Phil Higgins had to face two tough crowds of residents while asking for a funding increase for Winterport Volunteer Ambulance during annual meetings in Winterport and Frankfort.

The department is facing a deep gulf between revenues and expenses that is pushing it to either raise its requests for funding from the two towns it works with or make deep cuts in the amount of service it can provide.

“People want an ambulance service, but they don’t want it on their taxes,” he said.

It is the first time Higgins has asked Winterport for funding in 45 years. Usually the town volunteers to give a certain amount, but this year the department has used nearly all it had in its reserve accounts. Payroll is the largest expense for an ambulance service, and there are fewer volunteers than ever before, he said.

The department collected slightly less revenue to cover its payroll in 2019, with a payroll of $191,437 and revenue of $184,553. But other expenses like supplies and equipment maintenance added to the financial toll to the tune of $73,847.

In Belfast, records show the city had in excess of $1 million worth of unpaid ambulance bills over eight of the past 10 years. City Treasurer Theresa Butler said it was a result of insurance companies' dropping coverage of ambulance service costs.

Fixing reimbursement rates

Maine Ambulance Association Executive Director Jay Bradshaw, who was also the state’s Emergency Medical Services director for 20 years, said he has been working in the emergency services field for over 40 years and it has always been underfunded.

But he said now it is getting to a critical level where rural communities are losing essential coverage. It costs more to provide EMS services to rural communities than urban communities. The need for expensive equipment and service is the same in both areas, but the rural EMS call volume is less, so revenues are lower.

Nonetheless, Bradshaw said, EMS service is just as important in rural communities and they need coverage also. Rural departments also tend to be less knowledgeable about insurance billing and do not have revenue for accounting services, as do many urban departments.

There are 272 EMS departments in Maine; 165 of those offer transporting service, according to Bradshaw. And 75% of all EMS departments respond to fewer than 600 calls per year, which is the considered the dividing line between low- and high-volume departments.

He said rural departments have a low revenue stream, which means fewer EMTs, which results in a strain on services. It is a cycle that all ties back to finances.

“There is not a big enough pie to buy the ambulance, to buy the stretcher, to buy the cardiac monitor, to put in the diesel fuel and pay people what they really should receive for the services they provide,” Bradshaw said.

The EMS industry is constantly competing with hospitals for state and federal funding, he said, and usually the hospitals win, because they are viewed as more of a necessity. But they depend on each other in many ways and should be funded as two separate entities.

Maine Ambulance Association worked closely with the state last year to increase funding for MaineCare, which used to reimburse departments at a lower rate than Medicare, he said.

At the beginning of this year the MaineCare reimbursement rate was increased from paying departments 65% of what Medicare reimburses to 100%, according to Bradshaw. Most private insurance companies that still cover ambulance costs have started using Medicare’s reimbursement model.

Medicare takes into consideration the department size and urban or rural location when reimbursing ambulance departments, he said.

Community support

Searsport Ambulance Director Adrian Stone said his department faces the same revenue shortfalls as the Winterport department, but it is is fully funded by the town. “We’re fortunate in Searsport. The community is very supportive,” he said.

This year he predicts that the department will exceed 650 calls. The department has been above 600 calls for the past five years.

Revenues account for about half of the department's overall expenses, Stone said. But the department does not aggressively seek compensation for unpaid bills, which now amount to $220,000, because it is a municipally funded department and predominantly serves residents.

The town of Searsport makes up the department’s revenue shortfalls. The municipality recently approved funding to create paid positions from 6 a.m. to 10 p.m. and an overnight stipend, he said. He was nervous asking for the funding, but, he said, “The community was fully supportive of it.”

The department has 23 active members, but the only people who are paid a full-time wage are Stone and his assistant director, he said. The rest are paid at part-time or by stipend, with at least two people at the station to respond to calls all the time.

He said emergency response equipment is not cheap and can cost a department  hundreds of thousand of dollars. A new ambulance can run up to $200,000, a cardiac monitor costs up to $40,000, power stretchers go for up to $25,000 and mechanical CPR devices can cost up to $12,000, all of which are essential in responding to various medical emergencies.

A grim outlook

Unless revenues or town funding go up, Higgins does not have a positive outlook for the Winterport department. Revenue is becoming scarcer and volunteers are dwindling. He only has one volunteer left on the department, and the rest must be paid hourly by call or stipend.

Many of the department’s EMTs have to work second and third jobs just to make ends meet and tend to make little more than minimum wage starting out in the field, according to Higgins. It is a high-stress job, but at the same pay rate as other people in low-stress and low-responsibility jobs.

“This is one occupation of a larger system,” he said. “You really have to have a heart for it to see some of the events we go through.”

Frankfort voted to approve $7,500 to fund the department for the next fiscal year. Initially, Higgins asked Winterport residents for $75,000, but that was voted down. Instead the town approved $30,000, contingent upon a committee on the funding issue being developed and the ambulance service’s impact being considered at two public town meetings before the funds are released.

Higgins said his department will probably not go away within the next couple of years, but it might have to take a hard look at the amount of service it can provide daily if funding continues to be constrained.

Bradshaw said the fact that EMS services have been there forever does not mean they always will be, and he thinks people would be surprised to realize how close some departments come to not being able to respond to a call.

“Twenty years ago, EMS was described as living at the intersection of public safety, public health and health care,” he said. “And I think that’s absolutely as true today as it was in 1996. … A lot of people think ‘I called EMS, EMS came.’ They don’t think about what happened behind the scenes.”