Editorial: MREMS changes are needed
It makes sense for the Middlebury-based ambulance service, Middlebury Regional Emergency Medical Services, to change its system of funding as it recently proposed to the 10-member towns it serves. Rather than be presented as an optional line-item to be funded at Town Meeting, the amount would be incorporated into each town’s budget as a contracted commitment, as is currently being done in Middlebury but not the other nine towns.
The reason for the change should be obvious: In an era of rising medical costs and tight employment, MREMS was losing staff, management and volunteers to other similar units that were paying more. To keep a viable force, management needs a dependable revenue stream with the flexibility to respond to the market.
Area communities should embrace the change with open arms. It’s a given Middlebury and the nine other communities served by MREMS, as well as the towns served by other ambulance services in the county, need reliable and financially stable ambulance services.
With this new arrangement and commitment, however, should come added transparency of services provided and fuller negotiations with the host communities.
Both Vice-Chair of the Middlebury selectboard Andy Hooper and selectman Dan Brown praised the ambulance service for its past performance but expressed more need for transparency and a collaborative negotiating process. (See story Page 1A.)
“My concern…is that it feels a lot like a municipal service, (but) they have none of the transparency or oversight that we expect from municipal services and entities,” Hooper said. Brown added the towns should be “sitting down with each other and talking about this and looking at the contract and discussing the various costs,” rather than simply receive a contract to sign.
Both board members are correct, and changes should be implemented going forward, though it’s late in the game for current contracts.
At the Sept. 12 meeting, the Middlebury selectboard reviewed a contract from MREMS that increased the per capita fee from $10 to $13. That represents a $34,016 increase, from $84,960 in fiscal year 2023 to $118,976 in fiscal year 2024.
The increases represent the rapid changes in a field that used to be comprised of a greater number of volunteers to today’s almost fully paid force of 7 full-timers, 35 part-timers and just two volunteers. The most notable jump came in 2021, when MREMS’s per capita fee jumped from $2.50 to $10, or, in Middlebury’s case, from a total assessment of $21,240 to $84,960. (Those fees only represent a fraction of the service’s $1.94 million budget for FY24, as it also bills the individual or their health insurance per trip.)
The good news is MREMS provides a good service at a comparatively low rate. Hooper said the local service’s rates are “about half” others on the Western side of Vermont, and “a quarter of the costs of the Upper Valley and eastern part of the state,” adding he thought the per capita increase was justified. Pay raises for entry level employees of MREMS recently went from $14.50 per hour to $16.50.
Nor would increases be expected to be put on hold. Managers said they expect they will need to get closer to $19 per capita, even though the state average is closer to $25-$30 per capita.
Those expected increases are all the more reason to structure a negotiating process that provides greater transparency, along with cost studies and mutual discussions. It’s a service we can’t do without; the challenge is to keep it as affordable as possible and that will take everyone in the community working together.
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