EMS flying car program saves lives, but increases costs for New York County
What is the cost of human life for taxpayers? It’s a question the government asks regularly and it’s also something Chautauqua County officials are grappling with.
In the summer of 2017, Chautauqua County launched its first flying car system, non-transportation emergency medical services vehicles that respond and provide emergency medical services without the ability to transport patients.
Noel Guttman is the county’s fire coordinator and director of the Department of Emergency Services. He wasn’t the director when the program started nearly five years ago, but he said the purpose of the flying car system never changed. “The overall mission is to save lives. It is to help and care for people. This is mission number one. It always has been and it always will be,” he said.
He noted that the flying car program is not intended to replace volunteer firefighters, but rather to work alongside them.
“We are a co-ed service in Chautauqua County. We work with volunteers, we work with other ambulance services and we work with the paid fire services, because the overall goal has always been and always will be to give the best possible patient care to everyone we call for,” he said.
When a call is made for service, it is usually a Basic Life Support (BLS) call or an Advanced Life Support (ALS) call. In recent years, it has become more difficult to have an emergency medical technician in a volunteer service who can provide care for ALS, and that’s where the flying car can help.
When the program started, there were three flying cars, each with a registered paramedic, from 6 a.m. to 6 p.m., six days a week. One flying car was in Mayville, one in Gerry and one in Arkwright.
There were three full-time and four part-time employees.
Over time, changes have been made. The flying car system went from 12 hours a day, six days a week, to 24 hours a day, seven days a week.
This allowed paramedics to respond to more calls. In 2018, the fly car program responded to 1,851 calls. That number jumped in 2019 to 4,861. In 2020, when the pandemic kept many people at home, calls dropped slightly to 4,680. But the numbers jumped again in 2021 to 5,576 calls.
CHANGE OF LOCATIONS
Also, the locations of the flying cars have changed. While the SUV that was parked in Mayville remains there, the Arkwright flying car has been moved to the Sheridan Fire Department and Gerry’s location has been moved to the Falconer Fire Department.
The flying car program has also added two ambulances – one in Celoron and one in Sheridan. The Celoron ambulance is staffed by an emergency medical technician 10 hours a day, six days a week, while the Sheridan ambulance is operated by volunteers from the East City of Dunkirk Fire Department, the city west of Dunkirk, Hanover and Sheridan.
In January 2021, the flying car program added a fourth site, parking a flying car in Lakewood.
According to Guttman, the flying car program now has 18 full-time paramedics, two who are primary supervisors, seven part-time paramedics and 13 causal paramedics. A “casual paramedic” is someone who takes over when called upon, but is not regularly scheduled. Many casual paramedics are professional firefighters or work for an ambulance service and help the county when they can.
Guttman praises all the staff, including the casual staff. “We couldn’t do this without them,” he said.
THE COST OF THE PROGRAM INCREASES
As staff levels and locations have increased, so has the financial commitment to having a flying car system.
In 2019, spending on the flying car program was $1,055,543. This amount increased in 2020 to $1,380,480 and increased again to $1,826,363 in 2021. For this current year, the program has been budgeted at $1,924,097.
But when the flying car program was first adopted, it was thought it would pay for itself through medical billing.
The county issued a request for proposals and hired Professional Ambulance Billing in Erie County to handle billing.
But Daniel Imfield, assistant fire coordinator, admits that billing for services rendered is quite complicated. “EMS billing is not straightforward. The shipping agency, if it is a billing agency, has to bill,” he said.
For example, in Dunkirk, their fire department sends an invoice to the insurance company. Dunkirk retains 60% of the income once collected and transfers the remaining 40% to the department.
Also, BLS calls are not billable, but ALS calls are. But if a fire department requests BLS assistance at the scene, the county will still provide service whether paid or not.
But the revenue the county received never came close to covering the costs.
In 2019, the flying car program revenue from billing was $588,304. This increased in 2020, but only to $631,327, then to $654,973 in 2021.
This means the flying car program deficit was $467,239 in 2019, $749,153 in 2020, and $1,171,390 in 2021.
In fact, excluding the first five months of the program, the flying car system has recorded a deficit of $2,773,993 since its inception. It’s far from breaking even.
Those numbers were provided to the Post-Journal and Observer by County Legislative Speaker Pierre Chagnon. The Bemus Point Republican legislator was a member of the county legislature when the program began.
He noted how the county knew volunteerism among fire departments was down and they wanted to see what they could do to help. At the same time, there was a consulting firm that said a flying car system, which was operated in Livingston County, could also work here.
“They came to us with a detailed study – inches thick, which they usually do – that basically said this would be a cost-effective proposal. Those of us in the Legislative Assembly were like, ‘This is a given,” Chagnon said in an interview. “Our communities are struggling to get paramedics and ambulances to respond to calls, especially rural communities and volunteer firefighters, so we jumped on it. .”
But less than two years into the program, the county realized the consultancy had got it wrong.
The company’s biggest mistake was to estimate who might be
“It became apparent to us that the consultant had assumed that we would be able to bill Medicaid reimbursement and in New York State you cannot bill Medicaid reimbursement. That was a big part of the problem” , said Chagnon.
There were also other problems.
In 2021, the county and the Jamestown Fire Department finalized an agreement to have the county paid after years of negotiations. Still, even though a contract was signed, Chagnon said they never sent a single check that year.
In February, Chagnon said Jamestown had finally sent its first payment, but that was only for appeals in 2022. There were no trained people, and they had to get state approval. It went on and on and on,” he said.
Even though Jamestown has finally started paying, Chagnon believes the city still owes the county’s revenue for all of 2021.
But even if the county asks Jamestown to pay the calls in 2021, it admits that won’t wipe out last year’s $1.17 million shortfall.
The county has made other strides to help with payments. The Falconer Fire Department partners with the county’s EMS department because it has county-wide need certificate authority to operate. By operating under the Certificate of Need, Falconer can now charge for its EMS calls, a portion of which will be returned to the county. Other volunteer fire departments are also considering having the county partner.
WEIGH THE COSTS
After lawmakers realized the flying car program couldn’t pay for itself, the question arose of how much the county is willing to pay. Every two weeks, Chagnon, County Executive PJ Wendel and others meet to discuss the county’s budget and spending. The flying car program is regularly mentioned.
Chagnon said some lawmakers have suggested cutting the flying car program. “Any time we get into a discussion about closing, downsizing, downsizing, part of the discussion is always, ‘What’s the impact if we do this? “, Did he declare.
There is also the recognition that many county-provided services may never be financially covered. “We don’t charge for road maintenance. We do not charge for bridge maintenance. We do not charge for planning services available to the county. We don’t charge for a lot of county-provided services, and some people look at the flying car program in the same light,” he said.
Now that the flying car program is here, Wendel thinks the county needs to do what it can to keep it going. “If you reduce something that’s there, then what time of day do you tell them we’re not going to have ALS. When does someone’s life become in danger because we don’t have it,’ he said.
Wendel sees a lot of value in the flying car program, especially with fewer and fewer volunteers. “What value do you place on a human life? There are myriads of people who have been saved by the program,” he said.
A volunteer firefighter and EMT at Lakewood himself, Wendel noted that when he first joined, they averaged 400 calls a year. Now they are more than double. “One year we were over a thousand,” he said.
And Lakewood isn’t the only one with increased needs. “I hear it every day – the number of overdoses and ALS calls, the number of times the flying car is in the town of Jamestown,” he said.
So for now, Wendel said the county will do what it can to generate revenue for the flying car, even if that doesn’t cover the entire program. “We’re going to keep finding ways to recoup revenue and make sure we get as much as we can, but at the end of the day, what price do you put on the lives that are saved?” He asked.