Steep ambulance fee hike OK'd, for now: Pleasant Valley will 'shop around'

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Low bid doesn't always get you the best service.....

Wednesday, August 22, 2007

Steep ambulance fee hike OK'd, for now

Pleasant Valley will 'shop around'

By John Davis

Poughkeepsie Journal

PLEASANT VALLEY - The town will pay for a sharp hike in ambulance service - at least on a short-term basis.

The Pleasant Valley town board recently agreed to pay the increase Alamo Ambulance Service is charging - from $1,054 to $9,366 a month. But the supervisor said he will not sign a long-term contract.

"We are going to shop around," Supervisor Jeffrey Battistoni said.

The hike in the Alamo fee is due to increased operating costs, said an official with HealthQuest, the Poughkeepsie-based company of which Alamo is an affiliate. Rising staff salaries and the cost of new ambulance vehicles are driving the fee hikes.

"Our operational costs have continued to increase," said David Ping, vice president of strategic planning and business development for HealthQuest.

The fee increase alarmed some in Pleasant Valley.

"What service could Alamo be providing to justify an 800 percent increase?" said John McNair, former town supervisor. "That's a lot of money."

Alamo will continue to provide ambulance service to town residents from 5 a.m. to 5 p.m. Monday through Friday.

Volunteers with the Pleasant Valley Rescue Squad provide ambulance service, and basic life support coverage, during the evening and early morning hours and on weekends.

Alamo also provides town residents advanced life support throughout the week.

The company bills the insurance companies of residents for treatment and transportation.

The fee the town pays to Alamo is supposed to cover the costs of uninsured or underinsured residents.

Some in town, though, say at $9,366 a month Alamo might be doing more than covering its costs.

"It's extortion," Chris Hart said. "How do we know they are not double-dipping?"

Ping said last year a symposium of Dutchess County Emergency Management officials concluded the annual cost of operating a single ambulance was between $500,000 and $600,000. This realization led to Alamo's cost increase.

The town supervisor said he plans to ask the board to form a committee to investigate the most economical way of providing ambulance service to town residents. The committee, he said, should include fire department commissioners, members of the rescue squad and town board members.

Reach John Davis at jpdavis@poughkeepsiejournal.com or 845-437-4807.

[MerlinMedic 5]

Some in town, though, say at $9,366 a month Alamo might be doing more than covering its costs.

"It's extortion," Chris Hart said. "How do we know they are not double-dipping?"

$112,392 for a service that the county figures costs between $500,000 and $600,000. Hmmm, who is getting the best deal? If I got a life saving process for 20% of cost I would be very happy. Come to think of it, that IS what my dental plan is; they pay 80% & I pay the other 20%. Pleasent Valley is getting an excellent bargin.

Please recall the drama with Pawling. After they looked around, tried the two other services, Pawling came back to Alamo.

[jfmuller 23]

$112,392 for a service that the county figures costs between $500,000 and $600,000. Hmmm, who is getting the best deal? If I got a life saving process for 20% of cost I would be very happy. Come to think of it, that IS what my dental plan is; they pay 80% & I pay the other 20%. Pleasent Valley is getting an excellent bargin.

Please recall the drama with Pawling. After they looked around, tried the two other services, Pawling came back to Alamo.

I think your math is off considering the ambulance is only 5AM to 5PM Monday-Friday, at the least, not counting weekends it would be half of the $500,000-$600,000. Unless you want to argue that a Paramedic covering the 24x7 is funded the same as an Ambulance. Then you figure it's just covering the uninsured or underinsured, I think Alamo is trying to take them to the cleaners. Since there's not much choice out there and the problems everyone else is having with the other Commercial EMS providers they can do this. After they try to justify that they are upgrading their equipment and ambulance fleet, you'll probably still see the same old tired ambulances covering their contracts and as usual coming up short with the backfill. I am not against staff pay increases as I feel that all EMT's are underpaid, considering my Life is in their hands. Last I heard (5-10 yrs ago) they were paid pretty much the same as cashiers at Home Depot and some of the other retail establishments. I hope this is no longer the case.

Perhaps they are under billing the Insurance Companies too? Especially after just learning they are under billing the Town. They should pursue that instead of relying on the town to cover bad business practices.

[Oswegowind 17]

Sorry, Good for Alamo if they are making a buck. This is America, Alamo is a private business, they are doing what they need to do. Better than saying they can't do it anymore cause they are going broke. They may be there to provide good care, but turning a profit is important also...they are not a municipal agency!!!!!!!!

Way to go Alamo!

[x129K 1,393]

Time for 2 more career guys and together, they can all run the bus themselves during the day!

[jfmuller 23]

Sorry, Good for Alamo if they are making a buck. This is America, Alamo is a private business, they are doing what they need to do. Better than saying they can't do it anymore cause they are going broke. They may be there to provide good care, but turning a profit is important also...they are not a municipal agency!!!!!!!!

Way to go Alamo!

Alamo is a HealthQuest affiliate, non-profit agency, making a buck should not be the priority. Providing a quality service at a reasonable cost should be.

http://www.health-quest.org/alamo.asp

[pd125 0]

Just another town that did not know how good they had it till it it was gone. The town had no cash input to PVFD because the fire district handled the ambulance cost and upkeep. Now when the town board walks in and wants full service on the cheap they act surprised. What will Beekman do when they get the same bill?

[Medibart 55]

Let's say the cost is on the low side $500K. They are running it 60 hours a week which is about 35% of a full week which is 168 hours. So let's say the cost is 35% of $500K which is $175K, though some of the costs i.e. the vehicle and insurance are the same regardless of how many hours the truck is run. The town is paying about $112K that leaves a $63K gap which has to come from billing. If you're lucky your average collection is probably about 300 bucks. That means to make $63K you'd have to do 210 transports, and that's transports, not calls. I don't know PV's call volume but I'd guess it is somewhere about 500 calls given a population of 9000. How many of them result in transports to the ER and how many of those are during the hours they are there, I dunno, but it's probably somewhere around 200ish.

So probably at best they are running break even and may still be losing money. I don't see how they can be making any money, much less anything extravagant.

Compare that to a bill of 12K a year and they could easily be losing $100K a year on the contract. I think anyone can see why any company would not tolerate that forever.

I think your math is off considering the ambulance is only 5AM to 5PM Monday-Friday, at the least, not counting weekends it would be half of the $500,000-$600,000. Unless you want to argue that a Paramedic covering the 24x7 is funded the same as an Ambulance. Then you figure it's just covering the uninsured or underinsured, I think Alamo is trying to take them to the cleaners. Since there's not much choice out there and the problems everyone else is having with the other Commercial EMS providers they can do this. After they try to justify that they are upgrading their equipment and ambulance fleet, you'll probably still see the same old tired ambulances covering their contracts and as usual coming up short with the backfill. I am not against staff pay increases as I feel that all EMT's are underpaid, considering my Life is in their hands. Last I heard (5-10 yrs ago) they were paid pretty much the same as cashiers at Home Depot and some of the other retail establishments. I hope this is no longer the case.

Perhaps they are under billing the Insurance Companies too? Especially after just learning they are under billing the Town. They should pursue that instead of relying on the town to cover bad business practices.

[x134 46]

Just another town that did not know how good they had it till it it was gone. The town had no cash input to PVFD because the fire district handled the ambulance cost and upkeep. Now when the town board walks in and wants full service on the cheap they act surprised. What will Beekman do when they get the same bill?

PD 125 I think you might have your facts a little bit wrong. Back when Alamo was first contracted in Pleasant Valley, the Fire district turned over the decision to the town board on what they thought should be done. The town board at that time hired Alamo with a full Ambulance EMT and MEDIC Monday - Friday 05:00 to 17:00 hrs. The cost was very little to the town budget. They also set aside $15,000 in a slush fund to cover bills to the patient not covered by the patients insurance. Alamo has been running ambulance calls in Pleasant Valley for almost 8 years out of the Fire house on Main street or Cottage street in Salt Point with 3 Career fire fighters to assist and run the ambulance on a second call when Alamo cant backfill. I know because I used to be one of those Paid guys. Since then I have transfered to another department. My family still lives in Pleasant Valley and I think that the increase is out of controll. I say just get a Alamo fly car and hire 2 more Career fighters. I think the cost would be alot less. If the Medic is not needed then he goes back in service and there is still 3 Firefighters to cover the fire equipment.

Edited August 22, 2007 by drobison82

[PVFD233 68]

I don't know PV's call volume but I'd guess it is somewhere about 500 calls given a population of 9000

Over 800 Calls a year Just EMS for 10,000 plus residents.

I say just get a Alamo fly car and hire 2 more Career fighters.

I believe if the math was done it would be cheaper, and that is becoming more and more what should happen.

All in All Alamo has been a great ALS provider for PVFD, Unfortunately money controls everything.

[Guest]

Of the 600 or so EMS calls in Pleasant Valley an average of 30% are no transports. Thus Alamo is not collecting money. On top of that look at American Ambulance Associations report and a June 25th congressional hearing testimony that states insurance carriers typically pay an average of 6-10% less then actual costs. These reports include volunteer and partial volunteer ambulance companies as well that have no charge or very little charge for ambulance service. AAA estimates that actual reimbursements to commercial services may be up to 25% below actual costs. Name any company that can buy a product for $100 and sell it to you for $75.

The cost of 24/7 ALS ambulance service costs about $5/month per capita for the residence of Pleasant Valley and Salt Point. How much is the town paying for career firefighters that only go into the ambulance when mutual aid is not available. For every other municipal FD in the area this is a job requirement. So hire more firefighters and let them do all the calls? Well that will cost taxpayers about $175/month. Look at Arlington, Fairview and LaGrange.

Let Pleasant Valley shop around for service. They’ll still be paying what it cost for service or they won’t have the service (Look at Putnam County)

[x134 46]

Of the 600 or so EMS calls in Pleasant Valley an average of 30% are no transports. Thus Alamo is not collecting money. On top of that look at American Ambulance Associations report and a June 25th congressional hearing testimony that states insurance carriers typically pay an average of 6-10% less then actual costs. These reports include volunteer and partial volunteer ambulance companies as well that have no charge or very little charge for ambulance service. AAA estimates that actual reimbursements to commercial services may be up to 25% below actual costs. Name any company that can buy a product for $100 and sell it to you for $75.

The cost of 24/7 ALS ambulance service costs about $5/month per capita for the residence of Pleasant Valley and Salt Point. How much is the town paying for career firefighters that only go into the ambulance when mutual aid is not available. For every other municipal FD in the area this is a job requirement. So hire more firefighters and let them do all the calls? Well that will cost taxpayers about $175/month. Look at Arlington, Fairview and LaGrange.

Let Pleasant Valley shop around for service. They’ll still be paying what it cost for service or they won’t have the service (Look at Putnam County)

First of all Pleasant Valley Career Firefighters have a work schedule of 07:30 to 15:30 hrs. No one said hire them around the clock. And Alamo is only contracted in the past for 05:00 to 17:00 Monday - Friday. When Pleasant Valley hired Career fighters in October 2001 the cost was $50,000 per man per year. Even if they decided to hire one more guy the tax payers are already paying for the other 3. The tax increase was $1.07 per $100,000. You can't even begin to compare Pleasant Valley to Fairvew,Lagrange or Arlington. Fairview and Lagrange have 16 Career firefighters and Arlington has over 70. As stated before they are going to shop around this is just another option. The new price tag for ambulance service is over $100,000,what is the price differance between a full als ambulance and a fly car. Don't you think that its better than $9,000 a month. Pleasant Valley Career members are at the lowest end of the pay scale for Professional firefighters in Dutchess County starting at $28,500 a year with almost no overtime. So the answer to your question is yes hire 1 more career guy, have them run the ambulance an contract for a fly car if there is going to be a cost savings. Sounds like you might work for Alamo.

Edited August 24, 2007 by drobison82

[MerlinMedic 5]

Even a fly car costs lotsa money. County said $550,000 average for 24/7 ALS ambulance. Cut that in half for a fly car, $225,000 for 24/7. Recall, Alamo still provides ALS service 24/7 to Pleasent Valley.

And PV is upset about $122,000/year. That is still half of what a fly car would cost them. That fly car for 24/7 coverage represents 4.2 FTEs for any company. When you add in vacation time, a supervisor or some sort, you are looking at more like 5-6 employees. At $17.50 for 5 employees with no OT, the cost for salery alone is $182,000 per year. That does not count the cost of: benifits, retirement, uniforms, training and equipment. And if you think you can keep people for long at $17.50/hr. in Dutchess County, I have a bridge to sell you.

[x134 46]

Even a fly car costs lotsa money. County said $550,000 average for 24/7 ALS ambulance. Cut that in half for a fly car, $225,000 for 24/7. Recall, Alamo still provides ALS service 24/7 to Pleasent Valley.

And PV is upset about $122,000/year. That is still half of what a fly car would cost them. That fly car for 24/7 coverage represents 4.2 FTEs for any company. When you add in vacation time, a supervisor or some sort, you are looking at more like 5-6 employees. At $17.50 for 5 employees with no OT, the cost for salery alone is $182,000 per year. That does not count the cost of: benifits, retirement, uniforms, training and equipment. And if you think you can keep people for long at $17.50/hr. in Dutchess County, I have a bridge to sell you.

They do provide service 24/7 but on nights and weekends Alamo is coming from Poughkeepsie or somewhere else in the county not out of the firehouses. The town also dosn't get billed for that service the patient does, if they get transported ALS or BLS. I think they need to look at every option possible and then make a decision. As far as benefits,uniforms, and retirement for Career Firefighters that is all included in the $50,000 figure I had put in a previous post. I do not know how EMS does there benefits, P.Vs firefighters are part of the New York Police and Fire retirement system.

Edited August 24, 2007 by drobison82

[MerlinMedic 5]

They do provide service 24/7 but on nights and weekends Alamo is coming from Poughkeepsie or somewhere else in the county not out of the firehouses. The town also dosn't get billed for that service the patient does, if they get transported ALS or BLS. I think they need to look at every option possible and then make a decision. As far as benefits,uniforms, and retirement for Career Firefighters that is all included in the $50,000 figure I had put in a previous post. I do not know how EMS does there benefits, P.Vs firefighters are part of the New York Police and Fire retirement system.

Soooo, using your figures PV would spend more than the ~ $112,000 Alamo is asking. It would be $250,000 for 5 FTEs. Also, please recall that my figures were for PV to hire their own medics for 24/7 coverage.

My point, whcih I must obviously not stated clearly, is that for $112,000/year, PV is getting a bargin. Yes, the government should shop around, that is thier job. But realise a bargin when they see one. Ask the important questions, such as: back fills, flycar or full rig, and is this enough money to keep you afloat or will you bail on us as one agency did with Pawling & Putnamm.

[x134 46]

Soooo, using your figures PV would spend more than the ~ $112,000 Alamo is asking. It would be $250,000 for 5 FTEs. Also, please recall that my figures were for PV to hire their own medics for 24/7 coverage.

My point, whcih I must obviously not stated clearly, is that for $112,000/year, PV is getting a bargin. Yes, the government should shop around, that is thier job. But realise a bargin when they see one. Ask the important questions, such as: back fills, flycar or full rig, and is this enough money to keep you afloat or will you bail on us as one agency did with Pawling & Putnamm.

YOU DONT UNDERSTAND THEY ARE NOT LOOKING FOR 24 HR COVERAGE IN THAT PRICETAG. THAT IS ONLY FOR DAYTIME COVERAGE. NIGHTS AND WEEKENDS ARE NOT INCLUDED. HOW ARE THEY GETTING A BARGAN THE PRICE IS 8 X WHAT IT WAS. THE TOWN DOESNT SEEM TO THINK ITS A BARGAN OR THEY WOULD NOT BE LOOKING AT OTHER OPTIONS. YOURE FIGURES ARE WRONG THE OTHER FIREFIGHTERS ARE ALREADY ON THE JOB AND WORKINGAND INCLUDED IN THE BUDGET.

[x134 46]

Sorry Merlin I did see that you said full time medics. But is that f.f. medic. The fire dept already pays around $150,00 for the firefighters on duty that does not include the ambulance coverage. So hiring 1 more Career firefighter would be about another $50,000 benefits , uniforms retirement included. Then figure out the cost for the fly car. Would the total cost be less? I don't know. But with the $122,000 for the Ambulance coverage and the 4 Career firefighters your at $322,000. Is a fly car less money? Thats just Monday - Friday daytime hrs weekends and nights not included. They are not looking for 24/7 coverage just days.

[MerlinMedic 5]

Thw whole venue of my posts were:

1) These would be PV employees.

2) Coverage would be 24/7/365

3) These would be Paramedics, not cross trained as firefighters. History has shown us

in Dutchess County those who are brought in as both quickly become one or the other.

4) 5 FTE is as follows: 4.2 medic FTEs working 40 hours per week to provide the 24/7 coverage. The.8 FTE is for vacation, training etc.

5) Notice there is no supervisor or Lieutenant included in this formula.

Alamo's bid is for medics 24/7. Even though it was not stated as such. Does any one really think Alamo would provide free of charge a medic intercept if they didn't have the contract? Mutual aid, yes. But if an other company had the contract Alamo would rightly tell PV to contact their paid service if they wanted a medic after hours.

I am not sure if Drobison82 is propossing that the current FFs get trained as medics. If he is, that is a major hit to the town budget, even if they took a one year class. Just think of all the OT they would have if they took a night class. That would come out of the FDs budget.

He said that the cost for Alamo at $112,000 was too much for the services. I think it is a bargin.

[MerlinMedic 5]

Reading over my post from last I realized that it could be read in such a way to presume that I spoke for Alamo, or am part of Alaom's management. Neither is true.

I do not speak for Alamo, nor am I part of Alamo's management.

My thoughts as to what Alamo may do are what I would do if I were Alamo;

based on my experences in the busuiness world and as a CEO/COO of a volly squad that bills & contracts with local governments.

[Oswegowind 17]

Alamo is a HealthQuest affiliate, non-profit agency, making a buck should not be the priority. Providing a quality service at a reasonable cost should be.

http://www.health-quest.org/alamo.asp

Non-profit agency does not mean that someone (CEO) may be making a ton...You should research npa's and see what you may learn. I believe the CEO of the Amer. Red Cross makes a few million a year...but the organization itself doesn't show a profit margin cause it is written off and the extras are passed along to a few (lucky people) of the "employees". As well, you are blinded by the fact that they should have a reasonable cost for high quality, but in the private sector (NPA's included) most of the time they are just filling a spot in the bus!

[Goose 188]

Non-profit agency does not mean that someone (CEO) may be making a ton...You should research npa's and see what you may learn. I believe the CEO of the Amer. Red Cross makes a few million a year...but the organization itself doesn't show a profit margin cause it is written off and the extras are passed along to a few (lucky people) of the "employees". As well, you are blinded by the fact that they should have a reasonable cost for high quality, but in the private sector (NPA's included) most of the time they are just filling a spot in the bus!

Trust me, Alamo is not raking in the cash. For years it lost millions due to poor management and low-balled contracts. Right now the PV contracts barely covers fuel and equipment costs. What is so wrong with requesting a fair price for the services provided so that operating costs can be covered and monies can be re-invested in equipment, recruitment, wages, etc.

[Oswegowind 17]

There is absolutely nothing wrong with it! If a private company can do EMS and make a profit, then it is the politicians faults for not coming up with a muni system that pays for itself! I doubt that any private outfit actually turns a profit in its EMS portion...EMS separated from the other entities or jobs!

[x129K 1,393]

Why is it OK - not just in Pleasant Valley - but world wide for EMS to be farmed out to a private commercial service, but if you thought of doing the same with police or fire services - a riot would ensue?

[Goose 188]

Because its not recognized as the third emergency service it is and you have knucklehead politicians like that town supervisor in pawling who go around saying "oh we don't have to legally supply an ambulance." Couple that with any lack of real law that mandates municipalities to provide ambulance service, and the lack of small towns to effectively cooperate to provide a multi-jurisdictional service you've got yourself a boondoggle

Edited August 27, 2007 by DOC22

[helicopper 1,050]

Because its not recognized as the third emergency service it is and you have knucklehead politicians like that town supervisor in pawling who go around saying "oh we don't have to legally supply an ambulance." Couple that with any lack of real law that mandates municipalities to provide ambulance service, and the lack of small towns to effectively cooperate to provide a multi-jurisdictional service you've got yourself a boondoggle.

So we should all lobby for an amendment to the state law to change the law from "a municipality may provide for transportation of sick and injured" to a municipality must provide for BLS and ALS services within their community and conform to response time standards, minimimum training requirements, etc.

[MerlinMedic 5]

So we should all lobby for an amendment to the state law to change the law from "a municipality may provide for transportation of sick and injured" to a municipality must provide for BLS and ALS services within their community and conform to response time standards, minimimum training requirements, etc.

Becareful of what you ask for, you might get it. 1973 Federal Law Pl 93-142 passed, guarantening for all students a "free an appropreate education." Also know as the law mandating special education. No problem with that, all kids should be given an appropreate education, but who pays for it? As we now know, the cost of special ed is prohibitive due to the unique talents these educators bring to some of the needest im our communitues.

Property taxes many now are out of sight, mainly to pay for unfunded federal & state mandates. IIRCC MYS did a study in 2005 that said volunteer EMS saves the taxpayers between five to seven Billion dollars per year.

With that in mind, do we want to mandate taht any/all municipalities will have some form of EMS?