OK. One final kitten update, then I’ll cover the EMS portion of the Brattleboro Selectboard meeting tonight for you.
The kittens have rapidly become young ladies with distinct personalities. They’ll be 15 weeks old this Saturday. On Thursday they get spayed and adopted! (Thank you kitten donors!)
Margot (grey) likes to investigate any food that she can see. She’s tasted goat cheese, beet dip, cottage cheese, a creamy salad dressing, almond milk, and more. She’s also become quite the techie. She’s hopped up on my keyboard and done some foot commands to open up iTunes and play a funky mixed tape, she’s typed letters into a search box, adjusted the screen brightness, and more.
Bianca is able to carry things she likes around in her mouth. Her latest find is an old catnip-filled mouse. She’s quite possessive of it. Grrrr. Mine! She also acts like the older sister (by an hour or two?).
Both continue to romp and explore. They’ll also hop up on lap and slowly settle in for a purr-filled nap.
Our older cat Mickey isn’t sure what to make of it all, but all cats continue to investigate one other every day for a short while.
Outdoors, we still see momma Mimi and the one we couldn’t catch – Six. Six is large. I’ll be trying to catch that one sometime in August, I think.
Thursday, though, is the big day. After spaying and adoption papers, they are official. I’m still amazed that I’ve known these fur balls since before they were born. Our bond is strong, so it should be lots of fun.
Now, at around 7 or 8 or somewhere in there, we’ll pick up with Brattleboro EMS discussions by the board.
Public Participation
I was just checking in to make sure connections were working. Wow – Dick Degray tells the board downtown is the worst he’s seen in 40 years. Quite the speech. Dora complains about their document formatting… okay. Back later.
That EMS public participation....
The EMS discussion is “scheduled” to begin at 7:20. That won’t happen. Board is stuck in Old Business discussing proposed Land Use Regulation changes, which was expected to end at 7pm.
They aren’t done, and there are still two more items before EMS. Hang in there.
EMS Public Participation drifts later
The Old Business has just ended with the adoption of the new Land Use Regulations at 7:40 pm.
They cancel the first new business item, then they approve a permit. We’re doing it!
EMS Update
(We start at 7:49…)
Chief Howard and AC Kier
Ian – this is a monthly report on EMS. This will be our full year report. We saw your memo in the backup materials.
AC Kier – I want to focus on one thing – appreciation of our staff. We respond to 4500 emergencies, and we also responded to fires, car crashes, etc.. Over 3k required EMS. We had countless policy and procedure changes and hours of training. We endured some hardship with Golden Cross. The staff has put in the work, and met every challenge head on. We appreciate it. As for yearly stats (reads memo….)…. 4:29 avg response time. Golden Cross invoiced over $1 million… have collected $620k.
Ian – thank you for the presentation. No motion here, so we’re … oh, there is a motion. I’ll take a motion now. (move to accept EMS update…)
Franz – in these response times, I’m not clear on whether there is a separate first response, separate from the ambulance?
AC – treatment starts when fire dept arrives
Franz – when does a fire truck go first?
AC – in West Brattleboro that’s pretty standard. (In downtown?) You might need a fire truck. Decision made by officer in charge. Happens through multiple avenues but through our dispatching app and our radio paging system.
Daniel – I echo the thanks. This is 12 months of reports and the staff that did the work – I probably didn’t thank enough.
Ian – yes, we’ll be talking about the future of EMS in Brattleboro, but that doesn’t have any impact on the work done over the last year. I’m grateful for the BFD and Golden Cross. It hasn’t been said enough. Thank you very much, and for your leadership and taking questions for the last year.. We’l continue to answer those questions as we move into the question of EMS in Brattleboro. Community questions. Bob Oeser will have something…
Bob Oeser – in the backup materials, if people missed it, they should commend the fire dept. It says the fired depot helped out in cleaning up of an encampment. I wanted to point that out. WE talked about staff, and policy change. There was information recently that 16 personnel departed over the last 18 months, and 11 shortly after being hired. That’s concerning because use that’s lots of expense to onboard someone. I thought there might be an easy way to get the answer – do exit interviews and ask those leaving for reasons why people left. Someone said we should have holdovers, fallbacks, and why so many people have left… I’ve spoken before and asked about overtime – now $320k? The estimate for the transition is $21k. One thing is the money, one is burnout, and why does the number keep going up. Franz asked about responses.
Ian – wrap it up…
Bob – why multiple vehicles responding to an incident? I saw a ladder truck, fire truck and ambulance responded… how much does that cost?
Chief Howard – I want to respond to the VT Digger article – 5 people went to another Fire or EMS agency. 3 left for personal reasons. One retired. Five opted out or couldn’t fulfill probation. If they can’t meet our expectations, we help them or we make the option for them to move on. The 16th one was a part time fore inspector. As of Aug 3 we will be full staffed. We are advertising for help, so if we do have an opening we have more to pick from. Overtime – I’ve answered this – 1. is because of FMLSA, 2. vacations, 3. expectations to meet, and sick and vacation times. The event with three vehicles – we got a call for someone not breathing and unconscious – we get 6 people there. You’ll see multiple vehicles. Once the CPR is in progress, or person is ok, then units are released. That’s why you see those vehicles going to a call. Today, those calls come in more frequently than they used to.
Dick Degray – I’ve been asking for several months – we had 2044 billable calls and that generate $1.17m. $670k collected. That’s under 70%. You’d have to invoice $1.25m to get enough revenue to meet your projections. The bulk of our riders are Medicare or Medicaid, plus “private rides” – I have a concern about your projections. I raise this because it is part o this. The invoice number isn’t going to change.
Ian – we’ll do most of that in the next agenda item.
Chief – …starting this process show 3-6 months before collecting a full reimbursement.
Bob – to clarify – the short term. Look at the exit interview document to see why the people left. The reasons for leaving are in the back up materials. The issue of three respond- the question was what the cost of that response?
Chief – I can’t give you that info, just like I couldn’t when we were with Rescue. I can try to get you a cost. It takes 6 people min for a cardiac arrest.
Ian – pending motion…
EMS update accepted.
Ian – we’ll break for 5 minutes and be back at 8:15.
Fire-EMS Transition Update (7:30 PM)
(i) Public Engagement Update
(ii) Municipal EMS Update – Operating Models and Costs
(iii) Contracted EMS Update – RFI Responses and Draft RFP
….
It’s 8:21 on a nice summer night, and time for the EMS discussions
…..
Ian – it’s later than I would like. Public engagement first.
John Potter – still on schedule for the tasks you approved in May for public engagement. Tonight is the 4th major opportunity for public feedback. The website has received over 1300 page views. We have had more email feedback. That will be summarized for you in September. Questions?
Franz – you could make it easier to link to the presentations…
Ian – and Dora’s point, make sure the downloadable content is easy to ready and print out…
Dora Bouboulis – we are addressing citizen participation. I still think there are more ways to reach out. The best way is to walk around and talk to people. Most don’t pay attention or have time to interact. There has to be more than these meetings and online info. This time of year, it is hard to get people to pay attention. More avenues and more sources of media would engage folks more.
Ian – thanks, Dora. You will have an in-person public meeting in September? (yes)
John – sometime between your two meetings in Sept we will do a public forum for anyone from the community. We’ll know what the options are by then.
Dora – I want to recommend you get the school as a place for the public meeting. Maybe the library.
Ian – I was thinking it should be at the library. Not my call. This room can’t hold that many people.
…
Municipal EMS Update – Operating Models and Costs
Patrick Moreland – (starts a powerpoint presentation). Municipal EMS Track Operating Model – these presentations are a team effort. We’re working as a team – John, the FD, Kim Frost and myself… we put it together. That team set about to try and come up with the ideal operating model. Two key components – ability to respond to multiple simultaneous emergencies, and fiscally responsible. The least impact on the general fund. The board set a goal in March for us to send 6 to a fire with 4 to others… so 10 is ideal. What would the net impact to general fund be – options vary greatly. WE looked at if we had 4 platoons of 8 – fiscally responsible but not effective. $ platoons of 10 wasn’t financially responsible. 3 platoons of 10 plus and EMS supervisor would then have the least impact to the general fund and be effective. The cost analysis has two revenue estimates – one is based on Golden Cross’ work with us – they should collect $837k per year. The second column is based on estimating – $942k. From there we can take a look at different expenditures. Staffing would be $90k, 6 FF/AMT at $342k + $264k in benefits plus $20k overtime. So, $717k for additional staffing. But what about billing? It could be a staff cost or it could be a third party. We’ve met with some and for a percentage they’ll provide that service. There has been some finance department shifting positions… we could easily move into FY25 adding and EMS billing position. Other costs fuel ($2500), $15k for medical supplies, $7,500 vehicle maintenance, and insurance ($50k), BIO Waste – $1k, Provider assessment -…. and more! There is capital equipment replacement – new radios, new ambulances. $600k for ambulances. $95k for radios. Replacement costs go up 10% a year.
We would eliminate the EMS contract (110k) – so $828k cost. The impact would be limited savings depending on revenue that comes in.
Are we suggesting it is profitable. Absolutely not. These figures don’t show everything. There are other costs in fire department budgets. These show NEW expenses. We wouldn’t need to raise taxes in the first year. In future years, staffing and supplies go up. We’d need to carefully monitor costs to keep things viable. We can look for other sources of revenue. There are pros and cons to doing each. Cost increases, they are born by the town one way or another. Costs will find their way to us whichever we choose.
Ian – thanks for the presentation. Board questions first!
Daniel -It doesn’t have to be me. I’m happy you pointed out many policy decisions yet to be made to impact numbers and start up costs. I’m grateful of the hard work. This presentation makes three bodies of work all put together. and you can see this is a possibility, right? There are policy decisions about startup expenses and rate setting and types of ambulances, but having this info out there is helpful. I hop other board members are open minded and open to this and not just go along with the assumptions… even if we go down this route… so thank you.
Franz – thanks Patrick – it is useable. Daniel says to have open minds, so this is helpful. One thing I continue to think we could do more accurate accounting and that we discussed previously which is if we don’t do the billing – we could decrease the Finance department by one position, which would be a savings to the General Fund. It would be more accurate to include that in our thinking. Town staff doesn’t stay at the same size depending on the model we choose.
Moreland – that’s totally fair, and I, um.. it is reasonable for everyone… um.. when we evaluate the municipal option of or a contracted option, those factors are clear…
Franz – thanks.
Peter – One thing the five us of all have more time to digest this than someone sitting at home. Sometime when I’m out one the street – don’t assume we’re going this way. It is one of the options that we could consider. This is one of the things to have a plan and not need it than to need a plan and not have it. It’s not a final decision.
Ian – I appreciate that. I like to mention that this is a multitrack model discussion and we’re in the Municipal EMS discussion and the next item is discussing the third party. We’ll decide in September.
Peter – completely transparent in this process…
Public Comment (8:48pm)
Kate O’Connor – thanks, and thanks for pointing out the other EMS expenses under the FD, and that expenses will go up. I want to drill down on the slide 23… cost analysis… I appreciate what you are doing – this is not a cost analysis on year one operations. This is year one’s impact on the general fund. What’s missing, under staffing – if you add fuel and capital replacement – that’s $235k. That raises the costs and FY25… if you take out the $125k for ambulances… I want everyone to understand that’s great for FY 25, but year 2, FY26, based on this, you will be building the budget on $953k… those are the expenses. These are checks the town will write… Franz is looking at me like I’m crazy. All those things without the EMS contract taken out, and look at what you will raise, you are bumping up against your revenue, and costs will go up. Under this model with these figures is already bumped up to expenses exceeding your revenue estimates. If you pick this, you’ll see the gap in FY26, FY27, FY28… $935k is the figure you’ll be using.
Franz – I need these numbers written down.
Kate – the numbers should be subtotaled. No one in the public will understand that’s not the number.
Franz – I hear you – but I need to see..
Kate – just add it up. Just fix this document. In year one, use $935k – that’s what it will say in the budget. People need to understand it. $828k is not the right number. This is a really important point. People can see facts and figures, but it would be great to hear from other towns and providers.
Daniel – I’m not a finance director – as you spoke it made a lot of sense to me. It underrepresents the full impact, however, no. Every year, if awe don’t provide the service, we pay someone else. if we do it ourselves, we won’t spend that money, so it would be a savings.
Ian – using the Golden Cross number we are using low numbers. If we don’t provide it we contract it and that costs us.
Franz – I’m still in the dark as to where the numbers come from.
Ian – yes, we’ll subtotal them. It’s not fixing it, it is improving the presentation. Patrick and team are doing really hard work making it presentable.
Franz – Kate – you aren’t changing the numbers just adding different… okay.
Liz – like getting a coupon…
Peter Case – I see – she’s right. It’s like a car – sticker price is $10k and my car is $2k so it comes down. If we don’t have to write a check it should count as well.
Judy Davidson – I’m reiterating what Kate says. When I see the other revenue and expenses, I was confused by eliminating the EMS contract – of course it would…. why would eliminating this be operating expenses of our municipal ambulances. It’s very confusing to see the elimination of a contract be part. I suggest we take it out. Of course, we’d save that money. Don’t understand why it is even in there, and it wouldn’t be there in future years. Confusing to the public. Our cost will be the $952k on the ongoing basis.
Daniel – there is an issue with language that got confusing. The intent of the presentation would be the net impact to the General Fund – how does it compare to previous contracts? if we did it on our own would it cost more or less? The attempt here is to show how providing the services entirely would compare to the cost of a contract, so you kinda have to show… it’s not really revenue but it is an avoided expense. By portraying these as operating expenses, the avoided expense seems confusing.
Liz – My comment is merely that it needs to be accounted for. It isn’t a budget, it is an analysis. Kate said we have some supply and we are adding to it. The same way were are accounting for not having the EMS contract. That elimination is avery valid point of information.
Patrick – I can’t improve on what Liz just said.
Franz – I have other points but.. they don’t address this…
Dick Degray – couple of things – adding $15k into the supply budget to $10k already there, so in 2025 it will be $25k. I asked before about revenue and the Chief said they were running 3 months behind. Why haven’t you gone back and looked at the collection rate – the hard numbers from earlier in the year would give you a better estimate. Why haven’t you done it?
Ian – want to ask your other question.
Degray – I’ll get back up. You can talk coupons, but they are one time only. If this is a real cost and this is a the revenue projection – you wouldn’t spend $835k to make $110k.
Ian – I’ll remind the board and public – the $942k is one proposed possible revenue. There were multiple.
Moreland – so, I can reiterate – we agree there is a 3 month delay in collecting reimbursements. Golden Cross brought in estimated $837k, we anticipate. It is dependent on what they choose to do. What should we charge. Golden Cross is at a low end of the spectrum. Charging more would avoid leaving money on the table. Medicare and Medicaid are reliable. Town estimate is based on a larger billing rate of $1400. The spreadsheet is on the town website. I used actual number of transports for this estimate.
Daniel – you are talking about bills from last July. What about bills from May, June, July of this year? We don’t have the numbers. I might be wrong. I see it as a rolling lag. There will always be a delay. There will be lag time. We have real time revenue info, but there will be a lag. This model reflects our fort year. The model is based on our payer mix, ALS vs. ELS calls. The methodology is sound.
Franz – these are estimates. Your way sounds reasonable. This is a bit more sophisticated and has some other variables, not just your three month estimate. patrick has done a reasonable job. We can’t know the answer. We’ll do the best we can at making a prediction.
Peter Case – if we focus on the fact that with all this data of Golden Cross… we are discussing an option, not a rule or decision. These conversations get into the numbers but we aren’t make a decision.
Ian – run the number by Dale at Golden Cross if we haven’t already.
Liz – this is a cost analysis, and that’s why eliminating the EMSA contract needs to be included in the analysis.
Dora – why not do both – do the model, and get the exact accounting for a quarter. If we don’t have accounting for a year ago, we don’t get that money. There has been talk of differing insurances. Subsidized health insurance – is that paying any more than what Medicare or medicaid pays, or do the patients pay additional costs? Not sure anyone has looked into this. Many people probably earning 25-30k, and is being masked by the few making much more. If you talk of charging more…
Daniel – I appreciate your last point. That the rate… there are so many policy decision to make. One would be the rate? Same for all calls? Conversation needs to happen with those with private insurance. It is what insurance was held by those needing an ambulance… those include Blue Cross and MVP plans… each is different but will cover ambulance rides. When Triton did the study of payer mix, is the private insurance number accurate.
Bob – maybe a simple way – it’s gotten too complex – one thing – what does it cost to have an effective fire response team with no EMS, then what are the EMS costs? Add those up/ Two numbers. You can look at them Separate budget items. We are doing estimates. No question. So one thing we ask is confidence ration – what percentage – someone suggested Dale look at numbers? How about someone in Vermont? You spoke of different plans – Medicare Advantage has special rules for ambulances. They have special rules.
Dora – The point I was trying to make wasn’t just about private health insurance. What are people paying and what do people who qualify for subsidies, do they get a pass for being low-income?
Ian – thank you Dora.
Daniel – the policy is $x and the government kicks in $y and the polices are comparable, but subsidies vary based on income.
Dick – Page 107 – question..
Ian – we’re not at that item. Let’s wait…
Dick – It’s coming up?
Franz – if you add to the force, how about paramedics instead of AEMT?
Moreland – the pay charts – depending on qualifications you get different rates. We took a middle of the road approach. Not everyone will be a paramedic, but some may be?
Franz – how much more would it be for paramedics?
Moreland – would need to get back on that…
Franz – first repose and effective forces. If we have 10 people on a shift and a cardia response requires 4. What happens?
Chief – as soon as the CPR is in progress it could call back 4.
Franz – if you have two… you call mutual aid?
Chief – yes.
Franz – If we had two cardiac arrests, or a vehicle crash an something else… look at the statistics and see how often it happens.
Ian – move on to Update on Contracted EMS track…
….
John Potter – we issued an RFI on June 1 and we got 2 responses (Rescue and AmCare) – and we got some initial information, plus we posted redacted copies of what we received. We took information from those and took internal information and prepared a draft RFP for you and the public to review. A copy is in your packet. The purpose is to solicit proposals for an EMS ambulance contract for Brattleboro residents and visitors for comprehensive ambulance service… in this RFP we allowed for flexible responses. We’ll entertain dedicated ambulances as well as ambulances shared with other municipalities. Some will have FD personnel and other may not. We’d like to get multiple responses to get lots of compare. Also included are requirements for submitting a proposal. Also says how we will evaluate them. We’ll send this out Aug 1 and get proposals back Aug 29. After incorporating feedback, we’ll send it out as we did before. Hope to get multiple proposals back. Happy to step through or answer questions…
Ian – board, questions?
Daniel – I read it in detail and I am not a RFP producer but it seems clear and the only thing I’d say if everyone is happy with it, let’s not wait until Aug… get it out asap.
Peter – I don’t disagree. The process has been transparent.
Liz – I do write RFP’s and this is clear and meets our goal. I’m ready to release it.
ian that’s three right there…
Franz – I think it is reasonable. There is an unforgivable mistake – the term will be for consecutive 180 calendar days starting 2024….
Ian – other comments or questions? Given the board’s desire to put it out sooner, let’s keep deadline for questions. Public?
Potter – not in this draft but what has come up is we add a sample contract so they will see a sample town contract to help them plan pricing. The other thing suggested is that we ask for 5 copies, not just one.
Franz – I don’t look at RFP’s or write them but this one is really clear and easy to respond to.
Ian – public?
Bob – For the record – after reviewing the RFI – there is a corporate interest involved. What was your decision to redact the RFI? And, is the RFP unduly restrictive – it needs a clear concise description of technical requirements, but no features that unduly restrict competition?
Ian – trying to find it…
Bob – page 19 of your procurement manual…
Potter – redacting the RFI’s was to eliminate malfeasance… we’ll make them all available at once to the public. I don’t see this as unduly restricting completion. Multiple ways to compete on price and scope.
Ian – but we’ll check
Potter – I already asked and he said it was OK.
Ian – I hope the RFP allows for lots of proposals. It is open…
Dora – To be more specific – you got two responses to the RFI. You aren’t going to get a lot of applications.
Ian – an important point is that applying for the RFI doesn’t impact the RFP. You can make assumptions but they are assumptions. I don’t understand the competition issue.
Potter – there was no requirement to submit on the RFI, so we will welcome all comers at this point.
Ian – board members? Comments? Okay, we’ve gotten pretty… no need for a vote. Let’s just .. we’re changing the RFP request going out date.
Franz – thanks to everyone who came to this discussion tonight – for all the comments and consideration of the process. Thanks for being here.
9:46pm.