Ambulance service to Jefferson has allowed Waldoboro to regain some of the revenue lost after the Fieldcrest Nursing Home closed in 2008.
Waldoboro Emergency Medical Services Director Richard Lash told selectmen at their Nov. 27 meeting that Waldoboro began ambulance service to parts of the northern Lincoln County town after Delta Ambulance ceased handling that coverage. Central Lincoln County Ambulance continues to cover some parts of Jefferson.
“If the next six months continue like the last six months did (sic), it will be roughly 50 to 60 more calls than anticipated,” Lash said. Acknowledging that such calls were hard for the patients involved, he said the revenue generated from the ambulance runs was a plus for his department.
Lash said 44 percent of Jefferson patients are brought to Maine General Hospital in Augusta, with 39 percent going to Miles Memorial Hospital in Damariscotta, 16 percent to PenBay Medical Center in Rockport and 1 percent needing to be transported by LifeFlite of Maine helicopter.
In an interview Dec. 3, Lash said Delta covers a large service area and sometimes had to send an ambulance from Waterville to cover Jefferson. Waldoboro began negotiations in January 2013 to take over the service and made its first run in May.
“When Fieldcrest went out, we lost about 400 calls a year and about $100,000 in revenue,” Lash said. (Ed. note: A previous version of this story misstated how much revenue the ambulance service lost when Fieldcrest went out.) He said he was disappointed that Lincoln County Healthcare did not replace the nursing home with a similar facility.
“Jefferson typically has a total of 200 calls per year,” Lash said. “We get the bulk of them.” He said Waldoboro made 84 trips to Jefferson, as of Nov. 30.
“It’s working really well,” he said. We have a really good rapport with their first responders.”
Lash said the calls run the gamut from broken fingers to cardiac arrests.
Waldoboro EMS also provides service to Friendship. Lash said providing services outside of Waldoboro helps to pay for the 13 paramedics, 12 advanced emergency medical technicians and eight basic EMTs who staff his department. Waldoboro has three full-time employees, with the rest working on a per-diem basis.
Lash said three of the department’s advanced EMTs are currently training to become paramedics.
He said rates for EMS services are influenced by federal guidelines and limited for those covered by Medicare and MaineCare.
Lash said reimbursement rates for those 65 years of age and older, as well as for low-income Mainers, cover the costs of the service but do not provide a high enough payment to allow his department to set aside funds to pay for new equipment as it is needed.
He said billing for Friendship and Jefferson and transfers between hospitals creates revenue that offsets some of the cost of staffing and offers a significant savings to Waldoboro taxpayers.
“The town of Waldoboro gets a full-fledged, full-time ambulance service for under $50,000 a year,” he said. Lash said capital costs are above and beyond that figure.
Waldoboro EMS made a total of approximately 1400 ambulance runs last year. Of those, 873 were emergency 9-1-1 calls, seven were police calls that required the ambulance crew to stand by, 58 were inter-facility transfers that required a paramedic, 18 were mutual aid calls and 275 were transfers that did not require a paramedic.
In addition, the department provided paramedics in 15 cases where the call was in another town that has a mutual aid agreement with Waldoboro.
Lash said 60 percent of Waldoboro patients request to be taken to Miles Memorial and the rest go to PenBay.
Lash said he was told the Sprinter would get 20 mpg, but the actual rate of fuel use, over the 10,000 miles the vehicle has clocked since it was put into service in early September, is approximately 17 mpg. He said that was still significantly better than the 10-11 mpg a traditional ambulance gets.
Lash said he suspects fuel economy is hampered because the Sprinter is equipped for use as an emergency ambulance as well as for transfers.
He said space inside the vehicle is limited and that it is not used as a primary ambulance, but was purchased for long-distance transfers. Lash said the Sprinter was working well in that capacity.
In response to a question from Selectman Steve Cartwright, Lash said he would not request a similar vehicle when the time comes to replace the department’s 2001 truck-style ambulance. That vehicle has more than 200,000 miles on its odometer.
“It’s not nickel and diming us too bad, yet,” he said
He said the department’s Lifepak-12 cardiac monitor and defibrillator units will need to be replaced before 2016. Lash said the manufacturer, Foremost Medical Equipment and Supplies, will not support the units after that date.
Waldoboro EMS has four Lifepaks and the cost for replacement is approximately $30,000 each. He said he has some funds in the department’s capital account, but not enough to replace them all. The oldest is 12 years old, Lash said.
Since July 1, Waldoboro EMS has been outsourcing billing to Comstar Ambulance Billing Service of Rowley, Mass.
“It has gone very well,” Lash said. He said there were “a few minor glitches.”
Lash said delays in payment for Medicare and MaineCare (Medicaid) accounts were expected at the outset and revenues to the department for fiscal year 2013 could be 2-3 percent over the $489,186 anticipated in the budget.
He said Comstar’s policy in regard to collections of past due accounts has worked well so far and that no charges have had to be written off by the town.