Vermont EMS advisory committee launches statewide assessment, flags workforce and payment shortfalls

Drew, chair of the Vermont EMS Advisory Committee and chief operations at Down and Rescue Inc., told the Senate Health and Welfare Committee on Jan. 22 that the advisory group has hired a consultant to produce a statewide assessment of emergency medical services that will feed a five‑year plan.

The work stems from EMS legislation passed last year that authorized up to $150,000 for an assessment and directed the advisory committee to develop a five‑year statewide EMS plan. "Our current system does not meet our current needs," Drew said, summarizing the committee's view of system reliability and capacity.

The committee told senators the assessment will focus on three areas: workforce, cost and reliability. An initial round of data collection is due April 15 and the advisory committee expects to report back to the Legislature in December. The statute that authorized the work also required coordination with the state's public safety communications/911 dispatch group; the EMS advisory committee said it is working with that task force to align data already gathered on communications.

Why it matters: Committee members and the advisory group said EMS in Vermont is delivered through a mix of volunteer, fire‑based, nonprofit and for‑profit providers, which complicates comparisons of cost and workforce needs. Without standardized statewide data, local services and volunteer‑dependent towns risk unreliable coverage, particularly for higher‑acuity interfacility transports that now require ICU‑level care in ambulances.

What the committee reported - Funding changes: The state surcharge on insurance that feeds the EMS special fund was increased; the fund was previously supported with about $150,000 a year and was raised to $450,000. The advisory committee may use $150,000 of that for the assessment and said up to $370,000 is available this year to complete study work. The committee warned contracting delays at the Department of Health have already slowed work and said it may need a timeline extension.

- Provider tax and Medicaid: The advisory committee described the provider tax that EMS stakeholders created roughly a decade ago, which is levied at about 3.3% of net patient revenues to draw down federal matching dollars. The speaker said the tax currently generates about $1,100,000. EMS representatives also told the committee that recent Medicaid implementation has paid certain transports at the lower hospital/nonemergency BLS rate rather than the higher BLS emergency rate, producing roughly half the expected reimbursement for some calls.

- Workforce and reliability: Committee members emphasized workforce shortages among both volunteers and career EMS staff. The advisory committee said paramedic students often complete training out of state and do not return, and that many ambulance crews are covering long drives; the presentation included examples in which an EMS unit needed 58 minutes of drive time and a 9‑1‑1 response exceeded an hour and a half.

- Equipment and capital costs: Witnesses said ambulance and equipment costs have increased sharply. They reported ambulance prices and outfitting have risen 50–60% in recent years, with modern stretcher assemblies cited at nearly $50,000 and municipal examples of new ambulance price tags in the low‑to‑mid hundreds of thousands.

Discussion, direction and next steps: Committee members pressed how the advisory committee's findings will be used. The advisory committee said it is statutorily required to advise the Department of Health commissioner and the Legislature's health and government operations committees. The committee is gathering data for the April assessment, anticipates returning preliminary findings earlier if contracting permits, and expects a full five‑year plan by the December 2026 deadline established in the legislation. No formal votes or statutory changes were taken at the hearing.

Quotes from the transcript: "Our current system does not meet our current needs," Drew said. On reimbursement changes, the committee noted that "they took the BLS nonemergency rate versus the BLS emergency rate," producing lower-than-expected payments.

What the advisory committee asked of lawmakers: continued legislative attention to payment rules (including the Medicaid interpretation of BLS rates), continued funding for the assessment and flexibility in the project timeline to allow contracting and data analysis to be completed.

Ending: Committee members thanked the advisory committee for the update and said the committee will continue to request interim findings as the assessment proceeds.