BABBITT— At a time when many of the region’s small town ambulance services are struggling financially, Babbitt’s city-run service is managing to keep its head above water, while providing advanced life support level care much of the time.
It’s a combination of frugal fiscal management, a bit of good fortune, and “a real culture of volunteerism,” which current ambulance director Matt Littler credits to his predecessor, Mike Rhein, who led the service for more than 20 years and still serves as an EMT.
Babbitt’s performance is impressive, but repeating its model is likely to be a challenge.
That’s true, in part, because the community is able to rely on Littler and his wife Rebekah, both of whom are certified paramedics and have jobs that give them the flexibility to respond at almost any time to calls that require an advanced level of care.
The service recently added a third paramedic as well.
Most of the time, the service relies on a healthy stable of EMTs and First Responders, who fill the bulk of the service’s paid on-call roster 24 hours a day, seven days a week, as required by the state’s Emergency Medical Services Regulatory Board, or EMSRB, although the Littlers will fill in gaps in the schedule when necessary. But, for the most part, he said he tries to keep the service’s paramedics free to respond only as needed. When both he and his wife are in town, he said the service can provide ALS level care virtually around the clock.
Littler, who works as medical staff on national wildland fire teams, was in Missoula, Mont., at a week-long fire training this week. But even when he’s out of town for training or on a fire detail, he’s able to do much of his administrative work for the Babbitt ambulance during breaks or other down time. During a Tuesday interview with the Timberjay, he noted he had just submitted the ambulance payroll to city hall, from Missoula.
“A lot goes into running a service,” notes Littler. “The way that I am able to make it work, is I’ve been able to do a lot of administrative tasks remotely,” he said. It also works because he doesn’t handle all the administrative work himself. “All of our leadership is paid a stipend to do the administrative tasks,” he said. That modest stipend is in lieu of a regular salary for the supervisor position, which saves the service money.
The service also cut its payroll when it made the transition to a full paid on-call model. When the service first began paying for on-call time, paid on-call time was limited to daytime hours for the most part, while the service relied on its former all-call volunteers for emergency overnight and on weekends. But when the EMSRB began requiring ambulance services to maintain fully-staffed rosters 24/7, the service reduced its on-call pay to five dollars an hour to keep costs under control.
While pay cuts can be unpopular, Littler said there was little pushback from the service’s volunteers. In fact, he said some offered to take no pay for their on-call hours, but Littler said he insisted they take the funds to make sure the new system was sustainable for the long haul.
The impact of the reduction in on-call pay has been tempered somewhat, Littler notes, by a significant bump in pay for responders when they actually receive a call.
Addressing challenges
While Babbitt seems to have weathered the changes in EMS better than some other area communities, it is still facing longer-term challenges to its sustainability, notes Glenn Anderson. Anderson sits on the Babbitt City Council but he spent years as the city’s fire chief and also had a shorter stint as ambulance supervisor.
“On paper, we’re doing okay,” he said, noting that the service doesn’t rely on outside funding, except for a modest annual donation from Waasa Township and a small amount of subsidy from St. Louis County. At the same time, he noted that the service has been writing off about $200,000 a year on unreimbursed billings to Medicare, which he fears is not sustainable much longer. “We’re not broke but writing off $200,000 a year will catch up with us,” he said.
Anderson said the service has been able to stretch dollars further by running its ambulances a bit longer than most services. With two ambulances, they’ve maintained a ten-year cycle, which requires purchase of a new vehicle every five years. “We also set up a rotation system, so we don’t put all the miles on one vehicle,” said Anderson. “I think that was one of the smartest things we did.”
The service has also ramped up the number of inter-hospital transfers that it conducts each year, which can be a way for ambulance services to generate actual profits. Three years ago, the Babbitt service provided just 15 such transfers, but conducted 66 last year. So far this year, the service has completed 14 so they’re on pace to exceed last year’s number, which should help the bottom line. Last year, the service logged a total of 345 runs, a significant increase over the year before, due mostly to the higher number of transfers.
The service also benefits from the higher reimbursement they can receive for an ALS response. According to Littler, the service typically receives an extra $200-$400 for an ambulance call when ALS care is determined to be necessary, with the final amount dependent on the actual care provided. Last year, about 15 percent of emergency calls required and ALS level of care, according to Littler. So far this year, he said, that’s up to almost 25 percent.
Anderson said being able to provide ALS is a win for the community. “Since we went ALS, we’ve had two lives saved for sure, and probably a third,” he said.
Whether Babbitt can sustain ALS service is an open question, notes Anderson, since it largely depends on the Littlers remaining in the community and remaining willing to juggle the needs of the service with their otherwise busy lives. That, of course, is a perennial challenge for small town ambulance services everywhere.