TOWER— The city council here, on Monday, granted approval to expand the paid on-call staffing for the Tower Ambulance service even as questions remain about the financial viability of the existing …
TOWER— The city council here, on Monday, granted approval to expand the paid on-call staffing for the Tower Ambulance service even as questions remain about the financial viability of the existing paid on-call program. The council also okayed a pay raise for Ambulance Director Steve Altenburg, from his current salary of $1,800 per month, to $2,000.
The council’s action came as Altenburg outlined a new proposal developed with assistance from Virginia Fire and EMS Director Allen Lewis that would combine forces on some inter-hospital transfers requiring advanced life support. Details were sketchy as Altenburg presented the concept through a handful of email exchanges between himself and Lewis. He said he would provide more information in the future if the council gave him the greenlight to pursue the concept and flesh out a contract. He said the contract would need subsequent approval by the city councils in both Tower and Virginia and would likely need review from legal counsel.
Mayor Orlyn Kringstad asked if Altenburg could provide a cash-flow analysis showing the financial implications of the proposal over the next three years. “Well, no,” responded Altenburg, indicating that the plan was too fluid to make any forecasts.
As outlined by Altenburg, the Tower Ambulance would provide an EMT and an ambulance for inter-hospital transfers from Essentia in Virginia that require advanced life support service. While the Tower Ambulance currently provides only basic life support service, Virginia would provide a paramedic for the transfer, who would be certified to provide advanced life support.
Virginia would receive $600 for its involvement, leaving about $900-$1,000 for the Tower Ambulance to cover its costs. It’s unclear how many such transfers Virginia and Tower will actually undertake under the concept. Lewis has previously indicated that Virginia is unable to respond to about 500 non-emergency transfers per year, but what percentage of those require ALS is unclear.
Expanded paid on-call
Altenburg offered the council no definitive numbers on the cost of expanding paid on-call staffing to the weekend hours. Currently, the paid staffing runs 24 hours a day, Monday through Friday, and Altenburg proposed up to 27 hours of additional EMT staffing, possibly less, depending on interest from existing staff in covering those extra hours.
According to Altenburg, the added cost of the expanded staffing would be no more than $310.50 per week. Altenburg’s assessment, however, failed to include the cost of payroll taxes, which would add about ten percent to that total. On an annualized basis, the expanded staffing would add a maximum of $17,760 to the ambulance service’s operating expenses.
“So how does that look for the overall ambulance fund?” asked council member Rachel Beldo. Altenburg responded indirectly: “So overall, like this last year, and I didn’t go through everything, I spent somewhere between 70 and 80 thousand dollars of money that we made last year on buying equipment. So, we always have to still generate some revenue. The biggest thing is that calls steadily go up every year.”
In fact, according to the city’s auditor, the Tower Ambulance service spent $44,000 more on equipment in 2018 than in the prior year. How much of that was related to the implementation of the paid on-call service is unclear. Further, the auditor confirmed that the ambulance service’s operating surplus in 2018 fell from an average of $104,000 over the prior three years to just $4,000, due primarily to the higher expenses from the shift to paid on-call.
Altenburg had told city officials last year that the shift to paid on-call would pay for itself by allowing the service to accept more non-emergency transfers, which provide significantly more revenue than regular emergency calls. He had estimated that the service would need to conduct about 150 transfers annually, or three per week, to make the paid on-call system pay for itself. Yet the increase in transfers has fallen well short of Altenburg’s estimates. Since the start of the paid on-call system in April of last year, the ambulance averaged 2.4 transfers per week. Through the end of April this year, the service has conducted 33 transfers, or an average of 1.92 per week.
Converting to ALS?
Altenburg also talked briefly about beginning to upgrade the ambulance service from basic life support to part-time advanced life support, which would require hiring paramedics and purchasing additional equipment to provide the higher level of care. He said the process to obtain the licensure and certifications could take about a year. “It’s definitely a thing we should work toward,” said Altenburg.
The council gave its blessing to begin the process, although it remains unclear how the department will pay for the added cost based on its current run volume.