Vermont EMS advisory committee urges statewide assessment, warns of funding and staffing shortfalls

Drew Hazleton, chair of the Vermont EMS Advisory Committee, told the Senate Government Operations Committee on Jan. 23 that Vermont’s emergency medical services face widespread staffing, funding and capacity problems and that the committee has hired a contractor to complete a statewide data assessment.

“We know that EMS in Vermont is in trouble,” Hazleton said, describing a system with widely varying service models, inconsistent data sources and increasing difficulty filling ambulance shifts.

Hazleton said the advisory committee and the health department have secured a contractor to perform a data assessment; the contractor has been given until April 15 to complete the assessment, and the committee expects to deliver a comprehensive statewide EMS plan to the legislature by next December, with work on a five-year plan to follow. The committee is separating the engagement into a data-collection phase followed by a plan-development phase.

The advisory committee is convening information from multiple ongoing efforts, Hazleton said, including the health department’s work and a separate public-safety dispatch review. He said the committee will incorporate dispatch findings rather than duplicate that work, and that the regional governance group created last year has not yet been ready to coordinate but will be contacted in coming months.

Hazleton said a long-standing obstacle is that there is no single, statewide data source for EMS operations, which makes it difficult to answer basic policy questions such as the true cost of service delivery, the size of the workforce deficit and how many personnel are needed in different communities. To address service quality, the committee plans to apply quality standards to assess whether care is consistent across the state.

Last year’s legislation increased a special EMS fund from $150,000 to $450,000 and earmarked $150,000 of that increase to support the advisory committee’s work; the statute also included an allowance to use up to $370,000 in the current year. Hazleton told senators the committee will likely need to extend deadlines and may have to request language changes so money can be used into the following fiscal year to complete the second phase of the five-year plan.

On funding, Hazleton described a patchwork of local, municipal, nonprofit and billing-based revenue models across Vermont. He said some services are municipal and funded through town budgets, many are nonprofit and rely largely on billing (about 80 percent of revenue for his regional service comes from billing), and some are fully volunteer and fundraise all operating costs. He said there are two for‑profit ambulance companies in the state, with most remaining services nonprofit or municipal.

Hazleton said federal payment structures — Medicare and Medicaid billing rules — still treat EMS largely as transportation rather than a health-care provider, which compresses reimbursement rates. He referenced a recent New Hampshire Department of Financial Regulation report (which he offered to share with the committee) that estimated payers would need to increase fees to about 202 percent of current schedules to make EMS financially viable in that state; Hazleton said Vermont is likely to face similar cost pressures.

He also described administrative and reimbursement challenges created by billing categories (basic life support vs. advanced life support; emergency vs. nonemergency), and said Medicaid coverage for patients who are treated but not transported is being paid at the lower BLS hospital rate rather than the higher emergency rate in some cases. That difference, he said, can mean reimbursements that cover only a fraction of actual costs.

Hazleton listed equipment and capital-cost pressures as another driver of rising expenses: he said new ambulances now commonly cost between $250,000 and $300,000 (with some cheaper units around $150,000), and that modern powered stretchers can add roughly $50,000 to vehicle costs. He said those rising capital and operating costs are prompting some small services to seek large municipal budget increases to stay afloat.

Committee members asked clarifying questions about the special fund, the timeline and potential legislative fixes. Sen. White (Windsor County) confirmed with Hazleton that the committee may need statutory language changes to extend the period during which the special fund appropriation can be used. Sen. Larry Hart (Orange County) asked where EMS funding comes from; Hazleton replied it varies by town and service model.

Hazleton said the advisory committee will meet again the following week and has not yet finalized a formal legislative “ask.” He described likely topics for future requests: clarifying billing codes to ensure emergency calls are reimbursed at emergency rates, extending the special-fund spending authority into the next fiscal year, and pursuing Medicaid rate changes though he acknowledged that pursuing Medicaid reimbursement increases would be difficult.

Sen. Cottlemore, chair of the Government Operations Committee, and other senators expressed interest in continuing the committee’s work; Sen. White offered to sponsor a committee bill if the advisory committee requests one. Hazleton reiterated that the contractor’s assessment is intended to quantify gaps the committee has long observed anecdotally and to inform the five-year statewide EMS plan.

Hazleton asked to be invited back as the committee’s work progresses. The advisory committee’s next steps are data collection through the contractor, follow-up coordination with the dispatch and regional governance groups, and then drafting the multi-year plan that will include options on funding, governance and workforce development.