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Fire Chief Outlines EMS Contract Details
By Thomas P. Caldwell
BRISTOL — A review of the emergency medical services contract with Alexandria, Danbury, and Hill led Fire Chief Ben LaRoche to conclude that the current assessment formula, with some minor changes, makes the most sense for Bristol.
Former budget committee member John Sellers had suggested changing the formula from a calls-based assessment to one based on population. Bringing the proposal to selectmen two years ago, Sellers argued that the town is providing a service to the entire population of the towns, whether or not they need to utilize the service. He said the current formula unfairly leaves Bristol bearing the major portion of the cost of preparedness to respond. The net cost also rises and falls based on the number of calls, while basing it on population would provide a more stable assessment, he said.
The town negotiated the current formula with the contracting towns in 2009, replacing a flat fee with an attempt to capture the true costs of providing the service. It determines how many of the previous year’s total fire calls were EMS-related to arrive at a cost per transport based on the EMS budget items. That cost is multiplied by the number of calls to each town, with credit given for patient and insurance payments. The unpaid balance is billed to the towns as a “subsidy” to cover EMS costs.
Because of a change in management at the fire department last year, selectmen did not pursue Sellers’ suggestion at that time, but LaRoche took it up once he became the fire chief. He reported to the selectmen on June 29, saying he found some things he would want to change, but, overall, the current formula is working.
“We’re more than covering our costs,” LaRoche said, adding that there should be a financial benefit to the town providing the service. At the same time, the contracting towns are getting great service at a fraction of what they would pay providing the service on their own, he said.
LaRoche provided a chart comparing Bristol’s 2016 costs as they were with an EMS contract and what they would have been without a contract with the other towns.
The operating cost for the fire department, including its revolving fund, was $1,003,085. Client billing for EMS provided $257,221.52 in revenue, while the EMS subsidies from other towns provided $124,518.48 in income. The net cost to Bristol residents was $621,518.48.
If Bristol were not providing EMS services to other towns, the fire department’s budget would have been lower — $987,085 — but client billing for Bristol alone would have provided $135,769.60 and there would have been no town subsidies to offset costs. The net cost to Bristol residents, therefore, would have been $851,315.40, LaRoche said.
“We have a need for the ambulance service and, if we have the capacity, we should try to offset some of that cost,” LaRoche said. “When you provide the level of service we have, it leads to a better patient outcome, and to other towns as well. Also, it makes our providers better providers because they see more hits. When you send someone out, you don’t want it to be the first heart attack they’ve seen in a year.”
Nonetheless, LaRoche noted some problems with the current formula. The contract period does not line up with Town Meeting, he said, so they’re essentially working for a month without a contract, until voters have agreed to the budget. He suggested moving the contract period to June 1-May 31, but selectmen said it might be better to make it July 1-June 30 to conform to a more common fiscal year.
LaRoche said the current formula also forces the department to use the previous year’s calls to calculate the following year’s rate. By changing the period to Aug. 1-July 31, the calculation could use more current call numbers to calculate the contract numbers, he said.
The chief also noted that the contract uses a fixed number to assess the towns for the cost of the ambulance. He suggested that, with the next ambulance, the formula should use a six-year depreciation period to recover the cost.
He said some EMS expenses that are not included in the contract should be figured in, including the percentage of EMS use of the fire department copier, computer, and cell phones.
Finally, he said, the town should re-establish annual meetings with the other towns as outlined in the EMS contract. Those meetings would help to address strengths and weaknesses in the relationship, as well as helping to prepare for the future.
On that matter, LaRoche noted that there are 1,100 EMS calls annually and he estimates that current staffing can handle between 1,200 and 1,300 calls per year. When the department reaches that number of calls, it will be faced with hiring more personnel or ending the contracts with the other towns. The annual meetings will allow the towns to discuss the options, he said.
Selectman Paul Manganiello said the relationship with other towns might allow Bristol to station the new ambulance at one of their stations. The current ambulance will be 12 years old next year, and is slated for replacement, but new ambulances are larger than the current model, and the Bristol Fire Station has limited space. LaRoche they may be able to purchase a chassis like the one on the current ambulance so it would fit in the Bristol station.
“I love the idea,” LaRoche said of working with the other towns. “It starts to broach the subject of a bigger issue. … We’re not recruiting at the level we used to. It’s the case with all the towns. We need to start working together more than we do to continue to provide any level of fire and EMS services. We need to put people and pieces in the right locations.”
Returning to the EMS contract, LaRoche said, “There's not a perfect system out there. For us and the way we work with other towns, this is the best answer.”
In other business on June 29, selectmen followed through on some old initiatives, granting Community Development Block Grant authorization for the Newfound Area Housing Project and entering into a seven-year contract with Northway Bank for the $305,000 purchase of new dewatering equipment at the wastewater treatment plant, at 2.55 percent interest.
Selectmen delayed action on an amended transfer station ordinance that will change the existing fees to better match what is dumped off.
2 July 2017
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