Simsbury Volunteer Ambulance Association warns town: reimbursement shortfalls and volatile transports strain service

At the June 16 meeting of the Board of Finance, representatives of the Simsbury Volunteer Ambulance Association (SVA) warned elected officials the town’s ambulance service faces recurring revenue shortfalls and fragile cash reserves even as demand grows with an aging population. The presentation laid out how state-set billing rates and payer rules combine with unpredictable call volumes to make ambulance operations hard to sustain.

Chris Kelly, president of the SVA, said the state’s 2025 allowable charges include $960 for a basic (BLS) transport, $1,518 for a paramedic-level transport and $23.32 per mile. Using a typical example, Kelly demonstrated that a $1,244.50 billed run can result in Medicare paying roughly 39% (about $467) and leaving the association with roughly $586 collectible — about 47% of the billed amount — while the rest becomes an uncollectible write-off.

The association’s chief, Karen Stewart, and other presenters emphasized the service is paid only for transports; non-transport responses generally produce no revenue. They said 2024 billing showed roughly 38% of gross billings were Medicare and that Medicaid pays even less. That mix, they said, compounds the gap between the allowed charge and what the SVA actually receives.

Russ, a member of the SVA leadership team, walked the board through demand and cost projections. The association’s operating budget is about $1.6 million; its operating reserves were described as “very low,” roughly $50,000, and staff said an appropriate liquidity cushion would be on the order of a quarter of expenses (roughly $300,000). SVA officials noted that the town supported a second staffed ambulance unit some years ago; while that improved readiness, it also increased fixed costs and depleted liquidity.

SVA forecasting showed transport volumes are variable month to month and year to year. The group’s base forecast for 2026 was about 1,850 transports with a standard-deviation swing of roughly ±100 transports. Using a lower scenario — an annualized figure near 1,723 transports — would produce about a $95,000 revenue gap on the association’s current assumptions.

On staffing and operations, presenters said roughly 80% of the association’s expenses are wages and benefits; the service has six full‑time staff and a larger pool of part-time or per‑diem crew members. The association said it faces the same recruitment and wage pressures seen statewide, limiting the ability to make staffing costs fully variable.

The association also described performance measures: average on-scene times of about 21 minutes, average hospital transport times around 27 minutes, and an average priority‑one response time in-town of about 6 minutes 36 seconds. Mutual aid dynamics were discussed: mutual-aid responses lengthen total time-to-service because mutual-aid arrivals average about 20 minutes.

Kelly told the board SVA pursues revenue through transport billing, event standbys, CPR and EMT training and occasional grants; some one-time federal payroll-retention payments helped 2025 results but are not recurring. The presenters offered to provide line-by-line budget detail and to meet with board members and staff for deeper review.

The Board of Finance did not take a formal funding vote on the ambulance presentation at this meeting. Board members asked for follow-up materials and more granular forecasting so elected officials can weigh whether and how the town should bridge variability in collections or stabilize preparedness funding.

Sources and next steps: SVA provided the board with slides and an offer to walk the finance committee through detailed line items. Officials said staff will circulate the association’s supporting documents and that follow-up discussion could be scheduled during the budget process.