Written by Carol Frank Friday, 28 January 2011 00:00
The future of Vigilant’s ambulance system serving the north end of the peninsula is in crisis. Conflicts with and within the local units of government, villages and the town, that fund the system have been under the radar for a number of years. It is time that the public understand what we have in place now, how it functions, how it is funded, the issues involved and what is at risk. The following is a basic primer to bring the public up to speed for what should be a public dialogue on the matter.
If you live north of the railroad tracks and are in need of emergency medical attention, the Vigilant Fire Company’s trained volunteer members aboard an ambulance will respond within eight minutes, beating the average New York State response time by two minutes. They will rush to the scene of an accident or to your home, perform whatever is necessary to stabilize you, call ahead and get you to the closest available hospital emergency room. The EMTs are trained to rapidly evaluate a patient’s condition and to maintain a patient’s airway, breathing and circulation, control external bleeding, prevent shock and prevent further injury or disability.
You will be in reliable, experienced hands.
Afterwards, you will receive a bill from the hospital and the doctors who saw you. But you will not receive a bill for the ambulance and the services of the Vigilant’s members.
Chances are, you pay between $38 to $100 a year, based on the assessed valuation of your home, in taxes to a village or to the Town of North Hempstead for the potential of using that service, no matter how many trips you and your family may need to make to the emergency room by ambulance.
You pay more in taxes for fire protection. In the past, 70 percent of your taxes for these emergency services covered the fire protection and 30 percent paid for ambulance services. Some villages have argued that the 70/30 ratio should be changed, perhaps to 68/32. Keep in mind that the Villages of Kings Point, Great Neck and Saddle Rock contract with the Alert Company for fire protection and the Vigilant for ambulance services only. The Village of Great Neck Plaza contracts with the Vigilant for fire and ambulance for those residents north of the Long Island Rail Road, but their residents who live on the south side pay taxes directly to Manhasset-Lakeville which is a special fire and water district.
One source told the Record that the proposed change in ratio allotments would mean a difference in taxes that would work out to approximately $7 for the average household.
Each year, the villages and the town negotiated with Vigilant for their services, but with the economic free fall, last year many of the villages did not sign the 2010 contract with Vigilant. They continued to use the service, but paid the amount budgeted for 2009, as stipulated in old contracts. Why?
The short answer is money. Ambulance services have been viewed in the past as just that...a service. With local governments sharpening their collective pencils for savings, it is being eyed as a potential money-maker...if insurance claims can be made against the calls. The total cost of the Vigilant’s ambulance service is $900,000 a year. Because the EMTs are highly trained volunteers and the costs go primarily to employ dispatchers and buy equipment while space is shared with the fire protection side, the budget is relatively modest considering the fact that ambulances go automatically to all fire calls in case they’re needed and made 2,200 runs last year alone. The daytime dispatchers also perform maintenance for the firehouse and the equipment and since the 1980s have been required to have EMT training as well.
A recent ambulance study, costing $180,000, conducted in the Town of North Hempstead by an outside consulting firm estimated that some $2.8 million to $3.2 million a year might be garnered from insurance claims; however, this estimate does not account for administrative costs involved in making the claims. Or the potential cost of a collection agency to “go after” the uninsured. Nor is there any estimate of the legal and accounting costs that would be incurred if the Vigilant were to “divorce” the ambulance service from the fire protection service.
The Vigilant as a volunteer fire and ambulance provider may not, under New York State law, charge for their services. The study’s consultants, the Center for Governmental Research in partnership with Hofstra University, suggested that in order to file insurance claims for reimbursement, fire companies could “on paper only” divorce themselves from the ambulance division, thereby getting around the law.
Historically, the Vigilant membership has not been enthusiastic about filing insurance claims, even if the law could be circumvented. There is paperwork involved already in documenting any intervention done, medications and health histories, but they have balked at the idea of performing a volunteer service and then sending a bill.
David Weiss, who serves as chairman of the board for the Vigilant says, “We want to do what’s right for the community. We have been willing to sit down and talk about the situation and possible solutions, but we also want the community to be well informed about what is going on...And is anyone complaining about the services we offer?”
With the impasse in play, Town Supervisor Jon Kaiman jumped into the fray calling it a “crisis if the villages don’t all come to an agreement.” If one of the villages pulls out of the system, which has been threatened, it will increase the costs for the other villages and may jeopardize the financial viability of the entire system. Kaiman has tried to broker a resolution to the conflict suggesting that the town could collect the insurance and set up a fund with the profits to pay for big ticket items such as new ambulances which would in turn save the villages and the town money in future. It is unclear if villages would directly be reimbursed for their outlays. These meetings were private and the press was not invited to attend. We are told there were multiple suggestions, but no resolution.
The town and the Village of Great Neck were set to apply for a state grant to help them determine how to deal with the legal and logistical problems involved in such a new system; however, the grant application was not filed with the Department of State.
Certainly, non-emergency calls have stressed the system. At the time of the $180,000 study, there were those who thought that money could have been well spent if public service announcements had been developed and run to educate the public about what constitutes a real emergency. Routine trips to a doctor’s office do not an emergency make. Some doctor’s offices have contributed to the problem by suggesting that if a patient arrives at the emergency room in an ambulance, he or she will receive faster attention. That advice, however, is not accurate. Emergency room personnel must triage incoming cases so that those most urgent are seen first. But these unnecessary ambulance rides do tax the system.
Nassau County does bill insurance companies for ambulance services which are under the jurisdiction of the police department. They collected approximately $20 million in the most recent accounting year, but they have been criticized by firefighters because that money does not go back into the ambulance system to improve it, but rather to the county coffers. Currently, local ambulance services pick up the slack from the county in high volume periods.
Recently, Nassau County Legislator Judi Jacobs released the following ambulance rate increases. Basic Life Support from $450 to $999. Advanced Life Support 1 from $550 to $1,199. Advanced Life Support 11 from $650 to $1,249. Mileage for all three rates will be $15 per mile. These fees will take effect on February 1 of this year.
If claims were filed for insurance reimbursements, questions have been raised about what would happen when another volunteer ambulance, that does not bill, is called for mutual aid. Over the years, the fire companies have prided themselves in coming to the assistance of other fire companies when there are big fires, multi-car accidents or natural disasters. For example, this summer when Great Neck was hit with the micro-burst that in moments rendered our community a disaster zone, if there had actually been injuries, Manhasset-Lakeville and others volunteer ambulance back-up would have rushed to assist. The viability of the mutual aid arrangement is of major concern to the Vigilant leadership.
What about people who are uninsured? What would happen to them under such a system? At one time, Nassau County, which does bill for ambulance services, was not aggressive in going after the money. The federal government has ruled that this is discriminatory and is requiring that the county toughen up.
Many people question whether or not our insurance rates would go up appreciably if charges against insurance were instituted. Or if differences in billing and what insurance companies actually pay out would become out-of-pocket expenses for consumers. And other ask whether much of the “profit” would be eaten up if collection agencies were used.
Supervisor Kaiman told the Record that he plans to call another meeting of all the parties in an effort to mediate a workable solution. While he would like to tap into another revenue stream, he also sees that the Vigilant’s ambulance system is of great value to the community and he would not like to see it undermined.