Ambulance Finances
Still in Doubt

By Sandy Vondrasek Cooch

A hefty 45% increase in the annual assessment being requested this year by White River Valley Ambulance from its eight member towns is bound to spark a discussion about the future and direction of the service at a number of Town Meetings next Tuesday.

The need for towns to step forward and accept the increase is imperative, according to WRVA Board Chair Jocelyn Stohl.

Due to "cost shift" problems facing all of the health care industry, combined with fiscal and operational problems uncovered by the board in the last year, WRVA finds itself in a "cash poor" crisis, she said in a recent interview. Operational changes are being effected, Stohl said, but it will likely take two years for WRVA to turn the corner into fiscal stability.

Seven of the eight towns—Barnard, Bethel, Braintree, Brookfield, East Granville, Pittsfield, and Stockbridge—have included WRVA’s full assessment request, carrying an average 45% increase, in their budgets.

Only one town, Randolph, has budgeted a smaller amount. Instead of the $250,000 requested by WRVA, the Randolph Selectboard inked in $197,460, a 28% increase over the current year, based on a "compromise allocation" it thought it had reached.

That compromise was built on a smaller WRVA budget, which the Randolph budget committee proposed to WRVA officials at a late January meeting. The smaller assessment for Randolph was contingent on the WRVA board agreeing to the smaller budget.

However, Randolph selectboard members learned this week that the WRVA board instead reaffirmed its original budget at its next meeting, at least according to WRVA Board Chair Stohl.

Randolph’s representative to the WRVA board, Barbara Springer complained at Tuesday’s selectboard meeting that her job is becoming uncomfortable.

"Other towns haven’t spoken up, so Randolph is made out to be the bad guy," she said.

At this point it is too late for Randolph to change its assessment figure, which went off to the printers and is imbedded in the general budget before voters next Tuesday.

And selectboard members appeared disinclined Tuesday to raise the town’s contribution.

"We’re not simply going to pour money down a hole," Jim Hutchinson said.

However, Hutchinson said he and other town officials would set aside time to meet with the WRVA board.

Owned by the Towns

WRVA’s member towns, it should be noted, are also its owners. WRVA is a non-profit corporation, with the eight towns listed as "incorporated participants."

In recent interviews with The Herald, WRVA Board Chair Stohl and several town officials agreed that it is time for the towns to take a more active interest in the service. But there appears to be some disagreement among them about the particulars.

Stohl, who has been a WRVA board member for more than 20 years, stressed that she feels the towns need to recognize the need to contribute a larger share of the revenues, as income from other sources (most notably Medicare and Medicaid) have declined.

"It’s time for the eight towns to realize they own this—they have to take care of it," she said.

Stohl agreed that this year’s assessment increase was steep, but pointed out that increases have varied dramatically, and been quite low in recent years. (2% last year; and 4%, 9%, 5% and 45% in preceding years.)

WRVA’s budget for next year is up by 14.5%. Stohl said assessments to towns had to be raised dramatically in response to decreases in Medicaid and Medicare reimbursements, the number of "non-billable" trips, and poor collection practices.

The WRVA board and Administrator Pat Edwards are working to clean up operations and stabilize finances, she said, so that assessments will be more predictable and steady.

But right now, she stressed, the service is in a severe cash flow crunch: The balance in the checkbook a few weeks ago, Stohl said, was minus $138.

Problems Uncovered

She added that the WRVA board recognized last January that the service had pressing fiscal and management problems and since then has been studying and changing operations.

One change is scheduling employee shifts months in advance to reduce over-time costs, Stohl said.

The service is also starting to work more aggressively to collect unpaid bills, she said.

According to Stohl, another problem uncovered by the board, was that grant money, including big Homeland Security grants for equipment, had been placed into general funds, instead of into designated funds. The influx of grant cash, Stohl said, had "masked" WRVA’s growing money problems.

Time for a Change?

However, some town representatives are questioning whether WRVA can make the necessary management changes on its own.

The smaller budget pushed by the Randolph budget committee was "not a complaint about services," said Randolph Selectman and budget committee member Steve Springer this week,

"There are no service issues," he emphasized. "It’s a management and finance issue."

The Pittsfield Selectboard in the last few months has debated whether to leave WRVA and affiliate with a Rutland-based ambulance service, meeting minutes indicate.

The Brookfield Selectboard is also keeping a close eye on the service. Selectboard Chair Jeff Kimmel said this week that Stohl, at the board’s invitation, attended a meeting this week to explain WRVA financial pressures.

Bethel Selectboard Chair Neal Fox last week voiced overall support for WRVA, noting that an ambulance service is "one of the most important functions of a municipal government—you kind of have to have it."

However, Fox, who is also the executive director of the Green Mountain Economic Development Corporation, indicated that not enough attention has been paid to fiscal and business management issues.

Towns tend to appoint people who are interested in ambulance services as their representatives to the WRVA board, he noted.

"There is not a lot of business acumen there."

Fox said he recognized that Stohl and interim administrator Edwards, appointed after longtime administrator Amy Estey resigned late summer, have been working overtime to turn around WRVA finances and management.

He suggested, however, that it may be time for an outside consultant to come in and assist the service.

"Some hard decisions need to be made," Fox said, adding that a number of practical changes, for example, outsourcing billing, might yield big cost savings.

"I don’t want to hurt the ambulance," Fox added. "I’ve ridden in that thing a couple of times. It’s just that some things have to be done differently."