TOWER— Operational spending by the Tower Area Ambulance Service is expected to surpass $439,000 next year, based on the city’s 2019 budget approved by the city council here on Dec. 10.

That’s over $200,000 more than the department spent in 2017, which was the last year before the department’s transition to paid on-call staffing.

The estimated expenditures do not include the cost of purchasing a new ambulance. The city council, earlier this month, approved spending $243,000 on an ambulance for delivery in 2019, which could push the department’s expenditures next year to nearly $700,000.

The department spent just over $235,000 in 2017, a modest increase from the $231,842 the department spent in 2016, according to budget data provided by the city of Tower.

The ambulance service’s anticipated spending in 2019 is nearly $35,000 more than an analysis by the Timberjay predicted last March. Ambulance director Steve Altenburg had criticized that newspaper report for overstating expenditures under the new paid on-call program. In March, the Timberjay projected the shift to paid on-call would push the ambulance service’s expenditures to $402,900, somewhat less than the $439,800 the department now expects to spend next year.

The Timberjay had also projected in March that the shift to paid on-call staffing would likely boost ambulance revenues to $440,000 due to the department’s ability to respond to additional inter-hospital transfers. The city budget pegs anticipated revenue next year at $439,800, which is virtually identical to the Timberjay estimate.

The anticipated revenue for next year includes an increase in the department’s share of the city’s general property tax. City taxpayers have paid $7,500 to underwrite the ambulance service in recent years, but the latest budget doubles that amount, to $15,000. It also includes $37,500 in township subsidies, although that revenue is earmarked for ambulance purchases. The various tax subsidies are expected to account for 12 percent of the department’s total revenues next year.

On the revenue side, the new budget projects that ambulance call revenue will rise by $75,000, mostly as a result of additional transfers, but that additional revenue is projected to fall well short of covering the cost of the change to paid on-call staffing. The budget projects spending on employee wages to jump from the $54,100 that the department spent in 2017, to $180,000 next year. Final payroll costs for 2018 likely won’t be available until the city’s audit next spring.

Related payroll costs, such as FICA, are expected to jump next year by about $10,000, while the department will also spend more for fuel, supplies, meals, and additional maintenance as a result of the extra mileage on vehicles to undertake additional transfers.

The budget approved by the council projects no budget surplus in 2019. Director Altenburg has stated repeatedly that the department must maintain substantial margins in order to cover the cost of ambulance replacement. Altenburg has advocated for an increase in the subsidies paid by surrounding townships, to cover more of the cost of ambulance replacement, but he has, to date, found little interest from township officials.

Altenburg misstates run data

In advocating for a switch to paid on-call staffing in 2017, Altenburg claimed the change would result in higher margins due to the department’s ability to undertake more non-emergency inter-hospital transfers, which are significantly more profitable than emergency responses. Altenburg later acknowledged that switch to paid on-call would reduce department profits, as the 2019 budget plan suggests.

But Altenburg also cited necessity, repeatedly claiming that call volume had been rising sharply for years, which he said was all but forcing the department to switch to paid on-call in order to reduce burn-out among its volunteer staff.

At the Nov. 26, 2018, city council meeting, Altenburg repeated his claim, and accused Timberjay Publisher Marshall Helmberger of “lying” for suggesting that the run data shows no significant upward trend in emergency calls.

“We had five years in a row that went up 20 percent,” said Altenburg. “Why does anybody need to lie about the call volume?”

Yet call volume data provided by the city of Tower confirms that the six-year trend in emergency calls has barely budged. In 2013, the department responded to 340 emergency calls. In 2018, fully five years later, the department appears headed for a year-end total of approximately 350. That’s a five-year overall increase of just under three percent. Had the department actually experienced annual call volume increases of 20 percent for five years in a row since 2013, it would be expected to respond to 847 calls this year (see graph).

The department has seen an increase in the number of requests for inter-hospital transfers, but the department’s mission is to provide emergency response, not to provide shuttle service for non-emergency cases.

While ambulance services are required to respond to emergency calls, there is no such obligation to provide inter-hospital transfers and some ambulance services limit the number of transfers they accept in order to reduce demands on volunteers and to minimize the risk that a primary ambulance and crew could be out of the area when an actual emergency happens.

Yet even when requests for transfers are included, the department has experienced nowhere near the 20-percent annual increase Altenburg has claimed.

In 2013, the department responded to 383 total runs, including 43 hospital transfers. In 2017, the department responded to 425 calls, including 72 hospital transfers. That’s an average annual increase just of 2.7 percent. The department is likely to respond to about 460 calls in 2018, but that’s padded by the extra hospital transfers the department has taken this year to help pay for the paid on-call staffing.

Had the department experienced the 20-percent annual increase in total runs in recent years, it would be expected to respond to 953 calls or transfers this year, or more than twice the actual number the department is expected to complete.