Pa. EMS agency debunks public views on funding, urges sustainability
Volunteer Medical Service Corps Chief Shane Wheeler said communities must stabilize the ambulance reimbursement expense
By Dan Sokil
LANSDALE, Pa. — With budget season now underway, the Volunteer Medical Service Corps of Lansdale is making the case for help from local municipalities.
“We’ve never asked for support from our municipalities in the 90 years we’ve been around,” said VMSC Chief Shane Wheeler.
“Nearly every week, somewhere in our country, EMS systems are failing, are closing. A lot of challenges face EMS systems,” he said.
Over the past two years, since Wheeler was hired in early 2022, VMSC has largely transitioned from an all-volunteer staff to largely career EMS staff, in the face of several trends that Wheeler has presented in municipal meetings in North Wales, Upper Gwynedd, and Lansdale in recent weeks.
The Volunteer Medical Service Corps of Lansdale is an emergency response organization that operates ambulances, rescue vehicles, trailers, and other emergency vehicles 24/7 from three stations in the area: a headquarters on the campus of Lansdale Hospital in Hatfield, a substation on Stump Road in Montgomery Township, and a substation on the border of Upper Gwynedd and Towamencin on Allentown Road.
Since Wheeler’s arrival as the agency’s first fulltime chief, VMSC has formalized a partnership with the Souderton Community Ambulance Association to enhance medical service in that area, updated and modernized their bylaws, sent local emergency responders to help respond to weather disasters out of state, and worked to publicize the story of the corps’ founder, Dr. Frank Boston.
They’ve also begun talks about finding ways to increase the funds available to support the growing expenses, needed to attract and maintain a fulltime paramedic staff on hand for emergencies across the region — thus a recent shift in name from an emphasis on ‘Volunteer’ to ‘VMSC — Emergency Medical Services.”
“Part of the reason is, we’ve transitioned from the volunteer element, where labor costs aren’t such an issue, to a nearly $6 million labor cost that we shoulder as an organization,” Wheeler said.
While costs for staffing have risen, funding for EMS agencies has dropped, according to Wheeler. Changes in state law have reduced reimbursement for ambulance services, and VMSC has had to cover areas like Souderton where existing medical corps services have dwindled or disappeared entirely.
“We were responding multiple times a day into those communities, and therefore taking our trucks from servicing Upper Gwynedd and Montgomery Township, and responding there. Today, we respond over 100 times a month into their communities, because of their lack of ability to provide adequate coverage,” he said.
In 2021, VMSC was unable to respond to roughly 40 percent of the calls they fielded, and response times averaged roughly 16 minutes due to the lack of available staff, according to Wheeler: “There were days where there weren’t any ambulances on duty. So it was a bad situation for our organization, and for our communities,” he said.
Since then, the agency has invested nearly $2 million in wage increases, training, and added benefits, “a compete reboot of the organization,” bringing VMSC up from 41 percent to nearly 100 percent of fully staffed, and bringing response times down to below eight minutes per incident, with seven ambulances on duty and only one percent of calls turned over to other agencies, down from over 40 percent prior to 2022.
To reduce response times and increase survivability, VMSC has also spent money on training in cardiac arrest, IV access, heart attack and airway incidents, bringing the VMSC response times and percentages of successful calls from below to above national averages.
“We’re really making an impact on reducing mortality and morbidity, and giving people a little bit more of a chance of survival when these critical emergencies occur within our community,” he said.
A phone survey commissioned by VMSC provided several more data points: 37 percent of those surveyed said they believe the ambulance agency is funded by tax dollars, 67 percent of those surveyed said they would support VMSC “receiving tax funding, the way your fire and police do,” and 87 percent of those surveyed said they felt the existing ambulance service in the area was adequate.
“We didn’t say ‘VMSC,’ we wanted to keep that out of it, it was just ‘emergency ambulance service.’ But since we only called people in North Penn, we’ll take credit that they like that we’re doing,” Wheeler said.
Cost hikes have been caused in part by VMSC’s current compensation structure, which only yields payments if a patient is taken to a hospital, but not for calls that don’t involve hospital transport or for coverage of community events.
Costs are up
For roughly 30 percent of VMSC’s calls, insurers send payments directly to patients instead of the ambulance corps, and those cases have totaled roughly $11 million over the past 15 years in calls where VMSC responded but the costs went unpaid, Wheeler said. Inflation and supply chain issues have also increased costs, and increasing training and equipment requirements have reduced the supply of paramedics available, while increasing costs to recruit and retain them.
“Our EMTs have to wear ballistic vests when they go out on calls, because seven out of 10 EMTs in this nation are victims of assaults. It’s a tough job, so many ambulance services are getting out of that business completely, or have to do what we’re doing, which is coming to you for a monetary sustainability plan,” he said.
In the immediate area, a similar agency in Philadelphia is offering a $30,000 sign-up bonus for paramedics, and while VMSC currently has a roughly three percent staff attrition rate, national EMS attrition is at roughly 40 percent.
“We’re doing our part by paying the solid wages, but we’re looking for support to how we keep those employees, who live in our communities, to stay working in our communities,” he said.
As he spoke, Wheeler showed a series of slides comparing VMSC’s performance on response times and metrics to national averages, and charts depicting how much Medicare reimburses for their response calls — as of now, for every $1,000 billed and owed to VMSC, less than $500 is collected. For the fiscal year 2023, VSMC is projecting to operate at a slight surplus, of roughly $200,000 on their $6.3 million budget, but patient service income only covers roughly 86 percent of operating costs, thus the shortfall that local tax dollars could help bridge.
“I’m not coming to tell you that we can’t make payroll next week. I’m not coming to tell you that our ambulances are all broken down. I’m not even coming to tell you that we’re not making any money. We are OK. I’m coming to you with an ounce of prevention — we have to stabilize the emergency ambulance reimbursement expense in our communities,” he said.
Part of that shortfall has been made up by contracts with the Children’s Hospital of Philadelphia and with a military base in the region, but those contracts are rebid annually and could be lost if either looks elsewhere: “Those have been great to help us offset that 14 percent (deficit), but they distract us from our mission, and they are highly unstable: if we win them one year, we could lose them the next year,” Wheeler said.
Three areas have been identified by VMSC as to where the municipal funds would go, and all such tax dollars would be kept separate from all other funds and audited annually. The first goal would be equipment replacement, with a roughly two-year lead time to custom-order and deliver a new ambulance, plus funding could be used to establish a retirement plan for paramedics, and increase their clinical services that could reduce costs and increase survivability.
“We want North Penn to be safe. We want, when a resident has a life-threatening emergency, we want to give them every opportunity, every chance, a one percent, two percent, three percent chance so they can survive that incident. We want them to go home, and have a great rest of their life,” he said.
In most local communities, the most or second-most frequent incident response is for fall victims, and for certain seniors one fall can set off a downward spiral that hastens the end of their life, the chief added. A prevention program could also be funded by the tax dollars, and doing so could cut their call volume and allow for better responses elsewhere.
In their 2023 budgets, Montgomery Township has allocated $100,000 and Towamencin Township gave $30,000 in tax dollars toward VMSC, and that funding has been used for a paramedic training program that looks likely to yield ten new paramedics who are current VMSC EMTs, he said.
“We’re always trying to find ways to take care of our people, mentally and spiritually, so we use those funds that we collect to try to support that,” he said.
Membership and subscription drives could offset costs for those in need, but as of now only four percent of the community’s residents take part in those subscriptions, Wheeler said. In Upper Gwynedd, commissioner Katherine Carter said her 97-year-old mother moved in during the pandemic and had to call VMSC twice for emergency services, and she’s learned the ins and outs of the billing system, and problems patients might encounter.
“My mom was getting bills, and the billing envelope looks like the envelope that you get to donate. So, when I would get it, I would throw it away because I had already donated, and the envelopes look alike,” Carter said.
“And I had a meeting with Shane, and happened to be talking to him about it, and he said ‘You know you can join?’ And I think it would behoove us, as a North Penn community, to be educated better on exactly what the difference is, in terms of paying the bill — if I joined, the bill would be taken within the subscription. The two visits my mom had, that was $600 or $700, but if I joined with a subscription then it would be covered for that whole year. It’s a no-brainer,” she said.
She then asked Wheeler to explain the difference between calling VMSC directly versus calling 911, and said she had thought the ambulance response was provided by local fire departments, before digging deep into the details.
“I didn’t realize that they’re all separate entities. As a regular citizen, people really would benefit from understanding where and why the VMSC needs funding, and that they’re a separate entity and need separate funding sources,” she said.
Resident Beth Miller added her own thanks to VMSC for recently responding to her home to take a family member to a local hospital: “Everything worked out great, and all the years that we have been subscription members, we never thought we’d call you guys,” she said.
No formal budget request was made from VMSC to Upper Gwynedd when Wheeler presented to that board on Sept. 12, but township Manager Sandra Brookley Zadell announced that the commissioners will go over the township’s 2024 budget line by line during two budget workshop sessions, at 1 p.m. on Oct. 18 and at 4 p.m. on Oct. 23, both at the township’s municipal building, 1 Parkside Place.
‘The right ask’
In North Wales the presentation came with a request, for just shy of $22,000 in annual funding, which Wheeler said fit with his goal of asking each local municipality to contribute the same percentage of their annual budget. Councilman Mark Tarlecki asked if that amount would stay fixed or increase in future years, and Wheeler said his first goal is to create “a sustainable process” across the agency’s coverage area first.
“We believe, based on our projections, that this 14 percent gap can be bridged with this millage request, across all municipalities,” which would bring in between $1 million and $1.5 million depending on how much each municipality approves, Wheeler said: “We’re very comfortable this is the right number, and the right ask.”
Councilwoman Wendy McClure said she’s been a longtime subscriber to VMSC, and learned from the presentation: “Now I know how much it costs, every time you roll out of your station,” she said. McClure then asked if VMSC had approached any area senior communities to ask for donations or support, and Wheeler said they get occasional donations, but no annual contributions.
“In fairness, most of those facilities are operating very tight budgets as well,” he said.
Mayor Neil McDevitt asked if VMSC had any projections for what rate or how many subscribers the agency would need to make up the budget shortfall, and Wheeler said “that magic number” would be roughly 16 to 20 percent of those the agency solicits, but might not be a permanent solution.
“That would really fix all of our problems. But it’s fleeting, because the population changes, and it’s all about deciding whether or not to subscribe. We’re looking for a more sustainable way of moving forward: we’re looking for municipal champions,” Wheeler said, and council President Sal Amato replied: “Oh, we’re champions.”
And in Lansdale, where VMSC made waves with an initial request in August of roughly $300,000 for 2024, councilwoman Carrie Hawkins Charlton said in early September that talks with that town’s administration and finance committee have centered on a reduced request of roughly $114,000, which would average roughly $21 per household.
“They answered a lot of questions, they gave us a ton of information,” Hawkins Charlton said.
Council VP Mary Fuller asked if the budget request would be discussed further as council refines the borough’s budget for 2024 in committee and council meetings for the rest of the year, and Hawkins Charlton said it would.
“There’s a line item in the budget, to review and see if that falls into what we think we want to help them with,” she said.
“It’s not exactly what they’re looking for, but maybe it’s a stepping stone toward that service, or maybe we can find other options to fund it as well,” Hawkins Charlton said.
Finance Director Glenn Dickerson and councilman BJ Breish added that they’ve had talks with VMSC on how the town could aid the agency in ways other than a direct subsidy, such as offsetting maintenance expenses by borough staff working on VMSC vehicles, or adding a fee or surcharge to town event applications that could help cover VMSC’s costs.
“They want to be partners with us, and they want to work through this with us, and I was encouraged by the conversation. I’ll just say that there are other ways of looking at this,” Breish said, and council President Denton Burnell replied: “I think there are a lot of things we can do, other than just send them a check.”