MONTGOMERY COUNTY -- Montgomery County Executive Matt Ossenfort says the sudden shutdown of the Ambulance Service of Fulton County in February served as a wake up call for officials in his county.
Ossenfort said he has spoken to ambulance service leaders such as Tom Pasquarelli, the executive director of the Greater Amsterdam Volunteer Ambulance Corps., and determined that Montgomery County needs to address the problem of how to fund a sustained ambulance service.
"Nothing is in immediate danger, but over the long term, if things remain as they are, we could potentially be in a situation where ambulance service is a big issue in the county," Ossenfort said.
Ossenfort, Pasquarelli, Sheriff Jeff Smith and other ambulance service leaders and emergency management officials in Montgomery County are set to meet Thursday in a private meeting to discuss options for how to bolster the funding available to pay for ambulance service coverage.
The ASFC was forced to discontinue its operations Feb. 8 when it determined it didn't have enough cash to make payroll. Among the reasons cited by the entity were Medicaid reimbursement rates that are too low to cover the cost of an ambulance service call, forcing the nonprofit to lose money on a large portion of its operations.
While the ASFC has since resumed basic life support ambulance service calls, the Greater Amsterdam Volunteer Ambulance Corps. has received the state license to take all of the 911 emergency calls throughout Fulton County, the territory the ASFC used to derive most of its business from.
Pasquarelli said GAVAC currently has five ambulances in operation in both Fulton and Montgomery counties, each rig having two personnel assigned to it. He said GAVAC estimates it will spend about $4 million in annual costs in each county. Pasquarelli said in Montgomery County GAVAC had between 8,000 and 9,000 ambulance calls in 2018, of which 45 percent were paid for by Medicare, 23 percent were paid by Medicaid, 8 to 9 percent were paid by private insurance, and the remaining calls either had no insurance and either went unpaid or were privately paid.
While he said it costs between $367 and $410 for an Advanced Life Support ambulance call in Montgomery County, the county's Medicaid reimbursement rate for an ALS call is only $165, a rate set in 2013. Fulton County actually pays more, $220 per ALS call, set in 2014.
"If the county could be more active in asking the state to raise those rates, that would helpful," Pasquarelli said.
In last year's state budget, Gov. Andrew Cuomo's administration proposed eliminating the 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. The cut ultimately was not approved.
Pasquarelli said he's fearful that kind of cut could be back on the agenda for next year's state budget. He said he intends to communicate to Ossenfort and other county leaders how devastating a cut like that would be for his operating budget.
"If we were to lose $200,000 in revenue from a cut like that, we would have to adjust, and that could mean the difference between a three-minute response time in some areas to a 15-minute response time," he said.
On Wednesday, Ossenfort said all potential options will be discussed during Thursday's meeting, including establishing a taxing district or direct contracts between the county or the towns with GAVAC or other ambulance services. He said providing a stable revenue source for the ambulance services is a priority.
"I'm coming into this meeting with an open mind. GAVAC is doing a good job, but due to some structural problems with the reimbursement rates on the calls they receive, it makes it really difficult to operate. That doesn't look like it's going to change any time soon, thus the need to really brainstorm as to how we're going to fix it, both on the local level and with the state," Ossenfort said. "Right now, ambulance services are not considered essential services, and every year people go to Albany to lobby for that. We want to dig into what those issues are and how we can make changes to make sure this service — that I feel is an essential service — is there for the people who need it. We need to make sure we don't have any gaps in service."
Ossenfort said one option that will be discussed is whether Montgomery County should ask the state to issue it a certificate of need to operate its own county-run ambulance service. He said the city of Amsterdam's fire department ambulance service could also be looked at as a possible resource for helping to fill some calls outside of the city limits, which it currently does not have the license needed to do.
Pasquarelli said if New York state would designate ambulance services as "essential services" it would mean municipalities would be required to either contract with entities like GAVAC or establish their own ambulance service. He said the stable stream of tax revenue to his organization from municipalities would shore up its finances and help maintain the service.
"I ask the question 'would you pay $25 a year to ensure that there's an ambulance at your home when you need one?' I think most people would say yes, and actually it wouldn't cost more than one or two dollars per household per year in Montgomery County to get us the revenue we need. We're not talking millions of dollars, $500,000 would do it," he said.
Ossenfort said he intends to discuss progress made on the ambulance funding issue publicly, and with members of the Montgomery County Legislature, after the private meeting Thursday.