Photo by John Purcell
From left, Amsterdam Fire Chief Michael Whitty and 3rd Ward Alderman Chad Majewski discuss the proposal to move the ambulance service in-house during a Public Safety Committee meeting Thursday night.

By JOHN PURCELL

Recorder News Staff

Amsterdam Fire Chief Michael Whitty and 3rd Ward Aldermen Chad Majewski presented Thursday evening a more detailed breakdown of expense and revenue projections for operating an in-house ambulance service.

The Amsterdam Fire Department would purchase a single ambulance and necessary equipment to outfit the vehicle and support operations, which is estimated to total $251,635. The expense, however, would be spread out over a five-year lease with annual payments totaling nearly $54,650. If the service was implemented during the 2017-18 fiscal year, the first annual payment would not be due until the 2018-19 fiscal year. Leasing was determined to be the most attractive method to finance the purchases, compared to bonding and paying for everything upfront, acording to city officials.

Operating expenses for running the in-house ambulance service the first year is estimated to be $24,900, because there would not be any lease payment required yet. The lease payment and operating costs for the second year, 2018-19, are estimated to total $88,078. In the following years, the annual costs are estimated at $96,590 in 2019-20, $90,182 in 2020-21, $98,861 in 2021-22, and $92,454 in 2022-23.

There is an added cost bi-annually to renew the city’s certificate of need to operate the service, which accounts for the fluctuation from year to year. Gradually increasing costs for supplies and other expenses is also included.

Majewski said revenue projections are a little more complicated to pin down due to a variety of factors, but he is confident revenues will well exceed expenses to operate the service.

Whitty said conservative projections from experts on the potential revenue the city could realize from providing ambulance services for 1,620 billable calls is $634,787. This is the total amount of billable calls the fire department responded to in 2015-16. The projection is based on input from three medical billing companies.

“These projections are all based on what the experts are telling us,” Whitty said. “The only variable is that payer mix, which we bumped up to make it a more a conservative projection for this area.”

The “payer mix,” or composition of health insurance providers and non-insured individuals billed, to develop the estimated revenue includes 31 percent of patients having Medicaid and 52 percent having Medicare. The typical percentage for municipalities regionally falls around 10 percent of patients having Medicaid, which pays the least per billable call, according to Whitty.

City firefighters, however, would likely not be able to provide ambulance services for every billable call, because the proposal is to only purchase one ambulance. Mutual aid would provide ambulance services to calls firefighters are unable to provide transportation.

Whitty said what percentage of calls the firefighters could actually provide ambulance services is difficult to estimate.

Majewski reiterated several points from prior discussions about the proposal, such as firefighters would not need any additional training than already required and no additional firefighters would need to be hired.

Majewski said even though the department doesn’t operate an ambulance service, the city is currently sending two firefighters to the hospital with the responding ambulance company, typically GAVAC, on advanced life support (ALS) transportations. Whitty had said one firefighter rides in the ambulance to maintain care while the second follows the ambulance to pick up the first firefighter at the hospital.

“The only thing that we’re not doing is transporting in our own vehicle, which would allow us to bill for those services,” Majewski said.

For a basic life support (BLS) call, which is less severe than ALS, firefighters currently remain on scene at the incident but do not travel with the ambulance.

Majewski said the vehicle, Rescue 1, used to respond to paramedic calls needs to be replaced in the near future, which is estimated to cost $105,000. Instead of purchasing a new truck, the city would instead purchase an ambulance for $160,000 if it operated the service.

He said there is no additional insurance needed, but the city’s vehicle insurance is estimated to increase $700 the first year for taking on the ambulance. Whitty said the medical malpractice insurance is not projected to increase through providing transportation.