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Saranac Lake rescue squad: No one will be turned away

SARANAC LAKE – Julie Harjung, president of Saranac Lake Volunteer Rescue Squad, told the Harrietstown town council Thursday night that ambulance drivers “will never say show us your credit card first.”

Harjung had been asked to explain the service to the town council, as the town contributes $38,612 a year.

The EMS service used to be part of the Saranac Lake Volunteer Fire Department, until it began billing patients in 2010. Because fire departments, by law, can’t charge for their services, SLVRS became a separate organization.

Councilman Howard Riley was concerned that the change to billing was resulting in exorbitant fees to patients and asked what happens if people can’t pay.

Harjung explained how the ambulance service works, where the charges are coming from, and why some of them seem so high.

There are two ways the EMS company serves the community, she said. One is 911 calls, when patients receive a visit from the ambulance and decide whether or not to go to the hospital. Another is transports arranged by the hospital when patients need to move to another facility.

“We do charge for transports,” said Harjung. “Our contract with Adirondack Medical Center says we are the first call for all transports. If we can’t take someone, then there are other companies on the list.”

Riley said he’d had an experience with the ambulance that left him with sticker shock: a $1,400 ride to the hospital in Burlington.

However, other council members assured him it’s not unusual. Town Supervisor Mike Kilroy said he’d paid $4,400 for a family member’s trip to Boston. Town council member Tracey Schrader knew of a transport to Plattsburgh for $3,000.

“Three thousand dollars to Plattsburgh is outrageous,” Riley said.

“I know the bill sounds high,” said Harjung. “But you’re not paying for the trip so much as you’re paying for that crew to be sitting there waiting for you to need that trip. In reality, the service has improved tremendously since I started. We’re doing some high-end stuff in the truck. We transported someone recently who had five lines in him — and those patients maybe wouldn’t have made it if we hadn’t.”

Harjung said the service gets about half of its revenue from the transports, while the 911 calls are paid for from insurance reimbursements and the villages’ and towns’ contributions. With about 20 volunteers and 22 paid staff, including 8 or 9 full-time staff, the service answers 1,600 calls a year, of which slightly fewer than 1,000 are 911 calls. The village of Saranac Lake and the town of Harrietstown pay the majority share for 911 since most of the calls originate within their borders.

Council member Jordanna Mallach asked how many patients call 911 who don’t really need an ambulance. “What if you have a broken foot? You could take Uber.”

Harjung said there are a lot, but it goes the other way, too. “You get the whole spectrum,” Harjung said. “There’s also people having panic attacks, mental health issues, people with no vehicles.

“Last week, we had a guy having a major heart attack who refused to let us take him. I told him, if we get a second call from you, you might not make it. Fortunately, he had four big people in his family standing around and I just told them, on my way out, to grab him. They got him to the hospital. He ended up having six stents put in.”

For 911 calls the service uses “soft billing,” she said. She explained that the town’s $35,000 contribution pays for the 911 calls not reimbursed by insurance. They bill once, and if the person can’t pay, they don’t send it to a collections company. “We won’t charge for co-pays,” she said. “It’s also deductibles. A lot of people have high-deductible insurance where it won’t pay until they’ve spent $2,000. It’s also anybody who’s not insured.

“This is the compromise. So people know we won’t ever say, ‘We can’t take care of you because you can’t pay.'”

Mallach asked whether the rescue squad could submit quarterly reports, as stated in the contract with the town. In spite of the contract, yearly reports have been the norm.

Harjung said she could ask MedEx, the billing company, to prepare a quarterly report. “But you’d have to remind me to do it,” she added. “An annual report would be more realistic than a quarterly report.”

Kilroy said the EMS budget is stable.

“This year’s budget is the same as the last three years,” he said.

The consensus was that quarterly reports weren’t really necessary. Mallach asked that the town’s Memorandum of Understanding with the EMS service be changed to reflect that the town would get annual, rather than quarterly reports.

Harjung said it’s getting more difficult to find Emergency Medical Technicians. There are several levels of certification: EMT, Advanced EMT, Critical Care and Paramedic. Finding people with certifications is complicated by how few training programs there are.

“It’s really hard right now to hire people,” she said. “I have one just graduating from a program in Florida. She was able to do it because she lived with her mom while she was studying.

“North Country Community College is doing great things. They have an EMT class now, and they’re planning an advanced EMT class for next spring. Hopefully, two or three years down the road they can tackle paramedics.”

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