April 06, 2020

Emergency service expansion sought> Managed care demands a factor for Bangor

BANGOR — Add the Bangor Fire Department to the list of health care providers thinking about expanding services in order to keep up with the demands of managed care.

Chief Jeffrey Cammack made a pitch to the city’s municipal operations committee last week for allowing the department to get into “interfacility transfers.”

Doing so would involve adding two more ambulances so the department could transport people not only from accidents or other emergencies to a hospital, but between hospitals, private homes, nursing homes and other facilities.

Cammack explained that just as it has in other parts of health care, managed care is moving into emergency services and awarding contracts for those services. Those who receive the contracts will be those who can provide the full range of services.

Not getting in on the contracts could sharply reduce the number of calls the department takes each year, its revenue, and its ability to provide services to the indigent and others lacking the money to pay for an ambulance, Cammack said.

“They’re not going to pay as we know now,” Cammack said, referring to Medicare, Medicaid and private insurance companies.

Firefighters in Bangor have been increasing markedly their level of expertise and training in emergency services in recent years, Cammack pointed out. “There’s nobody in the state that does what we do.”

Cammack shared some statistics showing the current level of the department’s participation in EMS.

Last year the deparment answered 3,794 EMS calls, bringing in more than $400,000 in revenue, he said.

Medicare accounted for one-fourth of the calls and 42.7 percent of revenue. Medicaid calls were 23 percent of the total, but generated just 16 percent of revenue. Private insurance was responsible for 22 percent of calls and 22 percent of revenue.

If the department couldn’t continue to get those calls and money, Cammack said, it would reduce EMS revenues by 80.7 percent, making it very expensive for the city to continue to serve the indigent and those who pay privately. The department will always have to maintain some level of ambulance service, he said, so it makes sense to try to keep it financially feasible.

“We feel as though it’s time to move forward to be a little proactive,” the chief said, emphasizing that the department’s EMS committee had worked with management on the recommendation.

“We have the people” to staff the extra services, he added, and could lease two more rescue vehicles to make the expanded program possible. Cammack said it was possible that once the new services were added, revenue could increase to a level hundreds of thousands of dollars higher than it is now.

“You make an excellent point,” commented Councilor Michael Crowley. “We still have to provide services to others,” he said.

With the consent of the committee, Councilor Michael Aube told Cammack to go ahead and put together a plan for the council to consider.

Barrett reminded the council that the city’s relationship with Capital Ambulance, a private provider, was still under discussion. Over the last couple of years, Capital has questioned the amount of ambulance business the Fire Department takes while still depending on Capital to serve as backup when firefighters are responding to fires and other emergencies.

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