Barton Ambulance in the Northeast Kingdom auctioned off its vehicles and equipment on Tuesday, a casualty of financial problems. The ambulance service’s building, which is in foreclosure, didn’t sell.  

The ambulance service closed in 2018 after competing with two other nearby services for jobs in the thinly populated area.

With Orleans now providing service for Barton, and Glover also providing coverage nearby, “there has certainly been talk among some people about consolidating even further,” said Kristin Atwood, the Barton town clerk.

 One or two of the state’s rural ambulance services close each year, according to the Vermont Health Department, which licenses all of the state’s first responders. Dan Batsie, EMS chief for the state, said the Barton, Glover and Orleans services had been competing for about 1,000 calls a year.

Batsie on Tuesday described the Barton closure as an “evolutionary step” as the Vermont population and its needs evolve. There are about 90 transporting agencies and 90 first response squads in Vermont. Last year, there were six closures – an unusually high number that involved some mergers, including the Danville ambulance service into the Caledonia and Essex County service, Batsie said.

He noted that the Health Department has licensed two new ambulance squads this year, one in Essex and one in Brattleboro.

The leaders of ambulance organizations held an information day in the Statehouse last winter to tell lawmakers that insurance reimbursement and workforce issues were making it increasingly expensive to keep emergency treatment and transport operations afloat.

Many of the smaller rural agencies survive on Medicare, Medicaid and insurance reimbursement. Batsie noted this winter that Medicare funding falls between 10% and 18% short of the cost of doing business. Medicaid pays about 67% of the Medicare reimbursement rate, making the shortfall even greater. The state Legislature in 2016 had come up with a complex plan to steer more federal money to ambulance services, but the Vermont Ambulance Association said that it didn’t benefit all of the services in Vermont. Some even lost money.

Vermont’s ambulance services are mostly evenly divided between all-volunteer outfits and organizations that are a mix of paid and volunteer staff. Only 4.1% of services are fully paid. But it’s getting harder to operate those volunteer-only departments, said Atwood.

“There are not a lot of volunteers available, and as the regulations and course requirements become greater and greater, it’s harder and harder to find such skilled labor for free,” she said. “And the insurance costs and overhead is incredible.”

The Barton ambulance started as a volunteer service, but then moved to paid staff, Atwood said. In recent years the town had been paying $40,000 each year for it. The annual appropriation for the Orleans service is $50,000, but “that’s the whole town and both villages,” Atwood said. “Barton was only covering a piece of that.”

Batsie said public health officials in Vermont are looking for a new way to pay for ambulance services around the state.  

“There are a lot of ambulances in Vermont struggling,” said Batsie. “Populations change, and response plans are adjusted.”

He added that the same conversation is happening nationally. One problem is that first responders are only paid for the time they are actually moving patients. If they’re called to scene but not used, they end up without payment. Yet their fixed costs are high. 

“We are going to have to look at how the model of reimbursement works,” he said. “It’s a bit of a flawed model right now. It’s not all about taxes; there is probably a better way to pay for it. I don’t know what it is yet.”