More and more ambulance services are needing cash transfusions to stay in business.
Volunteers are scarce, operational costs are rising, and revenues are not keeping pace. So some of the most rural services are starting to consolidate.
That includes Calex—originally named for Caledonia and Essex Counties—which now serves St. Johnsbury, Danville, and Littleton, New Hampshire.
VPR rode along on a call that may have saved a life.
Around lunchtime on a warm fall day, a frail 89-year-old woman started to have serious trouble breathing. To protect confidentiality, we’ll withhold her name. Her worried son called 911. Minutes later a Calex ambulance sped out of its station near Northeastern Vermont Regional Hospital.
In her small, tidy home, the patient sat in a chair, shaking uncontrollably. Her son told the medics she has congestive heart failure and a history of pneumonia. Her face was gray and she looked disoriented, gasping for breath to answer questions from Calex Director Michael Wright.
“Have you done any of your treatments?” he asked, holding her hand. She nodded weakly.
Wright and another EMT worker slid their tiny, frightened passenger onto a wheeled gurney and into the ambulance. Wright rode in back, starting an IV for medication to open the woman’s airways. A computer screen showed her vital signs.
“Are you feeling a little bit at ease?” Wright asked, one eye on the computer. The level of oxygen reaching her brain was dangerously low. But by the time they reached the hospital, it was much better. An emergency room doctor took over.
“When was the last time you had a flare-up?” he asked as the two-person Calex crew rushed back to their ambulance for the ride back to the station.
Calex gets about 3,000 calls a year, some more serious, some less serious than this one. Wright says it’s not easy for a non-profit rescue service to stay solvent in a remote area where skilled medical workers have to be on call 24/7 to cover many miles.
And emergency 911 ambulance calls are increasing as the population ages. A government report shows emergency transports by Medicare beneficiaries nationwide grew 41 percent in very rural areas from 2004 to 2010. But Calex Director Wright says ambulance services get paid only for medically necessary trips—not for house calls that do not require hospitalization.
"We have hundreds of calls every year that we don't generate any money for," he says.
Meanwhile, operating costs are going up, Wright says. Medical equipment that saves lives in ambulances doesn't come cheap. Overtime can be a budget buster, especially in sparsely populated areas where the volume of calls is not high enough to cover even meager salaries, between $13-16 per hour. Then there’s the added cost of charity care for patients who can’t pay their bills.
"We get hundreds of calls every year we don't generate any money for." - Michael Wright, director of Calex Ambulance Service
A few years ago, Medicare boosted reimbursements. Congressman Peter Welch has sponsored a bill that would make the increase permanent. Pam Scott, Calex’s chief financial officer, says another solution is for small rural services to consolidate, as Calex did when it absorbed the Danville ambulance service.
“Bringing Danville on with their tiny little volume has turned Calex around because it’s enough volume, it’s enough employees so that Michael has figured out how to sit everybody…not risk patient care but combine them and use all those assets and again the most important are out employees,” Scott says.
She believes more regionalization will also help keep a lid on payments by town taxpayers. Lyndonville Rescue, for example, is warning that it raise its appropriation request this year. At least three other Vermont towns—Royalton, Sharon, and Tunbridge—are looking into merging their rescue services.
