Last evening we had a very productive meeting with
representatives of the City of Ogdensburg regarding the renewal of our
ambulance service agreement. We discussed the issues and the benefits of the
agreement to both parties. There are some areas that need to be modified, due
to changes in the manner that both the city and the Ogdensburg Volunteer Rescue
Squad (OVRS) currently operate. We look forward to a new agreement that
addresses those issues.
We acknowledge that we have not done a very good job of
keeping the city council, or the citizens of Ogdensburg well informed as to our
operational and financial challenges. In this post we are sharing with you much
of the information that we shared with the city. It is our hope that it will
answer many of the questions surrounding our operation, clearly illustrate the
financial positions and operational challenges facing the Ogdensburg Volunteer
Rescue Squad, and clear up many misconceptions.
The first thing that we wish to point out is that the OVRS
is not a part of the City of Ogdensburg’s government or services. The only
financial support that we receive from them is in the form of in kind services.
The OVRS provides some in kind services to the city in return. Our main sources
of income are in the form of revenue received through billing patients for our
services and donations from the public. Our service agreement helps to assure
that ambulance service is available to residents of the city.
The OVRS is a combination department currently consisting of
four full time and six part time paid ALS providers, two paid EMT basics, and
39 volunteers with varying levels of certification. Only 14 of our volunteers
live in the City of Ogdensburg. The rest are out of town volunteers, some of
whom come from as far away as Quebec to pull duty in Ogdensburg one day a week.
In 2015, we showed a surplus of $61,224.95. Without the
receipt of a $75,000.00 bequest, that would have been a $13,775.05 loss. In
2016 we were in the red by $28,452.68. In 2017, through the end of November, we
are running a deficit of $24,178.03. To top off the news, we just received an
estimate of $15,000.00 for roof repairs that need to be completed as quickly as
possible.
The city parcel (Old Hackett Hardware Property) is a single
parcel being utilized by the OVRS. As such it is exempt from property taxes per
state law. Should we rent a portion of the building, the entire parcel becomes
taxable, not just the portion that we rent. That has created a major
disincentive to search for tenants.
We have a purchase offer in place for the land that we own
outside the city on route 812. The land is currently being leased in
anticipation of that purchase. That lease has made the land taxable, and we are
paying town, county, and school taxes on that parcel. The funds used to
purchase this parcel came from our endowment funds. These funds will need to be
restored once the sale is complete. Our endowment consists of bequests, estate
gifts, and donations to be placed in savings with the purpose of providing
income from interest and financial returns.
A new ambulance of the type we have in service now costs in
excess of $200,000. We recently had the patient care compartment of an old
ambulance reconditioned and remounted on a new chassis for about half that.
Each of our four ambulances contains approximately $100,000 worth of equipment
and supplies. Most medical supplies have an expiration date, and must be
replaced on a regular basis. Our vehicle replacement program is well behind
schedule. This year, due to continued problems with the diesel engines on our
vehicles, we purchased a used ambulance to assure that we had at least two
vehicles in service. That fourth ambulance has become an important part of our
vehicle rotation with the increase in out of town transports.
We have been informed our cardiac monitors are no longer
being supported, cannot be covered under a service plan, and may not be able to
be fixed if a major repair is needed. They have suggested that we begin looking
to upgrade. At a cost of approximately $35,000 each, times four, it is something
that we cannot even consider at this time.
It is our opinion that our volunteers should not be expected
to work at fund raising events for the privilege of working for free. Our
volunteers each pull a 12 hour shift every week. Actually, every six days for
the overnight crews. It is increasingly difficult to recruit and certify
volunteers willing to put in the time necessary for duty and training, let
alone spending hours on fund raising. The profits from our most recent fund
raisers have barely exceeded the cost of holding them.
If the current trends in EMS continue, all of the
municipalities in NYS need to start making plans to increase the number of tax
dollars committed to keep their EMS systems in place, rather than looking to
cut.
The NYS DOH recently conducted a survey of EMS agencies in
the state. They found that the average cost to those agencies per transport was
$335.00. Remember that this includes volunteer, combination, paid municipal,
and commercial agencies. The OVRS found that, due largely to our mortgage, our
expense per transport was in the area of $500.00. Our average reimbursement
rate per transport is $353.78. We do not turn over unpaid bills for collection,
or report them to any credit agency. The only time that we aggressively attempt
to collect is when the insurance company has sent the check for service to the
patient, and it is not turned over to us.
A large number of our transports involve Medicaid and
Medicare patients. The current Medicaid rate is $154.58 for a BLS transport,
and $237.58 for an ALS transport. The current Medicare rate is $276.75 for BLS,
and $328.75 for ALS. Most insurance companies also pay a negotiated, or
industry standard, rate rather than the billed rate. Since the US government is
working very hard to reduce Medicaid, Medicare, and individual insurance
coverage, the future is uncertain, to say the least.
In an attempt to increase our revenue stream we have
recently begun accepting transports from CHMC to Syracuse, Plattsburgh,
Burlington, and other areas. We anticipate that we will need to take a minimum
of five paying transports per week to cover the increased cost of personnel,
maintenance, and vehicle replacement. The transport crew must be in addition to
the duty crew providing 911 coverage to our primary area.
Our primary coverage area consists of the City of
Ogdensburg, the Town of Oswegatchie, the Town of Depeyster, and the Village of
Heuvelton. We also provide Advanced Life Support and mutual aid response for
all of the surrounding towns and villages as far away as Hammond, Macomb,
DeKalb, and Waddington. No matter how much we wish that we could, we cannot be
in two places at once. The coverage of second and third calls is dependent upon
the availability of volunteers to respond at that given time and place. Often,
that extends to the availability of volunteers in our neighboring mutual aid
agencies.
The cost of providing care is increasing in every category,
but especially in the areas of providing certified emergency care providers,
which by law, an ambulance cannot roll without. The NYS reimbursement rates for
training have not increased since 2009, and the DOH EMS budget was cut again
this year. For the past several years, our providers have been able to take the
necessary EMS certification courses up to the EMT-CC level without charge to
the student or department. Due to the fact that reimbursement rates no longer
cover the cost of providing the course, the individual or agency is now
responsible for the increased fee. NYS has discontinued the EMT-CC level of
certification, which in St. Lawrence County was funded by the state. After the
currently certified EMT-CCs leave the field, the only ALS alternative will be
to hire Paramedics. There are not many volunteers that are able, or willing, to
take a two year college program (1000 -1200 hours) to become a Paramedic,
versus the 300 - 400 hour EMT-CC class over the course of two semesters. The
Paramedic program also involves a considerable financial expense to either the
student or the agency.
The basic EMT class is currently 150 plus hours in length,
The AEMT class is 160 plus additional hours, and the Paramedic class is 1,500
hours plus. Despite it’s name the Advanced EMT certification is a very limited
level of advanced life support. All certified personnel must re-certify every
three years, either through a refresher class (no longer available for the
EMT-CC ALS level), or a CME program. Most of our paid staff and volunteers are
completing their re-certification requirements through the Continuing Medical
Education Program. This requires 72 hours of CMEs every three years. It
requires attendance at conferences, seminars, and other training sessions,
often outside of our local area. The cost of this training must be picked up by
either the provider or the agency.
EMS agencies throughout NYS and the country are finding it
very difficult to recruit and maintain volunteers willing to give the time,
money, and effort necessary to be an active member. It is also very difficult
to recruit and hire paid personnel. 64% of all NYS EMS providers are currently
working for or volunteering with two or more agencies. Low reimbursement rates
make it very difficult to offer appealing wages. Benefits, if offered, are
pretty slim. The OVRS offers its full time staff single person health
insurance, additional disability insurance, and a simple IRA program. Last
year, nationwide, 8% of EMS agencies severely reduced or eliminated the
insurance coverage for their employees. We have been advertising for per diem
ALS providers for two months. We have had very little response, and have been
able to hire one person, far below our anticipated needs. There simply are not
enough ALS providers in the area. Nor, is there a pool of volunteers necessary
to maintain services on a strictly volunteer basis.
In NYS at least 10 ambulance services have closed or
consolidated within the past year. It is a nationwide trend, and is only going
to get worse.
