To Cut Costs, Randolph Considers Own Ambulance Service

The White River Valley Ambulance responds to a call in Randolph in 2013. (Herald File / Tim Calabro)

A proposal from the Randolph Town Manager has officials at the White River Valley Ambulance concerned for the future of the organization.

Adolfo Bailon, who began his tenure as Randolph’s town manager in late August, floated an idea this past week that would have Randolph leave the White River Valley Ambulance’s 10- town alliance and form its own town-wide ambulance service.

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The proposal, Bailon said in an interview, is just one option—and the most drastic—on the table to curb costs for the town. Preferable, he said, would be for WRVA to renegotiate Randolph’s per capita fee, which currently costs the town about $300,000 annually.

That fee is set to rise this coming year for the first time in four years, according to WRVA board chair Victor Ribaudo. WRVA’s bill to each of the 10 towns in its coverage area will appear on Town Meeting budgets based on a $63-per-person assessment. That’s a $3 (5%) increase over the rate for the previous four years, Ribaudo said. The increase reflects a slight shrinking of area—WRVA relinquished calls to remote parts of Brookfield to the Barre Town EMS Service, which is closer to some sections of the town—as well as ever-increasing operating expenses. Bailon believes there’s plenty of room for savings. “We have a new firehouse,” he said, “we have an empty bay, why don’t we buy our own ambulance? It’ll cost roughly [$180,000 to $200,000]. So the first year may cost us a little more because we’re buying the ambulance. The second year, all we’re doing is paying salaries for our EMTs and ambulance drivers. That would be anywhere from about [$180,000-$240,000], depending on how many we get, and their salaries, and everything else.”

WRVA, which is a nonprofit corporation governed by representatives from each of the member towns, operates on an annual budget of about $1.8 million.

The lion’s share of that budget goes toward staffing, Ribaudo said.

WRVA staffs two ambulance teams around the clock: one with a critical care paramedic (the highest EMS rating) and an EMT; and one with a paramedic and an EMT. About $1,081,000 pays salary and benefits for 11 full-time employees and 20 per-diem staff members to fill in gaps in the 24/7 schedule.

The staff includes an administrative assistant who works 24 hours per week, as well as full-time Executive Director Nick Tarr, who splits his time on administration and on an ambulance team as an Advanced EMT.

Going It Alone

Bailon’s proposal to set up a Randolph-based ambulance service is not unprecedented.

Gifford Medical Center flirted with the idea a little more than 10 years ago of creating an ambulance alliance, and smaller ambulance services have existed in the White River Valley for decades, with differing levels of success.

Like most Vermont ambulance services, WRVA began as an all-volunteer crew in 1974 and shifted to a professional staff as volunteers became increasingly difficult to find during weekday hours.

WRVA is one of three ambulance services in Vermont’s EMS District 8, along with First Branch Ambulance in Chelsea and Royalton Rescue. None has gone without financial struggles as they try to maintain professional medical personnel within very small communities.

The nearby Royalton Rescue squad shifted over a period of three years or so to a full-time professional staff by 2010.

That ambulance operates with an annual budget of $265,600 to staff a single vehicle with Advanced EMTs and EMTs along with a paramedic, when possible.

Royalton Rescue administrator Dave Palmer, who is also a paramedic— and, in the early ’90s, one of WRVA’s first professional responders— agreed that financial savings are possible with an independent ambulance, but “not in the short-term.”

The proposed FY19 Royalton budget, which will be voted on at Town Meeting on March 6, will include a line item from the rescue squad based on a $55.95 per capita assessment.

Like WRVA, Palmer said, Royalton Rescue’s biggest single area of expense is staffing, despite what he called “poverty-level wages.”

According to Palmer, Royalton Rescue has 18 total employees, including six full-timers.

“We’ve been very fortunate,” he said. “We’re the lowest-paid service in the area, but we haven’t struggled” to keep staffing at needed levels.

Palmer said that operating a single ambulance eventually requires having two outfitted vehicles. Having a truck that won’t start when a call comes is “not an acceptable situation,” he said.

Other small ambulance services have not managed to keep their budgets as tightly reined-in as either WRVA or Royalton Rescue.

Valley Rescue faithfully served the people in Rochester, Granville, and Hancock before finally folding in 2013. In that final year, the ambulance service had found it necessary to raise its per-capita rate from $112 to $137, in order to provide service to its rural population.

Since the closing of Valley Rescue, WRVA has taken in the towns in the Route 100 valley.

Call Volumes

Counting dollars and cents, Randolph pays the highest amount into WRVA’s budget of any of the member towns. By dollars per call, however, Randolph’s share is the second lowest, following Rochester.

The ambulance’s assessment to the towns is calculated based on population, so each member town’s per-capita rate is identical—this year climbing from $60 to $63.

The increase, Ribaudo said, comes in part due to a slightly lower population, now that a portion of Brookfield is serviced by Barre Town. Also, he said, 2017 yielded fewer billable runs than anticipated.

Tarr was quick to point out that the per-capita increase also comes after cuts to the WRVA budget in the areas of administration and wages and salaries.

In 2017, WRVA responded to 1,173 calls. A little less than 32% of those (371) were to Randolph and a further 25% (290) were calls to Gifford for transport. The next highest rate of calls was to Bethel at about 11% (130).

Those numbers vary widely year to year, but Ribaudo and Tarr agreed that Randolph regularly outpaces other towns in call volume. Further, they said, due to the number of calls, Randolph paid the second lowest amount per call of any town in 2017. Only Rochester’s assessment came out slightly lower.

Nonetheless, Bailon is concerned by the $63 per-capita figure. Other town managers with whom he has spoken, in Northfield and Cambridge, have found the WRVA rate quite high, he said.

Renegotiate First?

Before delving into the process of setting up an independent ambulance service, Bailon is interested in negotiating with WRVA, aiming to gain a lower per-capita rate for Randolph.

That, of course, would mean WRVA would have to charge a higher rate for other towns.

“I don’t want to put the other towns in a bind,” Bailon said. “So the option I presented to WRVA is, well, if they are able to get their towns to understand that if we pull out, they’re paying roughly about $100 per capita—if they were to agree to pay a little more, it would bring our costs down. We would still be paying more than if we had our own ambulance service; the other towns would be paying more to keep us in the cooperative … nobody gets everything they want, but everybody kind of wins.”

Ribaudo was skeptical that other towns would be eager to subsidize Randolph’s share of the ambulance service.

“That would be very difficult to accept,” he said. “It’s basically shifting the cost from one town to every other town.”

Randolph’s pulling out of the WRVA alliance would be financially catastrophic for the ambulance service, Ribaudo said.

Tarr worried that a split from WRVA would cause a decrease in the level of care available in Randolph since the pool of available paramedic-level providers is not large in the area and, he said, there are calls that simply require that level of expertise.

According to Tarr, the state assumes access to a paramedic level of care in its ambulance procedures, “and we provide that service as the only full-time 24/7 paramedic provider for 911 calls [in the district].”

Whether or not Randolph begins to pursue its own ambulance service, no change will take effect in the near term.

On Town Meeting Day, March 6, Randolph citizens will vote on a town budget that includes $301,000 for WRVA for FY19, which runs through June 2019.

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