In a split vote, the Derry Town Council has approved a new ambulance fee schedule.
The Council heard from Charles “Chuck” Hemeon, EMS (Emergency Medical Services) director, at its Aug. 16 meeting. While two Councilors expressed concern about various aspects of the plan, the 4-2 vote passed it.
Hemeon said the town’s charges for using the ambulance service are lower than surrounding communities. “We have been charging a user fee since 1972,” he said, which reduces tax liability for the service. The user fees bring in as much as $1 million, which is then used to defer operating costs, Hemeon said.
The fees for users have not been adjusted since April 2012, he pointed out. But the personnel costs and supply costs are increasing, along with the costs of the vehicles themselves.
Hemeon outsources his billing to a company in Pennsylvania, and said Derry’s rates are second to lowest of the towns that company deals with.
Hemeon said 88 percent of the community has “some form of insurance,” including Medicare, Medicaid or private insurance. Only 12 percent carry no insurance whatsoever, he told the Council.
The fee schedule change would not affect Medicare or Medicaid, whose rates are set by the government. “Medicare pays 80 percent, the recipient pays 80 percent, no matter what your transportation rates are,” Hemeon said.
That leaves two groups to be affected: those with private insurance, 25 percent of Derry, or the 12 percent uninsured. But he said raising the rates would increase revenues by 5 percent, or $55,000.
Hemeon said the residents in the 12 percent have the option of going before the town’s Hardship Committee, which will review their situation and ability to pay. This can range from a partial subsidy to a payment plan to waiving the expense, he said, adding that the committee also puts people in touch with needed social services.
Hemeon produced a chart of nearby communities and what they charge, For Basic Life Support or BLS, non-emergency and no advanced medical care, Derry currently charges $457. Best Care, a private ambulance service, charges $1,300; Londonderry, $509; Pelham, $516; Salem, $649; and Windham, $1,137. It’s not exactly apples to apples, Hemeon pointed out, noting that Windham’s fee includes several services that Derry provides on an a la carte basis.
For BLS, non-emergency, a 12 percent raise would bring it to $512, while a “bundled” rate would bring it to $617.
The 12 percent increase would put Derry in line with surrounding communities and bring more revenue to the taxpayer, Hemeon summed up.
Councilor David Fischer asked where the ambulance revenues go, and Hemeon said they go into the general fund.
In the public hearing, resident Ernie St. Pierre observed, “We don’t care what Windham residents can afford. I pay my own health insurance, $1,500 a month. To add more money to that would not set well with me as a taxpayer.”
Councilor Jim Morgan pointed out that the increase is for user fees. “The taxpayers are not seeing an increase on their taxes,” Morgan said. “Most of the increase will be paid for by the insurance companies.”
Morgan added that one thing he noticed during the spring budget process was that “costs are rising. We need to increase our fees in line with other communities – they’re the only benchmark we have.”
Councilor Richard Tripp asked Hemeon what Derry charges out-of-towners who use the ambulance, and Hemeon said, “They are charged the Derry fees.”
Fischer took issue with the idea that Derry is “behind” neighboring communities in what it charges. “The fact that we deliver the service we do, and have the lowest fees, should be a matter of great pride,” he said. “Is it ‘only’ a 12 percent increase? I recommend we do it more gradually.” The town does get that $55,000 in revenue, Fischer said, but with a $40 million budget, “That’s a drop in the bucket.”
But Chairman Brian Chirichiello pointed out that the extra $55,000 was already in the 2017 budget. “If we cut the revenue in half, we’d have to increase the tax rate,” he told Fischer.
“This is a minimal increase,” Morgan countered. “It’s a revenue stream we rely on.”
Tripp asked Hemeon about the makeup of the Hardship Committee. Hemeon said it currently includes representatives from the town Finance Department and Human Services, the Community Alliance for Teen Safety (CATS), Catholic Charities and the Community Health Network. The members are appointed by the Council, he said.
“I don’t remember appointing any of these,” Tripp said, to which Hemeon responded that there have not recently been new members to appoint.
Councilor Joshua Bourdon asked about the hardship process. Hemeon said the recipient of services makes application through the billing company, with supporting documentation. It is passed on to the Hardship Committee, which makes a determination, he said.
Bourdon also asked if the town could set a higher rate for out-of-town use, but Hemeon said the Center for Medicare Services, or CMS, requires consistency.
Did we vote for that?
Councilors detoured into a discussion of the $55,000 voted on as part of the 2017 budget. Fischer said, “I remember the $55,000, but we didn’t talk about how we were going to get that revenue.”
Morgan countered, “I made the motion to increase revenues by $55,000. It was discussed.”
“I remember Jim talking about it,” Fischer said. “I don’t remember a 12 percent increase in ambulance fees.”
He added, “I’m concerned that we’re talking about a specific amount now, when before, it was a chunk of the budget not clearly defined.”
“Your concern is legitimate,” Acting Town Administrator Stephen Daly said. “This is bad timing. It’s something that got lost in the shuffle.”
Fire Chief Michael Gagnon said Hemeon had come up with the 12 percent increase, which was forwarded to Chief Financial Officer Susan Hickey and used as part of the budget discussions.
Bourdon asked, “Why are we voting on this now if we already voted on the revenue?”
“We have to be specific, and vote on the rates,” Daly responded.
Fischer said, “I would like to review the notes of the budget discussion, and table this increase for now. If we vote on it now and then I get the notes, it’s already a fait accompli.”
Tripp and Fischer voted in favor of tabling the changes, while Morgan, Bourdon, Chirichiello and Charles Foote voted against it.
The votes were reversed in the vote on the increase, with Morgan, Bourdon, Foote and Chirichiello in favor and Tripp and Fischer opposed.