WILLIAMSTOWN — Despite the relative affluence of the communities it serves, Village Ambulance is working hard to remain sustainable.
And though it's based in Williamstown, the nonprofit has been negatively impacted by the closure of North Adams Regional Hospital and continuing changes in the health care landscape of the Berkshires and country.
Village Ambulance and its board of directors are now on a mission to educate the community about the services — and related expenses — it provides to Williamstown, Hancock and New Ashford as it plans for a donation campaign next month.
Reimbursement for services provided by insurance, Medicare and Medicaid has become less reliable while operational costs have increased, according to General Manager Michael Witkowski.
"We've got the perfect storm here," he said.
Erwin Stuebner, President of the ambulance company's board of directors, said Village Ambulance is facing the same issues as many other small communities throughout the country that want to maintain top-notch service with limited resources. Despite the economic comfort of many of its residents, a variety of factors make operating an ambulance service in Williamstown a difficult proposal, according to Village's officials.
Medicaid's reimbursement for ambulance services was already insufficient, Witkowski argues, and dropped another two percent within the last year. Additionally, health care plans are increasingly seeing higher deductibles and categorizing ambulance rides as an "auxiliary service" that counts toward that deductible. The year began with about a 60 to 70 percent drop in insurance revenue for Village Ambulance.
If the insurance company is paying for the services, there's about a 90 percent chance the ambulance company will get paid. If it's an individual footing the bill, that outlook drops to about 20 percent, Witkowski said, and many people don't even realize or plan for the fact that their coverage may not include ambulance rides.
Village Ambulance's inter-facility transfers, which are a predictable and important source of revenue for ambulance companies, have declined more than 25 percent since the closure of North Adams Regional Hospital in 2014. Transfers are a way of subsidizing the costly 24/7 emergency services.
"If I don't chase those transfers, I can't afford that standing army," Witkowski said.
Ambulances themselves are becoming increasingly expensive to purchase and equip, according to Joan Zegras, a member of Village's board of directors. Just the four epinephrine injection pens carried on every ambulance, as mandated by law, can exceed $600 a piece, according to Witkowski.
Employee-related costs — specifically their healthcare plans and workers' compensation insurance — have also rapidly increased.
Witkowski, who was brought on earlier this year, has attempted to streamline staffing levels by focusing resources on the busiest time of day. But if he were to cut any more staff, he said, he would be sacrificing public safety. Village currently employs 17 full-time emergency medical technicians and 10 paramedics.
In 2015, Village ambulance responded to 4,900 requests for service and maintained an average response time of five minutes or less while providing 24-hour, year-round coverage. It does not receive taxpayer funding from any of the three communities it operates in.
A non-emergency transportation service established by Village Ambulance has improved and, while maybe not enough to keep the emergency service afloat on its own, has brought in more revenue in the past three months than the entire previous year, according to Witkowski.
Village Ambulance's headquarters on Water Street were built in 1983 with a gift from Williams College, but officials believe it is well past its useful life and is cramped on a daily basis. It remains part of an ongoing town discussion about public safety facilities, but there is no immediate remedy in sight.
Despite the challenges, Stuebner said "we're not at all concerned about decreasing services" in the near-term, but Village Ambulance's sustainability largely "depends on what happens on a national level."
The day may come when local taxpayers are asked to chip in.
"Hopefully we won't have to have to go to the town for funding, but I wouldn't rule it out as a possibility."