By Patrick White
Ambulances save lives. They do. They push emergency treatment out into the field. They initiate life-saving care. The ambulance gets there fast, and people live. It’s as simple as that.
I’ve spent the last eight weeks immersed in ambulance delivery models in my new role as Chief Financial Officer of Southern Berkshire Ambulance. I’ve studied the cost structure, revenue streams, service delivery models, and so much more. I’d like to share some observations.
1. There is a huge shortage of paramedics and emergency medical technicians in South County, the folks who staff the ambulances. We need more training opportunities, more workforce housing, better pay scales, a designation as “essential workers”. It’s tough to both attract and retain folks when there are way more jobs than professionals to fill them. These are policy issues that are being addressed by Rep. Leigh Davis, Fairview’s Heather Barbieri and her working group on Emergency Medical Services, and many others. Thanks for your hard work on these matters.
2. There are three services provided by ambulance organizations: primary response to 911 calls, paramedic intercept to support 911 EMTs in life-or-death situations, and non-emergency transport calls to move folks in our community between facilities. 911 and intercept saves lives while transport is non-emergency but generates more revenue per call.
3. There are three revenue streams that fund ambulance service: insurance payments, taxpayers, and donors. Insurance funds roughly half the cost of delivering service. The rest must be made up by donors or taxpayers. Town leaders already recognize the need to fund ambulances, but there are many other priorities to fund as well. Here’s the reality: The more ambulance shifts across the network that are staffed, the more lives you will save, albeit at a higher cost that someone will have to fund.
4. There are also three organization models: municipal, non-profit, and for-profit. As you might imagine, the for-profit services prioritize non-emergency transport over emergency 911 and intercept. These transport runs pay the most. Municipal services, both existing and planned, are entirely focused on 911 calls. My take, having reviewed both the internals for SBA and the budgeted salaries for multiple planned municipal services, is that towns are vastly underbudgeting the cost for their firefighter/EMTs and under planning the staffing needs for more expensive paramedics. Not just by a little but by a lot: upwards of 40% or more. Nonprofit ambulance services like both Northern and Southern Berkshire Ambulance have the economies of scale around staffing, have fundraising strategies to relieve taxpayers of some of the burden, and have in-house expertise around dispatch, insurance billing, and other specialized skills that are essential to running this essential service.
The median age of many of our communities in South Berkshire is about 25 years older than the state’s average age. We have way more elderly folks living here than in other parts of the state. Add to that this reality: we just don’t have the density to support ambulance service as a stand-alone profitable business. It costs well over a million dollars to staff one ambulance 24-7-365. There just aren’t enough calls and corresponding insurance payments to cover the cost. Figuring this out is complex, but it is also vitally important. When you need to dial 911, it has to be there. It just has to be. It’s an honor and a pleasure to be part of a team focused on keeping it that way.
At Southern Berkshire Ambulance, we just ordered a replacement ambulance for one that is 11 years old. A new ambulance costs around $500,000. Municipal payments don’t contribute to capital costs such as a new ambulance. Please, if you have the means, consider donating.
Editor’s note: Is there any good information here as we plan our new fire department services?
