Economic pressures push ambulance service to expand

MIDDLEBURY — Three years after moving into its new, 11,860-square-foot headquarters off South Street, the Middlebury Volunteer Ambulance Association (MVAA) is now ready to expand its billing, dispatching and education outreach services. A major goal is to generate more revenues to stay financially solvent in the face of a still-tough economy and health care reform efforts that could present new budget challenges for all of Vermont’s emergency response organizations.
The organization, established more than four decades ago, plans to offer the new services under a new name: Middlebury Regional Emergency and Medical Services (MREMS).
“Health care reform is coming into place; medical reimbursement is getting lower and lower,” MVAA Chief Operations Officer Bill Edson said. “We are getting more and more calls and putting on more staff and it is costing more for technology … So we have to be more entrepreneurial and innovative to allow us to responsibly find other streams of revenue to help us maintain the organization.”
To illustrate the MVAA’s financial challenges, Edson noted the organization is getting reimbursed 20 cents for every dollar it charges for Medicaid patients and 62 cents on the dollar for Medicare patients. And he said 15 percent of the MVAA clients in a typical year either can’t or don’t pay. These are stranded costs that, as with hospitals, are passed along in rates to customers that have private insurance, Edson noted.
“Ultimately, what has to happen at some point is that barriers will have to be broken down and services will have to work closely together in a more trustworthy, dependent system that helps reduce costs and shares resources,” Edson said. “That’s the part of health care reform no one is really talking about.”
Edson said the organization is ready to launch ResQ Revenue, a new billing service it will sell to emergency response operations not only in Vermont, but also throughout the country. It’s a service that Edson said will present a cheaper option for emergency, medical, and health care organizations that currently farm that accounting function out to third-party billing agencies.
“We are all tucked into the same network of reimbursement,” Edson said of Medicaid, Medicare and private insurance carriers with which all the services deal. “It doesn’t have to be just local agencies that would gain us customers.”
ResQ Revenue is now open for business and searching for customers. And this fall, the organization will offer its expanded dispatching service.
“We realized when we built the building that it was going to give us the facility we needed to expand,” Edson said.
One of the most logical areas of expansion, Edson reasoned, was in the area of dispatching. The MVAA has been providing its own dispatching, but is now ready to do so for other area fire and rescue organizations. Some of those prospective clients were once dispatched for free (at night) through the Addison County Sheriff’s Department (ACSD). But the sheriff’s department was forced to drop that dispatching service last year when it closed its jailhouse. The volunteer fire departments in Cornwall, Whiting, Bridport, Salisbury and Ripton suddenly had to transfer their dispatching to the town of Shelburne. The switch meant departments suddenly faced a $30 charge every time they are toned out by Shelburne dispatch.
Other departments provide their own dispatching services, or are toned out either by Vermont State Police or Porter Hospital or through an increasingly antiquated “10-phone system” through which an E-911 operator activates a phone list of members within a department until a local dispatcher answers.
So the MVAA will be approaching area fire and rescue organizations to see if they’d like to consolidate their dispatching or paging within the MVAA at what Edson called “affordable and less-than-market rates.”
“We weren’t prepared at the time to do it,” Edson said of the additional dispatching opportunities that surfaced last year with the local sheriff’s department changes. “Now we are much more prepared to engage in that role, if it should happen. We are looking at a comprehensive communications center.”
Edson anticipates having to hire around six part-time dispatchers for the new communications center, which would be open 24 hours a day/7 days a week. Officials do not anticipate having to hire new staff — at least at this point — for the ResQ Revenue billing service.
Also on the MREMS docket: Offering classes for laypeople and health care workers covering a wide range of subjects ranging from CPR to advanced life saving techniques. For a nominal fee, community members will be able to learn sports first aid, babysitting safety tips and even pet first aid, to name a few. Edson anticipates current MVAA staff will be able to teach most of the courses. The staff currently includes 14 full-time paid workers, around a half-dozen per diem workers, and a dozen volunteers.
The MVAA responded to almost 2,100 calls in 2012 and is currently on pace for more than 2,200 calls this year, according to Edson. The organization provides services to 10 Middlebury-area towns representing 18,000 citizens and covering almost 400 square miles. Seven of the 10 member-towns have first response crews. The MVAA also provides mutual aid support and paramedic intercept services for the Bristol Rescue, Vergennes Area Rescue and Brandon Area Rescue squads.
“It is critical that the heritage and spirit of the original MVAA organization remains vibrant as a recognized brand within the new system of management,” said Kevin Parizo, president of the MVAA board of directors. “In this way, it is a tribute and recognition to all of the wonderful volunteers that have done so much to bring the organization where it is today.”
Reporter John Flowers is at [email protected].

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