A meeting with Fire Chief Michael Whitty and the Common Council in order to discuss details of a proposed city ambulance service was canceled Monday by Alderman Ed Russo, who is the chair of the Public Safety Committee. Whitty was supposed to present his research on Tuesday into the projected expenses and revenues involved with the proposal to have the city’s fire department replace GAVAC as the primary ambulance provider for the city. Projected revenues of $660,000 were included in Mayor Ann Thane’s budget proposal submitted April 1, although the Common Council has yet to approve the funding necessary to purchase the required vehicles and equipment.
Both Russo and Alderwoman Diane Hatzenbuhler had previously said they were expecting to hear Whitty’s presentation. However, Russo cited the city’s charter which was amended in 2004 by a public referendum to restrict the fire department from providing ambulance services as the reason for the cancellation. Russo said Monday he believed another referendum should be required to remove that restriction. Council members Hatzenbuhler and Ron Barone have also publicly stated their agreement with this position. According to Corporation Counsel Gerard DeCusatis, the removal of the restriction does not meet requirements in NY State laws for a referendum.
According to NY State Municipal Home Rule Article 3, Section 23f , a referendum is required if a law “abolishes, transfers or curtails any power of an elective officer.” According to a written opinion issued by DeCusatis on Tuesday, since a referendum is not required, a referendum cannot be held. According to the same opinion, the council could approve a local law to remove the restriction, which would only require a public hearing before a vote.
With the presentation canceled, Whitty agreed to an interview on Tuesday in order to explain the details behind the projected revenue and expense numbers that the proposed budget is based on.
Revenue and third-party billing fees
Whitty said that all billing for the ambulance services would be handled by a third-party service. Whitty reached out to two different services, one which would charge a flat $35 per call fee, and another which would take a 10% fee of the bill amount. Both services would take their fees first, before transferring the remaining amount to the city.
The city would be able to bill for both transportation and mileage traveled on the call. Both services provided estimates based on an estimated 1,866 transports and 3,700 miles per year. Whitty said that only the service which provided the flat fee service responded in time with numbers on which to base the proposed budget. He said the service’s estimate as to the amount they would receive per call was based on the city’s size and demographics. The service estimated a total of $718,620 per year in gross revenues. After subtracting the service’s $65,310 fee, the city would receive revenue of $653,310.
Whitty also showed an estimate that came in later from the other service, which projected a $707,340 gross revenue with $636,555 in revenue to the city after their fees were deducted. In addition to the two third-party services, Whitty also provided a more conservative figure based on his own estimate of the “payer mix” or the percentage of medicaid, medicare or commercially insured patients, which came out to $589,866 in revenue after third-party billing fees.
Reached for comment later, Mayor Ann Thane said that she felt comfortable with the $660,000 revenue figure included in the proposed budget after talking with other municipalities and the third-party billing companies.
Additional staff and operating expenses
The biggest cost associated with operating the proposed service is additional pay for fire department staff as well as for an on-call doctor to serve as a medical director. Whitty said that no additional staff would be need to be added, however during vacations and other time off, he would need to maintain a seven person crew, rather than the current minimum of six. He said he had an unofficial agreement with the firefighter union that the extra hours would be paid at the regular rate, not as overtime. Total additional staffing charges add up to approximately $85,000 which is included in the proposed budget.
Additionally, costs associated with supplies and maintenance for the two ambulances is projected to cost $15,000, which is included as an additional contractual line for the fire department in the proposed budget.
Other additional yearly expenses included $4,000 for fuel, and $4,000 to insure the vehicles.
Whitty said the total cost to purchase one new ambulance and one used ambulance, as well as to furnish each vehicle with the proper equipment would add up to $231,318 and would need to be borrowed for along with other capital projects being considered by the Common Council.
The yearly cost of servicing the debt will be $27,000. However, according to Controller Matt Agresta, only an interest payment of $3,000 on the debt will be due in the first year.
Reached for comment later, Thane said she expected the additional minor expenses could be absorbed by other lines in the budget.
|Billing fees ($35/call)||-$65,310.00|
|Net revenue to city||$653,310.00|
|Personnel, medical director||$85,000.00|
|Maintenance and supplies||$15,000.00|
|Additional vehicle insurance||$4,000.00|
|First year interest payment on apparatus||$3,000.00|
|Total first year expenses||$111,000.00|
Double taxation, training and other related issues
“I’m hearing an awful lot of misinformation out there,” said Whitty in regards to current public discussion, “I’m hearing double taxation. I don’t see how this is double taxation.”
He explained that GAVAC, the city’s current ambulance provider, already sends a bill to a patient’s medical insurance provider which could be medicaid, medicare, or a commercial insurance company. Since GAVAC transports patients to the hospital, they can bill for the service, but the city’s fire department cannot, even though department staff respond to all emergency medical calls, provide both basic and advanced life support, and often accompany patients in the ambulance to the hospital.
The patient is always billed regardless of who provides their service, but currently only GAVAC receives a reimbursement. GAVAC currently shares a portion of their revenue with the city, which would be approximately $100,000 per year under a recently revised agreement. The city would forgo that revenue if it were to run its own ambulance service.
Whitty said he had heard the idea of having the fire department get rid of its current emergency medical vehicle, which cannot transport patients, and stop responding to medical calls. He explained that if the fire department stopped responding to those calls, he would still need to maintain the same level of staffing as he does now, so there would be no significant cost savings.
If his staff were cut any further, Whitty said he would not be able to meet OSHA’s minimum requirement of having two firefighters outside the building while two other go into the building to save it. Rather he would be forced to switch to a “defensive” strategy, keeping firefighters outside a burning building with the goal of preventing the spread of the fire instead of attempting to salvage it.
In regards to training, Whitty said that 23 out of 32 staff members are already certified as paramedics, which requires the highest level of emergency medical technician training. Whitty said that an additional two employees will be certified later this year.
“EMS is nothing new to the fire department, the only difference would be the transport. You’re getting more production out of your employees here, how can that possibly be a bad thing?” said Whitty. “Granted, yes they are going to make some more money if they come in for this. But the fact that they are willing to do this at [non-overtime pay] to me speaks volumes about their dedication to this project.”
Whitty said his primary concern for the city was the safety of his officers, the people of the city and their property. “I don’t have a political agenda. I have a public safety agenda,” said Whitty. In regards to impact of the proposed service on the overall budget and on his department, he said, “If we can stabilize fire protection at the level it is at now, then that’s a good thing. And his would certainly go a long way toward doing that.”