N.Y. city may hire collection agency for EMS agency

Auburn City Ambulance has a deficit of nearly $1M

By Kelly Rocheleau
The Citizen

AUBURN, N.Y. — The city of Auburn may hire a collections agency to help secure more revenue for its ambulance service.

At a Feb. 16 Auburn City Council meeting, Kezia Sullivan, director of operations for Auburn City Ambulance, provided an operation overview of the service that started in the fall of 2021. The presentation included financial data showing that actual revenue collected has lagged behind expenses.

Since Nov. 1, 2021, the city has received $2,308,344 in ambulance service revenue. Total expenditures in that same time frame are $3,283,701, creating a deficit of $975,357.

But overall outstanding receivables, which are bills for which the service has not been reimbursed, amounts to $1,891,580. Of the receivables total, the city conservatively estimates it will secure 60% to 70%, which would be around $1.1 million to $1.3 million.

Auburn Mayor Mike Quill asked if that 60-70% collection rate is "an industry standard, or is it just Auburn?" Sullivan said the rate was based on "past performance for the city."

Councilor Jimmy Giannettino then asked if the city has been experiencing challenges regarding ambulance collections and what is being done to address those issues if there have been challenges. Sullivan noted Auburn currently doesn't have a contract with a collections company for the ambulance fees, but hopes to send out a request for proposals for such a service.

City Manager Jeff Dygert said the RFP should go out by the end of March and the city could award a contract by the end of April.

Sullivan also noted that "amount is not all money that would require a collections agency, some of its just in the process of insurance reimbursement," adding that the turnaround time for such reimbursements is not always quick.

Giannettino said there are "industry issues in collections that we really, I think, have really dedicated ourselves to educate our state representatives on and hopefully further that agenda and get some assistance from them."

Giannettino, who was one of four councilors out of five who approved the authorization of a city-run ambulance operation in June 2021, said Dygert has given the council frequent examples of other municipalities and counties who "are experiencing the same issues we were experiencing 18 months ago," referring to quality concerns with private providers.

TLC Emergency Medical Services had served as Auburn's longtime private ambulance provider before the city-run service took over.

"Based on our experience over the last 18 months, I feel like we've kind of set the example as a city on how this can be done. It was a tall task to pull off, and I just want to say I'm proud of the work that all of you have done collectively to accomplish this," Giannettino said. "I don't think it's an exaggeration to say that most municipalities would struggle doing this, and I think there's been challenges, but I think we're dealing with those challenges as they arise and for me, it was a question of public safety.

"I feel that's a role and duty and responsibility of government, to provide public safety. We do it for police and fire. We know that the level that we expect and that we see from police and fire, wasn't there previously with the ambulance service. And I heard that, I think we all heard that from constituents, and I've heard the exact opposite recently."

Sullivan's presentation slides displayed a graph breaking down the types of insurance carried by patients transported by the Auburn ambulance service, with the most being Medicare at 53%. The second highest carried insurance was Medicaid at 27% and self-pay came in at third with 10%. Another graph showed the average amount of reimbursed incidents by payor type for 2022, with facility being the highest at $1,524, then government at $1,396 and then commercial at $1,162. The average amount reimbursed by Medicare and Medicaid, which is carried by around 80% total of the ambulance service's patients, was $434 and $247, respectively.

Other statistics were covered during the presentation. One slide included the average times for each phase of an emergency or interfacility transport in 2022, including being en route to a scene, the time at scene, transport time, wait time, and more. Sullivan noted long-distance transports are included, causing the service's average time for interfacility — between two health care intuitions —transport to be 164.3 minutes. The slide also included the average total time for 911 responses, which included the same phases as interfacility transports, such as being en route, on scene, transport, etc. The service's total average time for a 911 response in 2022 was 83.2 minutes.

"One thing that some people don't realize is that a big portion of our calls is after we arrive at the hospital, there is often a wait for the patient to get into a room, so our crews will stay with them," she said.

For an interfacility transport, the average time crews waited at a hospital for a room assignment in 2022 is 46.7 minutes. For 911 call, that average wait time was 41.9 minutes.

The slides said the full-time staffing for the Auburn service is 12 emergency medical technicians, two advanced EMTs, 11 paramedics, an administrative assistant and the director role, which is filled by Sullivan. The service's part-time staff are two EMTs, one advanced EMT, one paramedics and a physician medical director.

The service has five ambulance vehicles overall, and those vehicles have traveled about 150,000 miles combined since operations began. Auburn had 7,076 responses in 2022, including 4,761 911 transports to a hospital, 809 interfacility transports and 578 patients refusing transports.

In an interview with The Citizen Wednesday, Dygert said the city's aim has been to make the ambulance service as "financially self-sustaining as possible, and I think we're able to do that."

Dygert also said that while the city is confident in the endeavor's finances, the city has been focused on providing quality service. He praised the operations side of the service, lauding Sullivan and staff.

"Operationally, the service has done extremely well, it's extremely busy. It's taken on a significant workload in a period of time when COVID has really changed the face of (emergency medical services)," Dygert said.


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