NEW SWEDEN, Maine — Caribou City Manager Dennis Marker and Fire and Ambulance Chief Scott Susi spoke with several New Sweden residents about EMS rate increases during a public hearing in the town office on Tuesday.
Marker and Susi have hosted multiple public hearings in towns affected by the rate increase, explaining how outside factors have had an impact not only on Caribou’s ambulance service, but also EMS services throughout Maine.
With state and federal insurance reimbursements covering only a fraction of the costs necessary for emergency services to operate, ambulances across the state are struggling to stay in operation.
Susi cited how MaineGeneral Health — a Jackman-based organization that had two ambulances and operated an 18-bed nursing home — shuttered in 2017 after operating at a loss of roughly $630,000 annually. The next-closest service for Jackman residents is 50 miles away.
For insurance reimbursements, the city receives 100 percent of what is billed to patients with private insurance, 80 percent from those with federal insurance, 40 percent from patients with state insurance and nearly nothing from uninsured patients.
Marker said Susi and other Maine firefighters and EMS employees recently worked to have the state reimbursement closer to the federal level. While the state reimbursement rates did not climb up to 80 percent, Marker said the state has since increased it from 40 to 60 percent.
Susi said Medicare rates have not increased since 2012, and that they actually went down by 1 percent in 2013.
“We’ve only seen a decrease since 2012, while everything else around us has gone up by about 2 to 3 percent,” he said.
In Caribou, the fire and ambulance service costs roughly $2.7 million to operate.. Neighboring towns served by Caribou pay approximately $11.50 per capita for the service while Caribou residents were paying approximately $180 per capita, Susi said.
In an effort to evenly distribute the costs based on population, city council and officials arrived at a cost of $47 per person for fire coverage and roughly $60 per person for ambulance coverage, adding up to about $110. But Marker said that when considering future maintenance and repairs at the Caribou Fire and Ambulance station, the total for fire and ambulance service would be closer to $125 per capita for the residents of Caribou and neighboring towns.
The new prices were announced in mid-December and the towns were given a deadline of Jan. 31 to decide whether to keep coverage through Caribou and what contract option would work best for them. When towns expressed concern about having enough time to get voter approval, Caribou extended the deadline to March 31.
Caribou is offering towns three options: Pay $500 per emergency call but the call may not be prioritized and an ambulance may not arrive in a timely manner if Caribou Public Safety workers are otherwise occupied; pay $100 per capita for EMS services so coverage can stay the same; or pay $125 per capita for both fire and ambulance services.
Many towns in the coverage area have their own fire services, but Woodland, Connor and New Sweden do not and would need to consider the third option.
As it stands, these offers are non-negotiable.
One New Sweden resident asked Susi if he has ever faced a situation where Caribou was dealing with such a high number of calls that they weren’t able to respond to an additional call in a contracted town.
Susi said that while this has never happened in their contracted region, it has happened outside of contracted communities.
As an example, he cited a situation where the Presque Isle Fire Department called Caribou for assistance and they did not have enough staff available to handle the call. The call then goes to the next available ambulance service in the area, and how quickly that service can respond depends on the situation.
“With Crown Ambulance vacating out of Caswell and Limestone, Limestone has more runs than everybody west of Caribou right now,” the city manager said. “We’ve been sending an ambulance to Limestone two to three times a day — the opposite direction of the majority of our service area.”
The next biggest user of Caribou Fire and Ambulance is New Sweden, Susi said.
One resident asked North Lakes Fire and Rescue Chief Darren Woods if he had considered upgrading his operation to include ambulance services.
Woods said that he is simply not equipped to establish an ambulance, adding that his annual budget is $74,000 for the operation of fire stations in Cross Lake, Sinclair and Madawaska Lake, 43 firefighters and 10 trucks. The price to start an ambulance service would be significantly higher.
As an example, Susi said that Fort Fairfield, a town that is considering starting its own ambulance service, is planning on spending $960,000 after revenues in order to maintain it.
Marker said that he and County Administrator Ryan Pelletier have discussed establishing a districtwide service that would provide fire and ambulance coverage. Discussions on the idea are expected to continue.
Selectman Sven Bondeson said there is only one realistic option for New Sweden.
“We’re over the proverbial barrel, so to speak,” he said. “There’s only one option. We can’t run out of Fort Kent and we can’t run out of Presque Isle. So in the end, realistically, we’ll probably end up with Caribou.”
One man asked what would happen if someone from out of town was on vacation and accidentally hit a moose or was in an ATV accident, as recreational activity is popular in New Sweden.
Marker said they would be covered, just as someone from out of town falling and breaking a leg while shopping in Caribou would be covered.
Near the end of the meeting, one woman asked when exactly New Sweden would need to pay Caribou, and if they need all the money by March 31.
Susi said that since many towns operate on a fiscal year as opposed to Caribou — which operates on a calendar year — and payments are generally made quarterly, towns can skip a quarter to make payments depending on the timing of their annual town meetings, when their budgets are typically set.
Marker agreed, and Susi assured residents they would be covered once they inform Caribou that they’ve agreed to a year-long contract.
“We’re going to make sure people are taken care of,” Susi said. “[Marker] is the money guy. I don’t care. All I care about is that if you say you’re going to go with this service, then we’re going to have an ambulance at your front door.
“If we know this is the service you want, then we’re going to continue with the status quo, but it’s important that you keep the service. That’s No. 1 — that we get people to the hospital. That’s what we do it for.”
