Financial losses force cuts to off-Island ambulance runs

Facing steep financial losses, the off-Island ambulance transport service the Oak Bluffs Fire and EMS provides to Martha’s Vineyard Hospital is planning to cut down to one on-call ambulance.

At a selectmen’s meeting Tuesday night, Public Safety Director Erik Blake told selectmen that little or no financial reimbursement for transports to Woods Hole and Boston, the pandemic keeping sicker patients at the hospital longer, and an overall decrease in transports have created a snowball effect that has crippled the service financially.

By July 1 at the latest, Blake said the town will only be providing one ambulance, staffed seven days a week, to provide transport service.

This cuts the service, which normally has two fully staffed ambulances on standby, in half. The staff for those two ambulances can respond to regular 911 calls, but Blake said they are still being paid to be on call for the transport service, but not generating revenue since there are fewer runs.

Blake said he hopes the service will break even, but explained that even with downgrading to one ambulance, the town could still face a $220,000 financial shortfall. With the current two-ambulance service, the town is facing up to a $700,000 deficit, according to Blake.

“The transport business, the revolving fund, has been a victim of its own success for many, many years,” Blake said. “We were … at one point the envy of other towns, and they wished they had the transport business, but where we are today, there’s been many, many changes over the last few years.”

The ambulance service fills a unique void for the Island. For those in dire condition, Boston MedFlight steps in to airlift patients, but most other transports from the Island are done by Oak Bluffs ambulances.

On average, a Boston-area hospital run costs $4,200. In 2020, the service’s average reimbursement per Boston run was $1,675. “Right there you’re at a deficit of $2,500 and change just to do a Boston run,” Blake said. 

Blake, who has been working with selectman Brian Packish on a financially viable solution for the service, told the full board the ambulance transport business has been in financial decline for a while.

In its best days, Blake said, the service was completing 800 transports a year — making enough money to absorb the town’s 911 ambulance budget, while also funding new police cars, fire trucks, motorcycles, and gear for the town.

But the service has been hit by changes in hospital protocols and changes in insurance billing.

Oak Bluffs used to make money by taking patients from the hospital’s emergency room and bringing them to the helicopter pad to be airlifted off-Island. Now the hospital provides that service for patients.

The town used to be able to charge for transports to Woods Hole, but Blake said the federal government stepped in and said that wasn’t allowed.

Since the pandemic started, Blake added, the hospital is keeping patients at the hospital longer, requiring fewer off-Island transports.

The town’s ambulance service made 542 transfers to date in 2020 — down from “800 and something only a few years ago,” according to Blake, who also said projections show the service will only make 330 transports in 2021.

There have been other changes at the insurance reimbursement level. 

“If you’re a patient and the hospital decides to send you to Mass General, the insurance companies are coming back and telling the billing company, ‘Well, that service could have been done somewhere else, so we’re not going to pay for the transport to Boston, we’re going to pay for the transport to Hyannis or Plymouth,’” Blake said.

But the biggest issue for the ambulance service has been a decrease in reimbursements from MassHealth, Medicare, and Medicaid.

“We’re trying to provide a service, but we’re losing money. We can no longer afford to have the transport side of this equation supplement the 911 side and pay for equipment and health insurance,” Blake said. 

Selectman Ryan Ruley said the town is essentially providing a service for the entire Island that is no longer sustainable.

“The hospital needs to, in a quicker fashion, work with us to come up with a better solution, because I can’t fathom going back to the taxpayers for a whole ’nother year,” Ruley said.

Finance committee member and Oak Bluffs EMT Rich Weiss said he’s watched the ambulance service lose money for the past five years.

“For the life of me, I do not understand why Oak Bluffs is in the insurance payment collection business,” Weiss said. “If it costs $4,500 to go to MGH, why are we working with an insurance company that only gives us $1,600? If we are, why aren’t we negotiating, not even negotiating, demanding that the hospital make up the difference? They are a giant entity that pays no taxes in this town.”

Blake said the hospital is looking at contracting with an off-Island ambulance company and having the Oak Bluffs ambulance bill the hospital directly for runs to Woods Hole. 

“Our position right now needs to be steadfast; this is a service we’re going to provide and that’s all we can do,” Blake said. “We’re not capable of doing more.”

Selectman chairman Jason Balboni asked Blake to continue working with Packish to come up with solutions. Selectmen will discuss the issue with Blake at their next regular meeting.

In other business, selectmen unanimously appointed former clerk of courts Joseph Sollitto to the Steamship Authority Port Council and Rizwan Malik to the Martha’s Vineyard Cultural Council.