Information For Our Comunity
The information below has been provided in an effort to further educate our community on the costs of operating an Emergency Medical Services agency. Below you will find detailed information on our operating costs, and the financial strains we are currently facing in these economic times.
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We understand there is a lot of information here, however we feel it is important information for you to know.
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Estimated Annual contribution per household.
This chart represents the estimated cost per household, at what our current ballot article is and what it could be if it were to be increased. To give you a better idea of a single household contribution vs the total amount.
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In most of these cases, apart from what it would cost to fund our entire operation, this costs less than it costs for you to contribute to our agency per month then it costs for a cup of coffee.
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We have received $50,000 annually from the Town annually since 2016.
Prior to 2018, Pownal Rescue Squad relied heavily on mutual aid services to respond to emergencies within the community from 6am-6pm. Mutual aid services were needed due to the volunteers of Pownal Rescue Squad working during those hours. Pownal Rescue Squad volunteers answered the calls for services from 6pm-6am.
As volunteering began to dwindle and the responsibility of providers and services increased, we were faced with the options of putting a stop to our services, which meant our community wouldn’t have emergency medical services, or hire paid staff. We chose to hire staff in an effort to provide for the needs of our community. Having paid staff has allowed us to provide emergency medical services to the Town of Pownal and our surrounding communities when we are called upon. We began hiring staff at the beginning of 2018, where we saw an increase in the number of calls we were able to take. From 2018 to 2019 we saw a 53% increase in call volume to our community and surrounding areas. We saw a drastic increase in numbers from 2019-2021 during the COVID pandemic. As imaginable, the pandemic put strains on our agency, both financially and with personnel.
In 2018, during our transition from volunteer to paid staff we needed the assistance of mutual aid to our community, 51 times. Since then, from 2019 to current, we have only needed the services of our mutual aid partners 31 times. Of those 30 times, 4 times Pownal Rescue was on scene and needed multiple ambulances and the remainder of the 27 calls all Pownal Rescue ambulances were in service.
A 9-1-1 is an emergency situation that requires immediate assistance.
Mutual aid is when an agency requests assistance from a nearby community.
No transport is when a patient is evaluated and does not wish to go to the hospital. Services such as bandaging, wound care, vitals, medications, and assessments are still provided but a patient can then decide not to be transported to the hospital. We cannot bill for these calls “no-transport” despite providing emergency services. Medicaid is currently the only insurance company that will reimburse a small fee for these types of calls.
Cancellations are typically standbys in which we are requested for support, but no services or care is rendered.
Local Transfers are non-emergent transfers back to a patient’s residence or a local nursing home.
Tertiary Transfers is the transfer of a patient from one hospital to another hospital, typically for services that are not available at the local community hospital that need a higher level of care.
Most insurance companies only compensate ambulance services for transported calls. Even if supplies are utilized on the call where a patient refuses transport to the hospital, we are not compensated. Unfortunately, the cost of supplies, insurance, fuel, and wages continue to go up. This continued loss on our end is unsustainable.
Even for transported calls, most insurance companies only pay their set rates regardless of the amount that is billed. Contractual allowance is the difference between the billed cost of the service and what the insurer agrees to pay. The amount which the insurance company does not pay becomes the responsibility of the patient. How much the patient is responsible for depends on the type of insurance in which they have, plan, deductible and co-pays.
The cost of equipment, supplies, insurance, general expenses, and wages continue to rise. Due to our lower call volume, agency size, and location, we are unable to offer health insurance and other benefits that larger agencies can offer, which makes recruitment and retention difficult. Being surrounded by two much larger agencies that are able to offer higher compensation and benefits impacts on our ability to recruit and retain employees.
In 2017 when we replaced one of our ambulances due to its age, and mechanical issues, at that time, the price to replace that ambulance was about $150,000. This is for a base model ambulance, no 4WD, and has a gas transmission. Today, the cost of that similar base model gas ambulance is at a minimum of $225,000 with a 2-3 year wait for the ambulance once ordered. This is just the cost of the ambulance, this does not include the cost of the radio’s ($4,000), a stretcher system ($38,000), Zoll cardiac monitor ($53,000), stair chair ($15,000), medications, supplies, and the cost of employees to run the ambulance. The cost of our base station communication system is around $18,000 which is what allows us to communicate with our dispatch center and others to keep our employees safe. These costs also do not include the preventative maintenance that is required annually on the equipment.
Payroll has nearly doubled in two years to be able to provide 24/7/365 to our community and surrounding towns. As we have largely professionalized as a service, volunteering has become, more extinct than not. With only 1 current volunteer left in the agency, that employee is also paid staff as well. Volunteering has become too demanding in a profession that requires continued education requirements, and the physical, emotional, and mental strains have increased tremendously. Things have drastically changed economically, requiring those of age in a household to bring in a paycheck for their family. The simple fact is that with the current economics, very few people have time to stay proficient in EMS as a volunteer, despite good intentions to do so. EMS has grown from providing simple first aid to an increasingly complex part of the health care system. Competitive wages in our small rural community, surrounded by much larger agencies that offer health care coverage and other benefits are able to better recruit and retain employees. The costs listed above are just wages and a very small portion of supplemental insurance (Colonial Life Insurance).
Pownal Rescue Squad has received $50,000 annually from the Town of Pownal since 2016, prior to that we received $30,000 anually. Other than the donations we receive, we rely on insurance reimbursements. Please see the breakdown below of what it currently costs each household per year and if we were to increase our ballot request, what it would look like. In the grand scheme of things, the general population thinks, “I get a bill, they get paid for taking me to the hospital so they don’t need to get anything from the town”. For this reason, we are trying to educate our town members about the costs of our agency and the general broken system of EMS reimbursements as a whole.
Insurance companies have set fees in which they pay for services, regardless of what is charged to them. With many of our patients being on Medicare and Medicaid, who have lower reimbursements, our adjustments are much higher. Our uninsured patients play a large role in our funding as well, as we typically do not get any sort of reimbursement from them. Over 80% of the patients that we serve are Medicare & Medicaid. Medicare’s average return rate is only 43% and Medicaid’s average return rate is only 37%. How would you feel if you were asked to throw away $57-$63 of every $100 you were paid? You go to the grocery store; you pay for your groceries at that time. You receive services for your vehicle, you pay for the repairs at that time. Medical services, treatment, and care is one of the only services in the country in which you do not pay for at the time of the service. Many people are under the false impression that because they have health insurance, it covers the entire costs of their emergency medical services.
The contractual difference is shown in the loss column. This is typically the lowest amount of adjustment that is made per call. Every call we respond to requires a different level of care that requires different interventions, procedures, and assessments.
Frequently Asked Questions:
Q: Where do you provide mutual aid and ALS (Advanced Life Support) services to?
A: We typically provide mutual aid and ALS services to Bennington, North Adams & Williamstown, MA along with Rensselaer County.
Q: Why do you respond to mutual aid when you are Pownal Rescue Squad?
A: We receive federal funding; we are legally obligated to respond to requests for mutual aid when we are available.
Q: Why do you take transfers?
A: Some patients require a higher level of care, or care that cannot be provided at our local community hospital which requires them to go to a hospital that can provide those services for them. These patients cannot safely transport themselves, as such an ambulance is necessary to get them there safely.