Capital Region

Shutdown of Fulton County’s largest ambulance service has others pointing out precariousness

Services fear state funding cuts
A recent shutdown has other area ambulance services sounding the alarm about potential state funding cuts.
A recent shutdown has other area ambulance services sounding the alarm about potential state funding cuts.

The recent shutdown of the largest ambulance service in Fulton County has other area ambulance services sounding the alarm about potential cuts proposed in Gov. Cuomo’s executive budget.

Ray Otten, executive director for the Community Emergency Corp. in Ballston Spa, said there are two proposals in Cuomo’s budget that, if approved in the final state budget, will damage the current business model of most state ambulance services:

• Eliminating Medicaid payments for Medicare Part B co-insurance — Medicare Part B patients are currently responsible for a 20 percent co-insurance co-pay. Where a Medicare patient is also eligible for Medicaid, Medicaid pays this 20 percent on behalf of the patient in what is known as a “crossover” payment.

Cuomo’s proposed budget eliminates crossover payments, meaning providers already operating below cost will lose out on a further 20 percent.

• Eliminating the Medicaid Supplemental Funds for ambulance providers –  A 2017 study by the state Bureau of Emergency Management Services recommended a $31 million increase during the next five years in money set aside to pay ambulance services for transports that qualified for Medicaid Supplemental Fund payments.

Providers have been receiving Medicaid Supplemental Funds annually as “catch-up” payments, based on the number of Medicaid-qualified calls reported by a provider the prior year.

The governor’s proposed budget eliminates this catch-up, a move that would cost ambulance providers another $6 million annually.

“Effectively, this loss of funding means fewer ambulances on the road, longer wait times for hospital transfers, likely personnel layoffs and the very real possibility of ambulance services permanently closing their doors,” Otten stated in a release.

Thomas Pasquarelli, executive for the Greater Amsterdam Area Volunteer Ambulance Corps, said during the past nearly 30 years, he’s seen the revenue model used by ambulance services come under increasing strain.

Medicaid reimbursement rates have not kept pace with increases in costs, including state-mandated minimum wage increases, Pasquarelli said. It costs GAVAC $367 to put an Advanced Life Support (ALS) ambulance out on a call in Montgomery County, Pasquarelli said, and that’s before using any supplies required for the call. But the county’s ALS Medicaid reimbursement rate is only $165.

“Everybody is functioning in a non-sustainable system now,” Pasquarelli said. “It’s not just the Ambulance Service of Fulton County, it’s all over the state and all over the country.”

Pasquarelli said GAVAC has responded to the challenging funding environment by finding ways to stretch dollars, like only replacing ambulances every four to five years instead of three years, and by expanding its territory, first into Broadalbin, and now into the territory formerly controlled by the Ambulance Service of Fulton County.

Pasquarelli said ambulance services are not allowed to lobby the government for additional funding. But all of them are fearful about the proposed cuts, he said.

“Everybody is watching what is actually going to happen with this,” Pasquarelli said. “About 76 percent of ambulance services, certainly in our area, are funded by government payers, if you will, the Medicare and Medicaid system.”

Daniel Schuttig, a labor relations representative for the United Public Service Employees Union, said paramedics who work for the Mohawk Valley Ambulance Corps, the Empire Ambulance Service and the now shuttered Ambulance Service of Fulton County (ASFC) are concerned about potential cuts to Medicaid applicable to EMS.

“So many ambulance companies operate so close to the edge that even a slight reduction in funding will be the demise of countless ambulance services across the state,” Schuttig said. “If you think about it, these guys are making $12.50, $13 an hour and these organizations are either not surviving or barely surviving.”

“How are they going to survive with further cutbacks?” Schuttig asked. “It’s just not going to happen.”

Funding options

One of the top reasons given by ASFC officials for the service’s shutdown was a high volume of Medicaid calls, nearly half the calls the service was providing. Also cited were reimbursement rates that were too low.

Medicaid funding reimbursement rates vary from county to county, based on different factors, including the distance to hospitals. Some haven’t been updated in more than a decade and none more recently than five years ago.

These are the current Advanced Life Support Medicaid reimbursement rates for counties in the greater Capital Region, and the year they were set:

• Albany, $186.45, 2007

• Schenectady, $186.45, 2007

• Rensselaer, $186.45, 2007

• Saratoga, $191.45, 2014

• Fulton, $220, 2014

• Montgomery, $165, 2013

• Schoharie, $160, 2014 

• Hamilton, $200, 2000 

Dean Romano, the executive director of Rotterdam Emergency Medical Services, said his ambulance service was in talks with the board of directors of ASFC to partner in a reestablishment of service. But talks broke down Friday.

Romano said he doesn’t believe the ASFC’s funding woes were caused by Medicaid rates, which are actually higher in Fulton County than the rest of the Capital Region.

Romano contends that the real problem was ASFC’s inadequate and antiquated billing system.

“We could fix that,” Romano said.

ASFC shut down Feb. 7 when it couldn’t make the agency’s $70,000 bi-weekly payroll, and didn’t have enough to make insurance payments. The ambulance company laid off 55 of its 60 employees and has said they need a $200,000 cash infusion in order to resume operations.

Alan Mendelsohn, vice president of the ASFC board of directors, has argued in favor of Fulton County authorizing a taxing district to provide ASFC a guaranteed annual revenue stream.

Creation of a taxing district has helped other local ambulance services maintain a core revenue source. In 2018 the residents of Galway voted to approve a taxing district to help fund the Galway Emergency Medical Services.

Romano said a taxing district would certainly help his ambulance service upgrade its equipment and provide a better service, but he questioned whether it would solve ASFC’s issues.

“More money doesn’t solve money problems,” Romano said. “Having better systems in place solves money problems.”

A key to maintaining an effective ambulance service is effective management, Romano said.

One of the reasons a deal for his agency to partner with ASFC fell through is because he declined to take on the service’s existing management team. Romano said ASFC made mistakes, including investing in a “fly car” to handle advanced life support (ALS) calls in Hamilton County, where the call volume doesn’t support that service.

Pasquarelli said he thinks creation of taxing districts, as well as making EMS an essential service eligible for more federal grants like fire departments, would be two steps toward stabilizing funding for ambulance services.

“Who wants to pay more taxes?” asked Pasquarelli rhetorically to frame the argument. “But when you put things into consideration, if it cost each household $25 to make sure when they dial 911 that they have an ambulance available, would it be worth it to them?”

“I would venture to guess that a majority of people would say, ‘Yes’,” Pasquarelli said.

Categories: Business, Fulton Montgomery Schoharie, News

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