Williamstown Ambulance Service in Dire Straits, Seeks Town Funding
Dr. Win Stuebner explains the ambulance service's dire financial picture to the Finance Committee on Wednesday.
And if Village Ambulance does not receive town support, it likely will go out of business in the next six months, according to the president of its board of directors.
"I don't want to be an alarmist, and I don't want to be threatening, but I will be factual," Dr. Erwin Stuebner told the Fin Comm. "If Village Ambulance doesn't receive significant funding by July 1, we are probably going to have to shut down.
"We cannot afford a prolonged study commission or whatever. Gap funding would provide time for a more detailed study of how to fund us."
The private non-profit ambulance service currently does not receive town tax dollars. Stuebner said the perception among some residents that the service is town subsidized is part of the reason why the organization's fund-raising efforts have seen only modest results.
For most of the three decades since its founding in 1983, VAS has been able to cover its expenses through its primary revenue stream, insurance reimbursements from transporting patients. But in recent years, the economics of the transport business have seen a dramatic change in the wake of the Affordable Care Act, Stuebner and VAS Executive Director Mike Witkowski explained.
"In the last few years, there has been a decrease in Medicare reimbursement and increased deductibles on private insurance," Stuebner said. "It's left a lot of people owing the bills."
And those patients are not always able or willing to pay.
In 2016, the ambulance service saw a spike in its volume of "non-collected revenue," bills that it issued that went unpaid. In 2015, that number was $224,825; last year, it jumped to $462,350, an increase of just more than 100 percent.
The $462,350 in unpaid bills represented about 32 percent of the service's $1.4 million operating budget, according to slides shown to the Fin Comm.
"We have a lot more figures we can throw at you that we did not want to throw at you tonight," Stuebner told the committee.
They also had anecdotal evidence.
Stuebner said some of the nonpayment results from clients who don't realize their insurance coverage has changed and assumed that the ambulance service does not have to be paid to meet their deductible.
Witkowski told the committee that he recently made calls to clients representing, in aggregate, outstanding bills totalling $50,000 to explain the situation. From those calls, he was able to collect just $500.
"One gentleman who owes us $2,000 said, ‘I'm not going to pay you. Take it up with my insurance company,' " Stuebner said.
The VAS officials said they have been working with their billing company to address the non-payment issue, but the local nonprofit is reluctant to use "strong arm" tactics on its neighbors.
"The thing I've wanted to avoid is going to some senior citizen and saying, 'Sorry, you broke your arm. You owe us $800,' " Stuebner said.
Another impact of high deductibles: An increase in the number of ambulance calls for which VAS can't issue any bill.
Witkowski explained that if the service responds to a call and the patient declines to be transported to a hospital, "There's no place for to generate a bill for that."
While total call volume has remained relatively steady the last few years, averaging about 4,400 calls per year, the number of "non-transport" calls jumped from 575 in 2015 to 1,321 last year, an increase of 130 percent. Stuebner and Witkowski said they suspect the increase is because, in part, of the higher deductibles that scare people away from agreeing to be transported to the emergency room.
"When you go to your doctor's office, you're asked about your deductible and your co-pay, and they collect the money right now," Witkowski said. "Obviously, we don't have that luxury, nor would we want it. Regardless of whether you owe us a dollar or $100,000, we're still going to come to your house."
Witkowski was hired in February 2016 to run an organization with 22 full-time and 19 part-time employees. Though he intended to take time before instituting any changes, he was forced to institute cost-cutting measures almost immediately, he told the Fin Comm.
"This hit me right in the face: If I don't make adjustments and changes right now, we're not going to be here in June, and I came in in February," Witkowski said.
The belt-tightening included a drop in the number of ambulances in service at any given time. The rule at VAS used to be a minimum of two rigs in service 24/7. Now, it operates with one ambulance overnight and two during the day.
That means relying more on a mutual aid arrangement with the North Adams Ambulance Service, which covers calls in Williamstown when VAS' rigs are occupied.
If Village Ambulance goes under, the North Adams or Pittsfield ambulance may be the only option for residents in VAS' primary coverage area: Williamstown, Hancock and New Ashford.
"If we had to rely on North Adams, which is a wonderful service, response times would go up significantly," Stuebner said. "The standard time to respond should be less than five minutes to CPR, if you're going to have a chance to resuscitate someone. We have an average response time of just under four minutes. North Adams is about 13 minutes to Williamstown."
It is not unprecedented for the town to financially support non-profits. In recent years, it has awarded funds to the Williamstown Chamber of Commerce and Williamstown Youth Center at May's annual town meeting.
The members of the Finance Committee thanked Stuebner and Witkowski and recommended they give a similar presentation to the Board of Selectmen. They also reminded the pair that the town budget is crafted by staff, and they should work with Town Manager Jason Hoch to see whether the town could help subsidize the cash-strapped service.
Stuebner and Witkowski said those conversations are under way. Finance Committee Dan Gendron said he knew Hoch was interested in the situation. Hoch is scheduled to present his proposed fiscal 2018 budget to the Fin Comm and Selectmen in the next couple of weeks.
The Fin Comm had a similar response to another non-profit to come before the panel on Wednesday.
Representatives from the website Destination Williamstown were at Town Hall to make their case for taxpayer support for the promotional site. Carol Stegeman and Sandra Thomas made a case similar to the one the website has in the past presented to the Board of Selectmen.
The pair explained that the 2-year-old website performs a valuable role marketing the town to tourists and potential residents — satisfying one of the goals of the town's recent Economic Development Committee, which specifically recommended the town devote financial resources to marketing.
Thomas explained Destination Williamstown's strategy for reaching more internet users and its success rate in putting the town's attractions in front of potential visitors.
The site is asking the town to provide $15,000 toward a projected operating budget of $47,500. The site's current $45,000 operating budget, which pays, in part for Thomas' half-time position as curator and manager, comes from donations, the pair explained.
Members of the Finance Committee expressed support for Destination Williamstown's objective but also encouraged it to strive for greater collaboration with the Williamstown Chamber of Commerce, which already receives financial support from the town in the form of a percentage of Williamstown's revenue from the rooms and meals tax.
Thomas, the one-time interim executive of the Williamstown Chamber, said Destination Williamstown's board has had discussions with the chamber in the past but the collaborators who conceived the website in 2013 had a slightly different mission in mind.
"Chambers have a specific role," Thomas said. "Chambers are about business development. What we're doing is the external work. We're not marketing to ourselves. We're marketing to tourists. There is some crossover, but we're also not a membership organization. We're not bound to serving our members. We're bound to serving the community."
Gendron said he talked with Hoch about the Destination Williamstown question as well and reported that the town manager said the town's contribution to the Chamber of Commerce ($46,774 in FY17) is not set in stone, implying that part of that money could be directed toward Destination Williamstown's marketing efforts or funding for the site could be added to the usual outlay for the Chamber.
Destination Williamstown board member Joe Finnegan told the Fin Comm that a $15,000 outlay to keep the promotional website afloat would be a good investment for the town.
"If we need to market this town to bring more people into town to support Village Ambulance Service and any other needs, this is how we can do it," Finnegan said. "We're asking for your help. We're not asking you to pay for it. We're asking you to help with marketing, marketing the entire town."
Tags: ambulance service, Finance Committee, fiscal 2018,
