MIDDLEBURY — Middlebury Regional EMS has decided to resurrect its practice of asking for Town Meeting Day contributions from the 10 towns it serves, money the organization will place in a fund for future capital needs.
Middlebury Regional EMS — once known as the Middlebury Volunteer Ambulance Association — began requesting Town Meeting Day contributions in 1998. The organization used those funds — an average of $25,319 per year — to help solidify its operating budget.
Representatives of the organization announced in 2012 that the Town Meeting Day requests would stop, in light of improved business practices and a steady increase in calls that helped solidify Middlebury Regional’s bottom line. The change took effect last year in the organization’s service towns of Middlebury, Salisbury, Ripton, Weybridge, New Haven, Cornwall, Bridport, Whiting, Shoreham and Orwell.
Recent months, however, have seen leaders of Middlebury Regional crunch budget numbers and determine the organization needs reserve funds to cover future capital purchases or major maintenance items that might surface at its new, $2.4 million, 11,860-square-foot facility off South Street. The organization has been engaged in a separate capital campaign to defray costs of the new station.
To put things in perspective, a new ambulance can run around $120,000, according to Middlebury Regional EMS Co-Director Shyla Clark.
That kind of a price tag — one that will recur over the years — led to some serious discussions among Middlebury Regional officials.
“With the capital campaign (for the new station) starting to wind down… we spent the year taking a hard look at our finances and doing some long-term financial planning to figure out what it takes to run the place year-in and year-out,” said Mike Roy, chairman of the Middlebury Regional EMC board of directors. “One of the things we’ve identified is a need to annually budget for some reserves that would allow us to purchase a new ambulance, put a new roof on when that comes up, and cover other large capital expenses. In looking at our current budget we have realized we hadn’t really built in a structure for building up reserves over time.”
 The organization last year updated its business plan in an effort to make its operating revenues more predictable and to reflect state and national health care reforms. Those updates included: taking on additional inter-facility transfers, operating an around-the-clock communications center offering dispatching and pager services to public and private organizations, hosting educational programming, and billing for other, outside ambulance and emergency services.
Middlebury Regional EMS has also, for more than a decade, been offering a subscription program to individuals, families and businesses. Annual subscription rates are $50 for an individual, $60 for couples, $75 for families and business plans for $100. The subscriber is entitled to, among other things, unlimited emergency transport twenty-four hours a day within the organization’s coverage area. The organization currently has approximately 2,600 subscribers, according to Clark.
But even with a new business plan and multiple revenue sources, Middlebury Regional EMS and organizations like it are facing increasing and unpredictable new costs, Roy noted. Those include the rising cost of fuel and insurance, as well as chronic under-reimbursement from the federal Medicaid and Medicare programs. At the same time, the Affordable Care Act and Vermont’s transition to a single-payer health care system offer additional fiscal uncertainties for hospitals and ambulance associations.
“We can’t rely exclusively on operating revenues, so we need to do a certain amount of fundraising through subscriptions, getting towns to donate and through occasional capital campaigns,” Roy said.
With that reality, Middlebury Regional EMS will again look to get financial requests back on the 10 town meeting warnings in March of 2015. If that means re-petitioning with signature drives, the organization is prepared to do that, according to Roy.
“As a free-standing, not-for-profit without an endowment, we need to look at all these different funding sources and how we can get them together to meet the needs of the organization so we can serve the community as best we can,” he said.
Reporter John Flowers is at [email protected].