Ambulance service in financial jeopardy

66-year-old service asking for $30K from each town for 2014

Jaffrey held it's town budget meeting at the Jaffrey fire station, Saturday.

Jaffrey held it's town budget meeting at the Jaffrey fire station, Saturday. Purchase photo reprints at Photo Finder »

After 66 years of providing medical transportation for emergency calls in the Jaffrey-Rindge area, representatives of the Jaffrey-Rindge Memorial Ambulance Service say that if existing financial issues, particularly with billing patients, continue, services may have to be altered or discontinued.

While vying for support from Jaffrey’s Budget Committee at its budget hearing earlier this month, in the form of a $30,000 petition warrant article, President of the ambulance’s Board of Directors Mark Winiecki said the company would need more support from the communities it serves if future billing issues aren’t resolved, in order to maintain the same services.

“We require the assistance of the towns that we serve now and in the foreseeable future,” said Winiecki. “We’re as efficient as we can be, but we can’t cover our operating cost.”

The proposed 2014 operating budget for the ambulance is $326,600, a figure that relies mostly on revenue from billing clients. According to Winiecki, the ambulance has trouble receiving payment from some patients. The low rate of successful billing has led to issues keeping up with operating costs.

The Jaffrey Budget Committee voted to recommend the petition article and attending voters also voiced support. The article came as the second annual $5,000 increase in proposed funding to the town – necessary, said Winiecki, to replenish the nonprofit’s capital fund, which was used to buy a new ambulance in December 2012. He said the ambulance needs the capital fund to be there, so they can be responsible and ready for the future.

In an interview Tuesday night by phone, Winiecki added that the business model used by the ambulance is not sustainable, despite a conservative operating budget and running as efficiently as possible. Because most of the problem stems from the current business model, it should be reviewed, said Winiecki. Some towns, he added, lump the ambulance service into their Fire Department, but he is concerned that it could cost taxpayers more money and wouldn’t necessarily be more efficient than the current operation.

“It’s been up and down in terms of sustainability in the 10 years I’ve been chief,” said Rindge Fire Chief Rick Donovan on Wednesday. “It’s very tough for a private outfit that doesn’t have municipal funding.”

He added that the towns provide annual funding to help support the service, because ambulance’s only source of non-municipal revenue is from billing.

“As far as I can see, we do try to value their service,” said Donovan.

Part of the issue, explained Winiecki, is that the ambulance is only able to bill patients who are treated and transported to the hospital. Then, only those patients with health coverage can be billed through their insurance provider and those without it must be billed directly. Sometimes, he said, it is difficult to get remuneration, as some patients without insurance are unable or unwilling to pay. According to Chris Sasner, co-director of the ambulance service, in those situations the bill is sent to a collections agency.

In addition to the issue of nonpayment, the ambulance’s emergency medical technicians responded to 893 calls in 2013, said Winiecki, but only 31 percent of callers actually accepted an ambulance ride to the hospital. Therefore, only approximately one-third of emergency responses were billed out and paid for.

According to Sasner, since the ambulance also pays its employees per diem, a set daily allowance regardless of unsuccessful billing and whether or not they receive a call while on duty, expenses are growing with the number of clients who do not pay.

“Not making money has been hitting us,” said Sasner. “It really affects us when people don’t pay.”

There is a misconception that the medical staff works on a volunteer basis, something that Winiecki says is not true. He added that people have asked him why there are money problems, if all the staff are volunteers. But he said they began paying employees years ago, a difference that means quicker response times to emergencies, since staff are already in the station, instead of coming from home.

When the service first started in 1948 as the VFW Memorial Ambulance, only a few veterans operated it with a single ambulance. At the time, it was not yet a nonprofit and has only gained that official status in the last decade.

Now, the ambulance is maintained and operated by 25 medical staff. According to Sasner, each employee undergoes significant medical training before being deployed in the field.

“When someone calls 911 and needs an ambulance, we get woken up with a page,” said Sasner. “Most of the people who do it here do it because they want to help the community.” The job is not a way of earning a living, he added.

Chrysten Shelly worked for the ambulance for over two years, but said it’s impossible to work full-time as a paramedic in New Hampshire, because the towns are small and can’t afford to pay people full-time wages and benefits.

Shelly said she would work for the ambulance again if she could, but because of student debt and living costs, she moved to Boston, where she could work as a medic full-time.

“It’s a great service that helps the community,” said Shelly. “I always enjoyed working there.”

Bernie Jones, an employee of the ambulance, has been working with the ambulance service for over four years. It’s her second job, which she works when she isn’t at her full-time job at Market Basket. She explained that working with the ambulance is not something she does for money. Employees manage their schedules by working one day a week, in addition to one weekend of every month.

“I love what I do,” said Jones. “You can’t do this unless you care for people.”

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