Simsbury ambulance volunteers warn of revenue shortfall, urge town support for readiness

The Board of Finance heard a detailed briefing on June 16 from the Simsbury Volunteer Ambulance Association (SVA) on the service’s finances, staffing and response metrics, and the implications for town support.

SVA leaders — including Chris Kelly (president), Karen Stewart (chief) and other staff and volunteers — told the board that Connecticut sets ambulance billing rates and that those amounts do not translate into cash. Using 2025 state rates as examples, they said a basic life-support transport (BLS) is listed at $960, a paramedic-level transport at $1,518, and mileage at $23.32. After Medicare and other payer adjustments, presenters showed a typical $1,244 billed trip yielding roughly $586 in collectible revenue — about 47% of the billed amount — with the rest written off as uncollectible.

"A BLS is a basic life support transport," Karen Stewart said, describing how the state rate translates into actual reimbursement. Presenters added that Medicare typically covers a minority share of the billed amount and Medicaid pays less; private insurers sometimes reclassify ambulance bills as out‑of‑network because patients do not choose the responding ambulance.

SVA officials told the board they average about $672 in revenue per transport (2024 final data) and are forecasting roughly 1,723–1,850 transports for 2026 under different scenarios. Because the association only receives revenue for transports, month‑to‑month variance in transports drives revenue volatility. The presenters said the service’s operating budget is roughly $1.6 million and that they currently hold about $50,000 in liquidity reserves, a level they characterized as “extremely low” and below their $300,000 target.

Russ, a long‑time SVA speaker, summarized the central tension: "This is not a money‑making business," he said, noting that roughly 80% of costs are wages and benefits and that readiness (staff and vehicle availability) creates fixed expenditures regardless of transports.

SVA described the second staffed unit the town helped fund a few years ago and estimated the fully burdened cost of a staffed ambulance unit at roughly $600,000 a year. Presenters said that, while the second unit improves readiness and reduces missed calls, it is not yet financially self‑sustaining on transport revenue alone; they estimated that to break even that unit would need several hundred additional transports annually.

The presentation included operational metrics: priority‑one response times in Simsbury average about 6 minutes 36 seconds and crews average about 21 minutes on scene; mutual‑aid arrivals average roughly 20 minutes. Presenters said mutual‑aid inflow and outflow are near parity and warned that removing a staffed rig would increase missed calls and likely draw complaints from partner towns.

SVA also outlined future capital asks and a multi‑year support plan: requests have included a capital ask for an ambulance later in the decade (presenters cited a $200,000 example for 2027) and recurring operating assistance if transport volumes or collections fall short. Presenters offered to bring detailed line‑by‑line budget spreadsheets to any board member who wanted further review.

Why it matters: the ambulance service provides 911 medical response for the town, and the board will consider whether and how to use town funds or short‑term credit to maintain readiness during revenue variability. Board members pressed presenters on reserves, staffing models, and whether there are untapped grant or subsidy options; presenters said grants are limited, many federal/state rates are set outside their control, and that volunteer recruitment and statewide pay pressure have increased labor costs.

Next steps: SVA offered to provide the board with detailed financial exhibits and per‑capita cost comparisons for nearby towns. The board did not take a formal funding vote during the presentation but flagged the issue for budget and capital discussions this summer.