Some Fire-Rescue Departments Expand

(from Maine Townsman, July 2010)
By Eric Conrad, Director of Communication & Educational Services, MMA

Maine fire and rescue departments are venturing into non-emergency patient ambulance transfers and providing billing and collection services for neighboring towns.

The gradual trend has resulted in increased revenues for cash-strapped cities and towns – and some complaints from private-sector ambulance companies that face increased competition.

Freeport’s Fire & Rescue Department made the move a decade ago. Back in 2000, Chief Darrel Fournier received the permission of his Town Council to move ahead with a plan to build his department.

Parkview Adventist Medical Center in Brunswick had approached the department rather casually to see if the town would consider branching out beyond emergency medical response. Fournier’s department purchased two new ambulances in March 2001, with that idea in mind. Business was strong right away.

“The program really exploded,” Fournier said. “There was a need.”

Today, at least four other fire and rescue departments are doing non-emergency transfers, which means they take patients on scheduled trips from hospital to hospital and from nursing homes or residences to hospitals. They include departments in the cities of Bangor, Augusta, Caribou and, recently, the Town of Kennebunk.

It can be a lucrative move.

Freeport now has five ambulances, 65 licensed emergency-care employees, three career firefighter-paramedics and does more than 3,000 emergency and non-emergency transports annually.

In Kennebunk, which started doing non-emergency transfers in July 2009, the move has resulted in adding about 500 such transports annually, netting the town an extra $200,000, according to Deputy Chief Andrew Turcotte.

“It’s definitely a way to increase a revenue stream,” Turcotte said. “In economic down times, any new revenue is a good idea.”

CHANGE IS NEVER EASY

That doesn’t mean it’s easy to do. Scheduling employees and vehicles can be difficult. For example, municipalities have to make sure that they can still handle an emergency at the same time when crews may be tied up making routine transfers.

Municipalities with unionized employees may have to negotiate the added service. And, there can be resistance from for-profit and non-profit emergency-response providers, which have high profiles in their home communities and are seen as good, valued employers.
In Freeport, Deputy Chief Paul Conley said the two keys are having flexible, part-time emergency-response staffers and providing excellent customer service to the hospitals, nursing homes and patients.

A departmental culture change is part of the picture, as emergency medical technicians and paramedics who are used to the adrenaline rush of responding to accidents and fire scenes must adapt to more routine medical situations.

“Leadership within the department needs to be committed to it or the service will fail,” Conley said.”A couple of failures in serving a hospital and the service would stop.”

Fournier and Conley acknowledged that, while their expansion in service has brought more employees to the Freeport department, the vast majority are “per diem” staffers, who work part-time hours. While they are paid well on a per-hour basis, most do not receive health care and other benefits.

“We wouldn’t be able to compete if all our employees were full-time,” Fournier said.

Freeport’s department routinely takes patients to hospitals in Brunswick, Portland and Lewiston. Crews have even made transports out of state, although trips like those have to be carefully scheduled so that emergency-response capability is maintained.

MUNICIPAL COOPERATION

There can be aspects of inter-municipality collaboration to all of this. For example, the Town of Durham houses a spare rescue vehicle for Freeport, one that is available 24 hours a day. Durham emergency-response employees keep the vehicle equipped and ready to roll.

Freeport’s program goes beyond providing non-emergency transfers. The department also provides billing and collection services for Yarmouth, North Yarmouth and Durham.

In this role, Chief Fournier attended the Maine Fire Chiefs’ Association’s annual Blaine House Conference last April – not just as a chief and MFCA member, but as a vendor. Fournier stood in the hallway outside the large meeting room at Point Lookout in Northport alongside companies that were promoting the sale of equipment and medical supplies.

Conley said Freeport’s collection rate for unpaid transport bills stands at 86 percent, well above the national average of 50 to 60 percent. Patients behind on their bills are more responsive when they hear from “friendly, local staff,” he said. “You’re not calling an 800 number.”

It probably doesn’t hurt that patients and former patients realize they might bump into the employee trying to collect the unpaid money at the grocery store, or that they might need emergency-response service in the future from the local department making the collection call.

THE KENNEBUNK EXPERIENCEFreeport Fire Rescue Dispatch

In Kennebunk, the town has been a little more conservative with its relatively new program, Deputy Chief Turcotte said.

Its Fire & Rescue Department provides non-emergency transfer services primarily to town residents and facilities based in Kennebunk. Knowing that eased the concern of some non-municipal providers which initially questioned the town’s plan.

“We are fortunate to have four or five skilled (nursing) facilities in town,” said Turcotte. “We also have a good relationship with Southern Maine Medical Center” in Biddeford.

Kennebunk responds to “2,000 to 2,500” emergency calls a year, he said. It is averaging about 500 non-emergency transfers annually right now. Kennebunk has 50 emergency-response employees and, much like Freeport, the vast majority of them work on a per-diem basis. The department has five full-time staffers, Turcotte said.

PRIVATE SECTOR OPPOSITION

Not everyone supports the idea that municipalities should venture into ambulance response and non-emergency transfers, especially when cities and towns reach beyond their geographic borders.

“We don’t agree with it,” said Doug Remington, Senior Vice President at North East Mobile Health Services, which is based in Scarborough. “It’s unfair competition.”

North East provides emergency and non-emergency ambulance service over a large area, from Rockland to Biddeford. It employs 180 Mainers, two-thirds of whom work full-time, with benefits.

Remington said municipalities don’t pay several taxes that his for-profit company does: property taxes; fuel taxes; and, capital-gains taxes. As a result, municipal fire and rescue departments have less overhead.

“What if a public works department went out and started bidding to do big construction projects?” Remington asked. “We think that municipality would get a lot of push-back from private contractors.”

He also questioned whether municipal ambulance services really make money. In many cases, for example, municipalities don’t factor in the cost of human-resources support when they do a cost-benefit analysis of whether their expanded fire and rescue departments make or lose money.

Further, if an organization like North East would be seriously hurt by municipal competition, it could be forced to lay off employees or otherwise reduce its work force. That, in turn, could mean less tax revenue for all levels of government.

Remington qualified North East’s opposition, however. If a municipality has a hospital within its border, that city or town may have good reasons for providing emergency and non-emergency ambulance service, he said.

North East doesn’t have a major problem with Kennebunk’s new operation, said Remington. The town is home to several nursing facilities and, so far, Kennebunk is staying within its municipal boundaries.

In some cases, North East is contacted by a small municipality that asks the company to start providing ambulance service. But if its population is too small, or if the community is located too far from the areas North East already serves, the company declines, Remington said.

In those cases, North East has no problem if a municipal fire-rescue department in an adjacent community reaches out to serve its neighbor.

GRANDADDY IN CARIBOU

Caribou Chief Roy Woods’ municipal rescue department was born out of need.

Way back in 1985, the private ambulance provider was struggling with complaints from several towns about service, Woods said. Several communities looked to Caribou to improve the situation.

“We took over,” said Woods. “After a year of skepticism, it turned out to be a big success.”

Twenty-five years later, Caribou Fire & Ambulance has five emergency vehicles and two fixed-wing aircraft that it uses for both emergency and non-emergency transport. The department has 14 full-time employees and about 30 emergency-trained personnel who also work on a per-diem basis. They handle about 2,300 calls per year.

But that’s not the most challenging part of providing emergency response and even non-emergency transfers in Caribou. The daunting part is the vast and rural geography that the Caribou department covers.Emergency Flight Crew

Although Caribou has a local hospital – Cary Medical Center – the nearest tertiary hospital is Eastern Maine Medical Center in Bangor.

“Our shortest transfer is three hours by road – 45 minutes by air,” Woods said.

The logistical challenge is one reason why Woods insists on a high level of cross-training in his department. All firefighters are also trained as emergency medical technicians. The department has 13 paramedics.

And, on the six to nine flights that Caribou averages each month, the plane is staffed by both a critical-care nurse and a paramedic. The planes routinely take patients to Boston, Portland and Bangor.

The news is not all positive, however. For years, the emergency services in Caribou have been a significant revenue-maker for the city. That’s no sure thing, these days.

“More and more people are dropping their medical insurance,” Woods explained. “We have losses. Since we’re a municipality, we can’t refuse calls. We have to take them regardless.”