Somers group seeks split fire, ambulance corps

[ONEEYEDMIC 68]

Somers group seeks split fire, ambulance corps

SOMERS — A small citizens group contends that separating the town's ambulance service from the fire district would allow it to generate hundreds of thousands of dollars a year in revenue

[Guest alsfirefighter]

Somers group seeks split fire, ambulance corps

SOMERS — A small citizens group contends that separating the town's ambulance service from the fire district would allow it to generate hundreds of thousands of dollars a year in revenue

Sure...it might...but how long before you start generating revenue after the start up costs? And how much do they really think they will generate after operating costs?

[JJB531 652]

Anyone from Mohegan who can advise how the split worked for them? Specifically the financial end of it including start up costs, operating expenses, revenue collection? Now years later, does Mohegan think they made the right decision splitting into a separate ambulance corps? Was the split beneficial?

[JohnnyOV 2]

FASNY has a resolution of a bill on the table about allowing fire districts to bill for EMS. Somers might want to hold off on splitting organizations until this bill is passed or vetoed.

http://www.fasny.com/legislative-alert-ambulance-5-10-2011.aspx

[SRS131EMTFF 471]

Anyone from Mohegan who can advise how the split worked for them? Specifically the financial end of it including start up costs, operating expenses, revenue collection? Now years later, does Mohegan think they made the right decision splitting into a separate ambulance corps? Was the split beneficial?

Wasn't there talk recently about merging them again or something along those lines.

[Monty 35]

Isn't this very similar to what happened in Croton? Although I believe it was an internal decision in Croton unlike how this appears.

I wonder whether the consensus is that EMS is better or worse off in Croton as a result?

And how it has worked out financially?

[GAW6 66]

FASNY has a resolution of a bill on the table about allowing fire districts to bill for EMS. Somers might want to hold off on splitting organizations until this bill is passed or vetoed.

http://www.fasny.com/legislative-alert-ambulance-5-10-2011.aspx

Not in favor of this at all. If you look at Somers, for an example, where it states that they have a $2.7M budget, and now you are going to bill the residents on top of what they are already paying in their property taxes?

[JJB531 652]

You're not billing the residents, you're billing their insurance for reimbursement. Now if the split would result in a new EMS tax district, now we're talking about more money coming out of peoples pockets.

[joetnymedic 43]

I was part of the crew who worked the split in Sleepy Hollow back in 2001 with Todd (Todd please sound off on this too). Where the split with the FD was amicible, as the split from the PD was later, Somers needs to look at a few things before they jump into the fire. First, you will have to pay for insurance, then Somers is going to have to support the ambulance until it really starts generating revenue. Until they do start generating cash, they are going to wind up being a line item on the budget, that budget money is going to have to come from somewhere. Then you are going to have to have funding in place for equipment, repairs, supplies. If I remember correctly, it was projected that the ambulance in the hollow wouldn't even start generating enough cash to hold it's head above water for somewhere between 2-5 years. Then you are going to have to do alot with billing. You are going to be placing alot on your volunteers. Who is going to actually do the billing? Are you going to directly hire an employee to handle billing? Are you going to hire a company? This stuff isn't free. Then you also have to justify the transport most of the time or you won't get paid for the call. You are going to have to have outright clesses so that the neccesary wording is there. Then, if you can't get insurance info on your patient right away, are you going to pay someone to go back to the hospital to get the proper billing information? Thats alot of responsibility to lay on a volunteer. Then you also run into staffing problems. Last I knew Westchester EMS was backup for Somers during the day, is that going to remain in effect? If you are going to run a true for pay service, you're going to need to make sure things are staffed 24/7/365. Maybe they did check into things, maybe they didn't. All I know is alot of work has to go into things and it is not going to be all peaches and cream for some time down the road. Good luck with your efforts however.

Joe

[Bnechis 3,961]

FASNY has a resolution of a bill on the table about allowing fire districts to bill for EMS. Somers might want to hold off on splitting organizations until this bill is passed or vetoed.

They have asked for this every legislative session for the past 18+ years. It has never even made it to the floor. While anything is possible, I would not hold my breath.

[Guest alsfirefighter]

Not in favor of this at all. If you look at Somers, for an example, where it states that they have a $2.7M budget, and now you are going to bill the residents on top of what they are already paying in their property taxes?

And any issue with that could be very easily handled with proper public education. We all pay property taxes but have to pay additional fees on they city, village, town level for certain things. Go to a pubically funded hospital (if you dare, lol) and you will still get billed.

[helicopper 1,050]

You're not billing the residents, you're billing their insurance for reimbursement. Now if the split would result in a new EMS tax district, now we're talking about more money coming out of peoples pockets.

And if un- or under-insured, you're also billing them (if you're doing it legally).

If the net result is a tax savings to all the town residents because the actual users of the service start paying their share it is a win-win.

[JJB531 652]

And if un- or under-insured, you're also billing them (if you're doing it legally).

If the net result is a tax savings to all the town residents because the actual users of the service start paying their share it is a win-win.

If you're doing it legally is the key statement... The idea of "soft billing", while not legal, is still practiced by local agencies.

[eagle5473 7]

If you're doing it legally is the key statement... The idea of "soft billing", while not legal, is still practiced by local agencies.

Show me the LAW that states you must send everyone to collections? There is none as far as I know. Medicare requires a resonable attempt to recover the outstanding balanceis concerned.

Aaron

[sympathomedic 383]

OK folks, I am the Bill in the article and here is the thinking on this:

Our idea is for the TOWN to establish an Ambulance Department. Unfortunately it will the name "SAD" Somers Ambulance Dept.

It is legal for the Fire tax district to transfer ALL of its EMS stuff to the Town. A NYS Supreme Court judge needs to sign off on it. So there goes a big chunk of start-up costs. The Fire tax district would need to transfer the operating license to the SAD.

Meanwhile, 80% of EMS calls in Somers are being done by WEMS EMT's, using the SFD ambulances. So the new SAD would have to pay WEMS, taking over as the contractee for WEMS. That is about $400,000 per year for two EMT's 24X7.

Then the folks who want to volunteer will need to incorporate a VAC Inc. The SVAC would manage the SAD, and staff it as much as possible. Our survey of the SVFD members indicated that under a VAC we could staff in house crews 50% of the time. Even if that is 50% off, we could still staff 25%, saving $100,000 per year.

Somers also pays WEMS $200,000 a year for dispatch. That's right, they pay for what 60 does for free. The SAD would use 60. The Fire Tax District also has 5 (FIVE) people staffing the office 0900 to 1300 daily- a secretary a clerk a treasurer a purchasing agent and a computer servics guy. That last guy is a former Fire Tax District Commissioner who we worked very hard to get voted out. They made up a job for him, never posted it, and hired him. He now gets paid to set up the new multi site SFD repeater system that is 100% reduntant to the 60 trunking system the taxpayer already bought.

The Somers VFD staffs and manages the fire and EMS efforts of the Fire Tax District. There is no reason a VAC could not manage the EMS effort of a Town Department. We could do it cheaper and more effectivley and possibley with fewer paid tours. We would also collect the $400,000 annual insurance reimbursement that the SFD nows turns down every year.

I urge my EMT Bravo brothers to weigh in on this. Right now, Somers taxpayers shell out about $1 million dollars for EMS a year, and all they are promised for that is ONE BLS crew. No promise of ALS availibility (I did a BLS arrest less than a year ago- she lived) and no certainty of a 2nd BLS crew. (that $$ is for WEMS medics, WEMS EMT's WEMS dispatchers, a new HUGE bus every two years, gear, fuel, repairs, service contracts etc). All this while the insurance companies get a 'get out of paying free' card on every call Somers does.

[JJB531 652]

Show me the LAW that states you must send everyone to collections? There is none as far as I know. Medicare requires a resonable attempt to recover the outstanding balance is concerned.

Aaron

Well Aaron, this is one piece of information that I found from , I'm a little busy now, but I will research more in a little bit. The following is an excerpt from the following website: http://www.katzmanlaw.com/new/free/article.cfm?id=52&date=March%202003&keyword=''

Background:

On July 28, 2001, the OIG issued Advisory Opinion No. 01-10 (www.oig.hhs.gov/fraud/advisoryopinions/opinions.html) that authorized "insurance only" billing of residents who pay property taxes. The OIG is the federal watchdog for violations of the Anti-Kickback Act. A municipal fire district that owns and operates an EMS squad sought the Advisory Opinion, in order to avoid any fraud investigations / prosecutions.

The Anti-Kickback Act makes it a federal criminal offense to give or receive anything of value in exchange for the referral of Medicare patient business. Violations of the federal statute can result in fines up to $25,000 and also imprisonment for up to five years, for each offense. The fire department can also be excluded from the Medicare and Medicaid Programs, thereby eliminating all billing of transports to these programs. In addition, there could be civil litigation brought by a private citizen "whistleblower" or by the federal government under the False Claims Act, with recovery of all falsely billed funds to the government and a "finders" fee to the whistleblower.

The Advisory Opinion authorizes only fire & EMS departments that are publicly owned to "soft bill" residents of that fire district. Understandably, the federal government generally opposes any "waiver" of co-payments or deductibles, and therefore has not authorized "soft billing" of residents by private ambulance companies, since this may be an illegal "inducement" to use one private (for profit) service over another.

Legal Lesson Learned:

On behalf of a municipal fire & EMS department in Northeastern Ohio, we recently contacted the OIG regarding the city's desire to "soft bill" not only its residents who pay property taxes, but also non-residents who are employed in the city and pay a 2% income tax that helps pay for the fire & EMS department. We were advised that in March 2003, the OIG would be issuing an Advisory Opinion authorizing this practice for publicly owned fire & EMS departments.

written by: Larry Bennett

partner at Katzman, Logan Halper and Bennett, Cincinnati, OH

[JJB531 652]

From the Office of the Inspector General website:

http://oig.hhs.gov/fraud/docs/complianceguidance/032403ambulancecpgfr.pdf

"A city or other political subdivision of a state (e.g., fire district, county, or parish) may not require a contracting ambulance supplier to waive copayments for its residents, but it may pay uncollected, out-of-pocket copayments on behalf of its residents. Such payments may be made through lump sum or periodic payments, if the aggregate payments reasonably approximate the otherwise uncollected cost-sharing amounts. However, a city or other political subdivision that owns and operates its own ambulance service is permitted to waive cost-sharing amounts for its residents under a special CMS rule. (See CMS Carrier Manual, section 2309.4; CMS Intermediary Manual, section 3153.3A; see also, e.g., OIG Advisory Opinion No. 01–10 and 01–11.)"

From what I have read, it seems that only a City/County/State owned and operated EMS system can waive collection of payments. Private EMS agencies, Volunteer Agencies that are not owned and operated by the local government, etc. are, from what I have interpreted, strongly advised not to waive collection of unpaid to prevent any suspicion of inappropriate practices. It's always been my understanding that "soft billing" is unlawful, but hey, I'm not a number cruncher, I'm 100% blue collar.

[sympathomedic 383]

When I worked in New Rochelle under Empress, NR paid a flat annual fee for the ambulances (1 24 hrs a day, the other 17 or 18). We gave copies of the PCR's to a clerk for billing out- same clerk that billed false fire and burglar alarms I think. Story was that if you didn't pay, they would turn off your water!! Could be a famous case of EMS exaggeration, though.

Bill

[Bnechis 3,961]

Story was that if you didn't pay, they would turn off your water!! Could be a famous case of EMS exaggeration, though.

Not likely since the water is provided by a private company and not the city.

[Monty 35]

Thanks Bill for posting the details. Certainly seems to make some pretty strong points and is obviously not a knee-jerk response or proposal.

OK folks, I am the Bill in the article and here is the thinking on this:

Our idea is for the TOWN to establish an Ambulance Department. Unfortunately it will the name "SAD" Somers Ambulance Dept.

It is legal for the Fire tax district to transfer ALL of its EMS stuff to the Town. A NYS Supreme Court judge needs to sign off on it. So there goes a big chunk of start-up costs. The Fire tax district would need to transfer the operating license to the SAD.

Meanwhile, 80% of EMS calls in Somers are being done by WEMS EMT's, using the SFD ambulances. So the new SAD would have to pay WEMS, taking over as the contractee for WEMS. That is about $400,000 per year for two EMT's 24X7.

Then the folks who want to volunteer will need to incorporate a VAC Inc. The SVAC would manage the SAD, and staff it as much as possible. Our survey of the SVFD members indicated that under a VAC we could staff in house crews 50% of the time. Even if that is 50% off, we could still staff 25%, saving $100,000 per year.

Somers also pays WEMS $200,000 a year for dispatch. That's right, they pay for what 60 does for free. The SAD would use 60. The Fire Tax District also has 5 (FIVE) people staffing the office 0900 to 1300 daily- a secretary a clerk a treasurer a purchasing agent and a computer servics guy. That last guy is a former Fire Tax District Commissioner who we worked very hard to get voted out. They made up a job for him, never posted it, and hired him. He now gets paid to set up the new multi site SFD repeater system that is 100% reduntant to the 60 trunking system the taxpayer already bought.

The Somers VFD staffs and manages the fire and EMS efforts of the Fire Tax District. There is no reason a VAC could not manage the EMS effort of a Town Department. We could do it cheaper and more effectivley and possibley with fewer paid tours. We would also collect the $400,000 annual insurance reimbursement that the SFD nows turns down every year.

I urge my EMT Bravo brothers to weigh in on this. Right now, Somers taxpayers shell out about $1 million dollars for EMS a year, and all they are promised for that is ONE BLS crew. No promise of ALS availibility (I did a BLS arrest less than a year ago- she lived) and no certainty of a 2nd BLS crew. (that $$ is for WEMS medics, WEMS EMT's WEMS dispatchers, a new HUGE bus every two years, gear, fuel, repairs, service contracts etc). All this while the insurance companies get a 'get out of paying free' card on every call Somers does.

[Guest alsfirefighter]

OK folks, I am the Bill in the article and here is the thinking on this:

Our idea is for the TOWN to establish an Ambulance Department. Unfortunately it will the name "SAD" Somers Ambulance Dept.

It is legal for the Fire tax district to transfer ALL of its EMS stuff to the Town. A NYS Supreme Court judge needs to sign off on it. So there goes a big chunk of start-up costs. The Fire tax district would need to transfer the operating license to the SAD.

Meanwhile, 80% of EMS calls in Somers are being done by WEMS EMT's, using the SFD ambulances. So the new SAD would have to pay WEMS, taking over as the contractee for WEMS. That is about $400,000 per year for two EMT's 24X7.

Then the folks who want to volunteer will need to incorporate a VAC Inc. The SVAC would manage the SAD, and staff it as much as possible. Our survey of the SVFD members indicated that under a VAC we could staff in house crews 50% of the time. Even if that is 50% off, we could still staff 25%, saving $100,000 per year.

Somers also pays WEMS $200,000 a year for dispatch. That's right, they pay for what 60 does for free. The SAD would use 60. The Fire Tax District also has 5 (FIVE) people staffing the office 0900 to 1300 daily- a secretary a clerk a treasurer a purchasing agent and a computer servics guy. That last guy is a former Fire Tax District Commissioner who we worked very hard to get voted out. They made up a job for him, never posted it, and hired him. He now gets paid to set up the new multi site SFD repeater system that is 100% reduntant to the 60 trunking system the taxpayer already bought.

The Somers VFD staffs and manages the fire and EMS efforts of the Fire Tax District. There is no reason a VAC could not manage the EMS effort of a Town Department. We could do it cheaper and more effectivley and possibley with fewer paid tours. We would also collect the $400,000 annual insurance reimbursement that the SFD nows turns down every year.

I urge my EMT Bravo brothers to weigh in on this. Right now, Somers taxpayers shell out about $1 million dollars for EMS a year, and all they are promised for that is ONE BLS crew. No promise of ALS availibility (I did a BLS arrest less than a year ago- she lived) and no certainty of a 2nd BLS crew. (that $$ is for WEMS medics, WEMS EMT's WEMS dispatchers, a new HUGE bus every two years, gear, fuel, repairs, service contracts etc). All this while the insurance companies get a 'get out of paying free' card on every call Somers does.

Well explained Billy. If all you say is the absolute fact, it seems like it makes sense and I wish you luck with your endevour.

[x635 4,066]

Excellent post, Bill!

Having been Bill's partner at Empress, having worked 45-M-2, and having dispatched Somers, I've got an opinion (dated though).

One of the things that kills/burns out Somers EMS is Heritage Hills. They have EMT's who work Security, can't they also staff a bus? Or maybe contract with WEMS?

And I strongly agree with going to 60 Control, something that has been suggested by numerous Cheifs of Somers FD over the years, and the commisoners always knock it down, with the fear of "losing control". With the money they pay WEMS for 2 dispatchers, they could use that to staff two (more) EMT's.

Somers has tried numerous things over the years to improve EMS. My personal opinion is that Somers run two career EMS ALS buses 24/7 out of Lincolndale and Somers houses, and work with Heritage Hills to contract with WEMS, which could be very lucrative (but it takes away from other Somers residents).

[Guest alsfirefighter]

Just a question on your post Seth. If Heritage Hills were to contract out with someone, does that mean the district would pay for it? Or would they reduce the residents taxes to cover the contract costs in lieu of forking over some tax revenue? Not a bad idea...but also if its in your district it is what it is and that's where I agree that paid coverage supplmented by volunteers is the answer.

How many calls a year are out of heritage hill?

[x635 4,066]

Just a question on your post Seth. If Heritage Hills were to contract out with someone, does that mean the district would pay for it? Or would they reduce the residents taxes to cover the contract costs in lieu of forking over some tax revenue? Not a bad idea...but also if its in your district it is what it is and that's where I agree that paid coverage supplmented by volunteers is the answer.

How many calls a year are out of heritage hill?

I'm not sure, but they fund security and other things....maybe like an HOA fee. Heritage Hills has, in my opinion, a negative effect on Somers volunteers. Think about those places you always go to and how annoying it can be when you're paid......now would you do it on a volunteer basis?

Maybe IBM or Pepsi could fund a grant?

[sympathomedic 383]

I have heard that 1/3 to 1/4 of SFD EMS runs are into Heritage, and that number sounds right. More in summer, less in winter. Heritage has a contracted security service, Command Security. They take the EMS part of their work very seriously, and most if not all of their staff are EMT's. Before Somers stopped staffing their own first rig, we would frequently use HH security as an EMT on the SFD bus. Sometimes they even got 'tech-knapped' into doing a call on the way back home. In some cases the WEMS medic confirmed an ALS call and teched the bus with a SFD driver. That kind of thing is gone now: two emt's on the first bus now.

HH residents already pay for EMS two times: once in their fire taxes, and once with their medicare taxes. I don't think they would take well to paying a 3rd time to hire a WEMS standby bus- BUT if they did and set it up that at the end of the year, whatever funds that bus generated from insurance billing was subtracted off the annual cost, that would work because that crew would do several insured runs a day... but wait! That's kind of what I am proposing for a Town-wide system, and boy do the powers that be seem peeved about it, saying it'll never work. Course, they said that about horse driven rigs and steam powered pumps too.

Bill

[38ff 250]

Just a question... Say Im a member of the SVFD. I now join the SVAC. Im now a member of both. A call comes in for both fire and EMS needed. How does the IC even know who Im "working for" when I get to the scene in my POV? Who's my IC I take orders from at the scene, Fire or EMS? Who covers me for insurance if I get hurt going to/at/coming back from a call? As a member of both, it could be confusing.

Just trying to understand how this might all work down at the worker bee level.

Edited June 8, 2011 by 38ff

[grumpyff 1,159]

Depends on which service you respond with. If you respond with the FD, they are your IC and provide your insurance/workman's comp. The same if you respond with the EMS side of things. If you respond in your POV, then it depends on which service you decide to report to.

Edited June 8, 2011 by grumpyff

[38ff 250]

How is it decided who Im responding for when doing the "POV response"? Just another question that will need to be addressed and agreed to by both parties if something like this happens.

[JJB531 652]

I would assume if you are engaging in firematic duties, then you are working under the FD. If you are engaged in patient care activities, then you are working under the VAC. Go to the scene and stick with one or the other so you know who you are working under.

[x635 4,066]

At least from what I've witnessed, a fire call will most always trump a EMS call.