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Rushing to your aid - and helping pay the bills

In Melrose, a new ambulance should deliver more revenue

Melrose firefighters prepare to transport a patient from Willow Street earlier this month. The city recently expanded its ambulance service. Melrose firefighters prepare to transport a patient from Willow Street earlier this month. The city recently expanded its ambulance service. (Photos By Pat Greenhouse/Globe Staff)
By Kathy McCabe
Globe Staff / August 21, 2011

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MELROSE - The big red ambulance is factory fresh, made to order for the Melrose Fire Department.

Helmets, coats, boots, and other firefighting gear is stored in side compartments. Sheets, gloves, blood pressure, and oxygen equipment all have their places. Seats have four-point safety harnesses, ensuring that everyone aboard is buckled up tight. A motorized stretcher makes it easier for patients to be lifted safely into the cab.

“This is an ambulance built for the changing role of the fire service,’’ said Lieutenant Paul Collina, who helped oversee design and purchase of the $170,000 truck. “It also has been designed to meet the needs of the community. We have some narrow streets, but we’ll be able to get to any call.’’

The new ambulance service started May 31, responding to nonlife-threatening emergencies, such as broken bones and bad falls. In the first two months, the department responded to 357 calls in this community of nearly 27,000 residents, according to city officials.

The city anticipates responding to 1,400 calls during the first year of operation. The estimate is based on past call history provided by Cataldo Ambulance Service, the city’s longtime private ambulance carrier. The Somerville-based company still responds to major emergency calls in Melrose, such as heart attacks and strokes.

“We still work very closely with Cataldo,’’ said Fire Chief John O’Brien. “Actually, they’re our partner, providing [emergency medical technician] training to our firefighters. We couldn’t have a better partner.’’

Steady rounds of budget cuts led to layoffs in the Melrose Fire Department a decade ago. But federal grants awarded in 2008 and 2009 allowed the hiring of eight new firefighters, boosting total personnel to 58. All are trained EMTs, and eight are paramedics, O’Brien said.

With the grant money due to run out soon, Melrose needed to find new funds to maintain staffing. The city decided to restart the ambulance service, which was privatized in 1989 as a cost-cutting measure.

“We had to do this for survival,’’ said O’Brien, who has been chief for eight years. “We had to find some way of bringing revenue in. Melrose is a fairly busy city. We need to keep our [staffing] stable.’’

The city’s step is unusual because it comes at a time when budget cuts have forced most Bay State communities to cut public services. It also comes amid intense debate over the cost of public health care, including ambulance fees. Some communities that provide municipal ambulance services, either through fire or police, have been forced to raise fees to cover reimbursement shortfalls from private insurance companies and Medicaid or Medicare.

“The first two months have been a tremendous success, both in terms of service and operations,’’ said Mayor Robert J. Dolan in a prepared statement. “Each city needs to review their ambulance model, but we realized with the level of education and training that our men have, coupled with the partnership with Melrose-Wakefield Hospital and Cataldo Ambulance, that this model worked for us.’’

Currently, there are 235 municipal ambulance services in the state, including 31 north of Boston, according to data from the state’s Office of Emergency Medical Services. Included are cities such as Haverhill, Lynn, and Woburn, and small towns such as Newbury, Topsfield, and Westford.

A bill pending before the Legislature’s Joint Committee on Financial Services would give communities broader authority to set ambulance fees. It also would require insurance companies to send reimbursement checks directly to a municipality instead of to a resident, who then would have to forward it to their city or town.

The Massachusetts Municipal Association testified in favor of the bill during a recent hearing on Beacon Hill. “Ambulance fees are an important source of revenue for cities and towns,’’ said John Robertson, deputy director of the legislative division of the Massachusetts Municipal Association, a trade group representing Bay State communities.

Blue Cross Blue Shield of Massachusetts, one of the state’s largest private insurers, has said it will send reimbursement checks directly to municipalities, Robertson said.

“Communities need some sort of assurance that they will be able to collect the fees that should be paid to them. Anything that would interrupt that [payment] would be a problem.’’

Melrose charges $1,250 for a city ambulance run. Although it bills that amount, the city on average expects to collect $633 per call, said Patrick Dello Russo, the city auditor.

“You never collect 100 percent of what you bill,’’ he said. “You can get anywhere from 50 percent to 70 percent’’ depending on what insurance companies or Medicare/Medicaid will allow.

The city has hired a private company to handle billing. “One of the problems when we did it before was billing,’’ O’Brien said. “It was complicated, and you don’t want to get to the point where you have to start making collection [calls] for the service.’’

Revenues will be put into a special account, with all money going to fund the ambulance. The city set a first-year budget of $890,000 for the current fiscal year. The amount includes the cost of acquiring equipment, including the new ambulance and a used one purchased from Middleton for $6,000, O’Brien said.

After expenses, including wages and benefits, equipment, and other costs, the Fire Department should end up with $700,000 in the ambulance account. “Our goal the first year is to break even,’’ Dello Russo said. “We’re on track to do that.’’

Down the road, Melrose hopes to provide advanced life support services. That likely won’t be until 2014, O’Brien said. The additional duty, and the increased revenues that could result, would likely keep the ambulance rolling in the black.

“It would require additional training [for firefighters], but it would also enhance patient care,’’ O’Brien said. “For now we’re just focused on improving our [nonlife-threatening responses]. So far, so good.’’

Kathy McCabe can be reached at kmccabe@globe.com.

2 Number of ambulances purchased by the city to start the new service $170,000 Cost of new ambulance ($6,000 for used) 357 Number of ambulance calls Melrose Fire Department responded to in June and July $700,000 Revenue Melrose expects to generate in the first year of operation $1,250 Rate charged per trip on the new ambulance SOURCE: Melrose Fire Department


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