# My service is being pressured by the town



## Imagine (May 16, 2006)

To start billing. The selectmen from our town have been on our case for the last 2-3 years regarding their desire for us to bill. We have such a great thing going here right now, and our response time is usually far less than 10 minutes. WE have very few calls, and regardless of whether or not we billed, the service wouldn't rake in much money. The fact that we're volunteer right now is the reason we have such a large squad. If people had to definitively dedicate their time to running calls,there would be no drive to run, and people would "stick to their day jobs"

Any thoughts?


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## Jon (May 16, 2006)

You can still bill for your transports...

Around here, everyone bills and gets as much from insurance as they can. If insurance won't pay, we usually don't go after the local residents for the money "too hard"

billing just means that the squad gets money coming in for transports... it doesn't make you more busy.

Advantages of billing:
INCOME! - My FD's ambulance is self-supporting. We pay for a full-time employee (7a-3p M-F) as well as buying, with cash, a new ambulance every 3-4 years. Last year, the EMS side threw a lot of money into our new Special Service unit that we use to assist and QRS for the EMS side. We also have a points system where each call is worth 1 or 2 bucks... it is a nice check at the end of the year. All paid for by 1 ambulance doing 1000 calls a year, BLS.

Downisde - Documentation has to be "billing worthy" - may take some work to bring some blockheads up to speed. also, billing income can take 6 months or more to come in. Also, the town may "cut you off" funding-wise, which would be bad.

Best idea... contract with an outside billing agency and work with them and the town... run a trial program.


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## Imagine (May 19, 2006)

The thing is though, we dont want to bill. 

We like offering a service to our town for free, because we believe that there's no reason people should have to pay to get a trip to the hospital, and we haven't had any financial problems thus far, because our reputation is such that if you need us, and we respond, you'll probably be inclined to donate some money. The service has been volunteer for 30 years, changing that would be changing tradition, for what? A couple hundred dollars a year? We get 350 calls a year on average. THat's not even one a day. We don't have people "on call" all our emts have beepers/radios, and call in to respond to the ambulance when we're available due to that small call base.

And we're having someone from OEMS come in and meet with our director and some of our chairmen to discuss it.


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## Imagine (May 19, 2006)

Oh- and about the cutting off of funding, yeah it would happen. That's what a couple of the selectmen want. They hate us because we contest them from time to time...


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## Jon (May 19, 2006)

Most BLS services around here bill 300-400 a run... so this is thousands, easy!


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## GaEMT (May 22, 2006)

Like it or not it is a sign of the times.  I cannot imagine not billing for services.  You are a professional, don't be afraid to be compensated for what you do.   Under the guise people may donate after utilizing your services, this may be true, but not utilizing an adequate system to maintain your receivables is poor business sense. And as much as some will fight this statement, an ambulance service is a business entity. (I will save the part of we are all sales people until later)    Maybe I have a different perspective, but $ is what buys the new equipment and trucks on a fairly regular basis. (the oldest truck we have is a 2002)   True we are not a volunteer service (25000+ calls in 2005) but the business mechanics are the same.   Just my humble .02 worth


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## Ridryder911 (May 22, 2006)

I agree with the above posters as well. Call volumes are to be expected to be rising, as well as the off set of costs for EMS. (Fuel, malpractice, equipment) it is not only foolish, but suicidal not to be generating revenue for your EMS. Far as volunteers, like the sign of the time, it too is a dying breed, then why should billing change things?... Are they doing for themselves or the patients?... It would be nice to have working equipment and maintaining education for everyone... 

Good luck, 
R/r 911


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## Imagine (May 23, 2006)

I dont think you guys understand completely. We have the funds for a new ambulance, and just spent 3500 on supplies and equipment. Our budget is not suffering at all. We have a squad that is actually too big. We have never been unable to get a crew together, and often times the problem is more that we have too many EMTs, not vice versa. Our education, and continuing education is donated to us by AMR. The way things are now offers so many people a great way to help out the community, and we get very few complaints, except for those of a few selectmen.

Billing is not an option for our service. At least not one we're willing to choose.


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## GaEMT (May 23, 2006)

Let me ask another question.....Where did the funds that are set aside for a new unit come from?     I know it is a different concept, but our industry as a whole is about to experience some very dramatic changes over the next 18-24 months.    You may get to a point where you cannot self support yourself (if youa re not already subsidized to a degree)     And as I said earlier, as a professional, you should be compensated.    Consumers expect to pay professionals for services rendered.      If you guys can wholly support yourself, great....If you are subsidized, I would be looking at options to keep those with the checkbook happy.    If there are no billing systems which you like, I would research some more until you find something you can live with, other wise you may wake up one day and he who holds the check book has made that decison for you.....Again, my .02 worth.


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## Jon (May 24, 2006)

Again - I think billing, even a "small" amount ($100-200) a run would enable your service to possibly operate without financial support... I would talk with the selectmen and do a "trial run" ,for 3-6 months... The town is probably in the same situation as every place else in America - the town is trying to reduce its budget, etc...

Out of curiosity - how, exactly, does your sqad work? how many ambulances, do you have any "other" vehicles, are you BLS/ILS/ALS? Is there a "uniform"? Where is the ambulance kept? how are you dispatched? I assume your volunteers leave work for calls?

Also, if you bill, you could provide some "benifits" to the volunteers - some services in this area provide the active volunteers cell phones. one local service gave all "active" volunteers a $100+ Littmann stethascope last year, etc...

What I'm trying to say is that having some extra money isn't usually a bad thing.


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## 49er (May 24, 2006)

Imagine said:
			
		

> The thing is though, we dont want to bill.
> 
> We like offering a service to our town for free, because we believe that there's no reason people should have to pay to get a trip to the hospital, and we haven't had any financial problems thus far, because our reputation is such that if you need us, and we respond, you'll probably be inclined to donate some money. The service has been volunteer for 30 years, changing that would be changing tradition, for what? A couple hundred dollars a year? We get 350 calls a year on average. THat's not even one a day. We don't have people "on call" all our emts have beepers/radios, and call in to respond to the ambulance when we're available due to that small call base.
> 
> And we're having someone from OEMS come in and meet with our director and some of our chairmen to discuss it.


Where is the money coming from? For some reason you are not telling all.


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## Jon (May 24, 2006)

Imagine said:
			
		

> The thing is though, we dont want to bill.
> 
> We like offering a service to our town for free, because we believe that there's no reason people should have to pay to get a trip to the hospital, and we haven't had any financial problems thus far, because our reputation is such that if you need us, and we respond, you'll probably be inclined to donate some money. The service has been volunteer for 30 years, changing that would be changing tradition, for what? A couple hundred dollars a year? We get 350 calls a year on average. THat's not even one a day. We don't have people "on call" all our emts have beepers/radios, and call in to respond to the ambulance when we're available due to that small call base.
> 
> And we're having someone from OEMS come in and meet with our director and some of our chairmen to discuss it.


The thing is - beepers/radios break and need to be repaired/replaced.

As I said - the individual citizen isn't going to really be paying for the ambulance transport - their insurance is.

Donations are great - but why should the "kind" folks who donate, and the town itself, be the only way for you to pay the bills...

Try billing - give it a shot.


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## Wingnut (May 24, 2006)

I don't disagree with anything that's been said but I have to play devil's advocate here. Getting money isn't always a good thing, it complicates and changes things. It sounds like you have a good system going and one of my favorite phrases is "If it ain't broke don't fix it."  And it sounds like while everything is working well and as it should (and you are SO lucky for that, must be a great community) some money grubbing people saw an opportunity and are trying to get thier fingers in the pot.

Your best bet at putting this to an end is probably having a community meeting and let them decide.

Really I commend your service, you must have a great bunch of people there. I wish the economy would allow people the ability to volunteer, but like me, any time I spend away from home, I have to be getting paid for, the cost of living here is just way too high for me to do anything like that.

Good luck and keep us updated!


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## Imagine (May 25, 2006)

Okay, here's how things work.

The ambulance squad is a company out of our town, harvard mass. Thusly, it's included in our town budget. We get donations for being volunteer, and we get town grants. We're 100% non profit. The people in the town are generally pretty well off, financially regardless. Money for the new unit came from a grant that we put in to town hall.

I"m sorry if I don't answer all your questions, I"m doing my best.

We have a wonderful community, and there are no financial issues that any one of us see. There are just a few selectmen that hate the service because of some stupid dramatic issue last  year. 

Ask me specifically if I missed addressing anything...


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## GaEMT (May 26, 2006)

Seems they are the ones who hold the purse strings though   May I ask what "dramatic issue"


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## 49er (May 26, 2006)

Our Department is also a municiple dpt. and we "fund" our volunteer transport service 100% from our billing, we do not use any town funds, but we are still part of the town budget. There is a big difference in being funded by the town    
(town taxes etc.), or billing for professional services. How is your service structured? How much say do you have in how the money is spent IE: in reality do you have to ask the town for permission to buy equipment? or submit proposals, grants, etc.?


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## Imagine (May 27, 2006)

We have a budget that the town gives us annually, and we can spend the money on what we need. We only need to go through them if we need more money for whatever reason.

The dramatic issue was merely billing, but it got a little out of hand and became really heated.

Umm...We met with someone from OEMS to disscuss the issue. (OEMS, for those of you who don't know is the massachusetts ems organization). They told us that we didn't have enough runs to pay for a billing company, and that the only way we might be able to do it is if the town continued to pay, which if we started billing, probably wouldn't happen. The town doesn't really understand the system, and think that the ambulance squad would be bringing in money for the town, instead of suckign it out, when in reality the money we make in billing would have to go to our budget, and wouldn't funnel back into the town.


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## Ridryder911 (May 27, 2006)

Sounds like they want more money into the "general account" instead of EMS fund. Many townships and cities, sees EMS as a revenue for other programs without marking such as "strictly for EMS". 

I would inquire on how well other community programs and services are doing? There may be a potential short-fall somewhere and they maybe looking for something to cover the expense. 

Good luck, 
R/r 911


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## 49er (May 30, 2006)

We only respond to about 350 calls per year, with about 250 of the calls resulting in billiable transports. We used to use Medibanc for billing untill they got bought out. We now submit our bills to the county EMS department and they collect for us.
The department writes the budget and submits it to the town, since the Town Assembly has little or no knowledge of what we do, they may ask questions, but it is pretty much a rubber stamp process. The state and county have laws in place which makes sure that the funds stay with the EMS department. All towns are required to be auditted anually by an independent CPA. 
I can understand why you think your system is less work for your department, but by going to a billable service you would have more control over how your service is run. The real danger of your current setup is the fact that the town can and sooner or later will tell you how to run your service.


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## Imagine (May 31, 2006)

49er said:
			
		

> We only respond to about 350 calls per year, with about 250 of the calls resulting in billiable transports. We used to use Medibanc for billing untill they got bought out. We now submit our bills to the county EMS department and they collect for us.
> The department writes the budget and submits it to the town, since the Town Assembly has little or no knowledge of what we do, they may ask questions, but it is pretty much a rubber stamp process. The state and county have laws in place which makes sure that the funds stay with the EMS department. All towns are required to be auditted anually by an independent CPA.
> I can understand why you think your system is less work for your department, but by going to a billable service you would have more control over how your service is run. The real danger of your current setup is the fact that the town can and sooner or later will tell you how to run your service.



The town selectmen know nothing about what we spend our money on. They trust that we know what we need, and give us money based on that. We have complete control, which has been nice, they just want to turn us into a profit organization, which isn't going to happen with our call base. We might be able to lessen the town's influence on our budget by billing, but it wouldn't be all that significant, and our town, being rich as all hell, doesn't really have an issue including us in their budget. I can't think of another community service in our town...I think everything else might bill, in one way or another...


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## HFD EMS (Jun 20, 2006)

Our local ems service that i serve on right now is strictly volunteer EMTs and First Responders and we charge a flat rate of 300 dollars for each run and it keeps us afloat and we have a nice medtec Type 3 ambulance with a new pediatric care equipment and things break down and the money has to come from so where so there is definitely a plus to charging a flat rate and our EMT numbers are down however but that is because people are lazy and dont understand the important of an ambulance!!!:glare:


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## rescuecpt (Jun 20, 2006)

Imagine said:
			
		

> I dont think you guys understand completely. We have the funds for a new ambulance, and just spent 3500 on supplies and equipment. Our budget is not suffering at all. We have a squad that is actually too big. We have never been unable to get a crew together, and often times the problem is more that we have too many EMTs, not vice versa. Our education, and continuing education is donated to us by AMR. The way things are now offers so many people a great way to help out the community, and we get very few complaints, except for those of a few selectmen.
> 
> Billing is not an option for our service. At least not one we're willing to choose.



My department runs 3,200 - 3,600 calls a year.  We don't bill.  Our fund drive brings in around $100,000 a year from the 10,000 residents and couple hundred businesses in our district.  We don't want to bill, although our county has been talking about billing for BS calls (suitcase packed, fully dressed, on their way to a doctor's appointment at the hospital).  We don't have too many of those, so we're not really for it, but I know other departments in the county have a lot of them.

We provide this PROFESSIONAL service to our community for free, out of the goodness of our hearts.  Right now, billing is not something we are willing to do - I hear you Imagine and I would stick to your guns.  Good luck.  Also, remind the selectmen that they are, oh, what's that word... SELECTED...


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