to happen.”

Colchester, for example, bought a new ambulance last year for $230,000. This year, the same vehicle is priced at $310,000.

“It went up $80,000 in one year,” Crady said. “The costs are starting to go through the roof.”

As for other communities, Barre Town generates 65% of its nearly $3 million EMS budget through insurance, with local subsidies paying the balance of almost $1 million.

Milton raises about 60% of its $626,000 EMS budget through billing, leaving taxpayers to pick up about $250,000 this year.

And Stowe collects one-third of its $760,000 EMS budget from reimbursements and the remaining two-thirds (or about $500,000) from property taxes. That, in part, is because Stowe responds only to 911 calls, as another provider holds better-compensated contracts for other requests (as in Brattleboro, where Rescue Inc. retains that business).

Stowe's budget doesn't include municipal spending on a shared public safety building, general liability insurance, and vehicles replaced under the town's equipment fund.

“It would be hard to correlate one town with another without knowing what in total is included,” Stowe EMS Chief Scott Brinkman said. “But the need for additional funding continues to rise annually. We are seeing incredible wage pressure, the work is becoming more complicated due to advancements in medicine. [...] We are facing many more challenges than we ever used to.”

Nationally, ambulance operating costs jumped 22% between 2017 and 2020, according to a recent FAIR Health study of 36 billion claim records, while average Medicare reimbursement increased by just 5%.

Vermont, for its part, has a higher-than-average number of people covered by federal Medicare health insurance for older adults and Medicaid for anyone with low income, statistics show. But Medicare and Medicaid don't offer full reimbursement, instead offering lower, fixed rates.

“Years of inadequate reimbursement for services rendered, unreliable levels of local, state, and federal support, and the pressure of the global pandemic have pushed our fragile system and those who serve our communities to the point of crisis,” the Vermont Emergency Medical Services Advisory Committee wrote to the state Legislature in a recent report.

Public hearings scheduled in Brattleboro

In Brattleboro, those circumstances didn't stop former Town Manager Yoshi Manale from projecting that a municipal EMS takeover would reap “$500,000 to $700,000 net gain in revenue,” he said, just before the Selectboard approved a transition plan last spring with little notice or public debate.

An independent feasibility study conducted after Manale abruptly resigned eight weeks later not only debunked the former Brattleboro town manager's figures, but also found that Rescue Inc. was the most economical choice for maintaining current local coverage.

In comparison, the study determined that the proposed Brattleboro Fire Department takeover would increase costs but would bolster the town's understaffed system of crisis response.

Brattleboro leaders still haven't shared any of the facts or figures that caused them to drop Rescue Inc. But they revealed new numbers on May 16 that show 83% of the town's ambulance calls are covered by Medicare, Medicaid, or other state and federal sources with limited payouts.

The Selectboard is scheduled to use its regular meetings on the third Tuesday of the month to discuss start-up expenses on June 20 and operating models on July 18. Three more public sessions are set for Aug. 15, Sept. 5 and Sept. 12 before the board aims to vote on a long-term plan Sept. 19.

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