Mayor and Committee need to get beyond the finger pointing (more on this below) and establish a well informed and financially sound policy to provide emergency medical services. If they look at neighboring townships, they will see that emergency service billing programs generate substantial revenue that is used to reduce taxes. Tabernacle should follow their lead.
Every township provides emergency services to its residents in some form. They vary by how the services are paid for. Some local townships receive the insurance revenues directly and use it to fund the EMS service and to offset other township expenses. A third-party billing agent typically handles the billing and collection process and receives a percentage of the collections for their administrative work. The amount paid for each transport is usually set by the entity billed (for example, Medicare or the insurance company allowance).
Some townships contract with private EMS providers to provide EMS service. The EMS provider handles all of the administration, including insurance billing, and keeps the insurance revenues. The township receives EMS service at little or no cost in return. Payments for fuel, small equipment and rent are negotiated in the contract.
Unlike other townships, Tabernacle’s emergency services program doesn’t make money, it costs money. We make the maximum cash contribution ($70,000) to the Tabernacle Rescue Squad. We also pay the cost of their fuel, rent, building repairs, insurance, equipment, etc.. Yet the Township gets none of the insurance billing revenues.
Tabernacle is also the only township that allows its EMS provider to keep the information about the program secret. Other townships require monthly reports showing calls, transports, billings, collections and other basic data. These reports allow the township to monitor what’s going on.
I submitted OPRA requests to seven townships for their ambulance billing information. The Tabernacle Committee and staff could’ve easily obtained this information, but hasn’t bothered. Here’s a quick summary of the information that the townships gave me. Most of it came from the third-party billing agents.
•Evesham, Medford, Mount Laurel and Westampton Townships bill and receive the insurance revenues.
•Mount Holly doesn’t provide or contract for EMS services. Emergency calls are handled by a for-profit, independent provider.
•Pemberton contracts with Lourdes EMS and only provides fuel and portable radios. It doesn’t make a cash contribution.
•Southampton uses a volunteer squad and pays only for its fuel, insurance and maintenance of township-owned vehicles. It doesn’t make a cash contribution.
For the four townships that bill (Evesham, Medford, Mount Laurel and Westampton), I calculated the average annual amount they collected for each transport. The number of transports and the amount of collections were given to me for the period 2010 through August 2015.
•Evesham: $341.91 collected per transport
•Medford: $368.43 collected per transport
•Mount Laurel: $368.38 collected per transport
•Westampton: $285.66 collected per transport
•Tabernacle: $???.?? collected per transport.
Based on the average revenues of these townships, it seems like the TRS’s billing revenues are substantial. But to know its actual revenues, we need the billing records.
Mayor Brown and Committee should show the same zeal for saving taxpayers money on EMS services that they said they had for saving taxpayers money on fire services. They dissolved the Fire District for tax savings projected to be as low as $50,000. Far more than that can be saved by changing the way the Township provides EMS. It’s time for the Committee to get the revenue data, make it public and discuss a new EMS program.
At the October 13, 2015 public meeting, Mayor Brown singled out Mr. Barton for publicly discussing his dismay, at the September 28, 2015 meeting, that the Committee wasn’t told about the Shamong Agreement. Committeemen Lee and Yates agreed with Mr. Barton and also made similar comments at the September 28, 2015 meeting. Mayor Brown didn’t mention Committeemen Lee and Yates at the October 13 meeting.
Mayor Brown said that Mr. Barton should’ve first discussed his concerns privately with her, Mr. Cramer or someone from the Squad. Mr. Barton responded that Mr. Cramer said he didn’t know anything about the Agreement and a conversation with him would have been a waste of time. (Mayor Brown had also said she didn’t know about the Agreement, so a conversation with her also would’ve been useless). In her reply to Mr. Barton, the Mayor said: “Well, you don’t know unless you do it.” This response only makes sense if she or Mr. Cramer knew about the Agreement.
I’ve commented many times that Committee members do too much work outside of public view. It was informative to see them say something in public, particularly because it was out of the Mayor’s control.
Mr. Barton also reminded Mayor Brown that I had been asking about the Agreement at almost every meeting and no one from the Squad or the Township had bothered to respond. That’s pretty much true. They had plenty of opportunities to discuss the Shamong Agreement. But the only response I got from the Mayor and Committee and Mr. Cramer was that they didn’t know about the Agreement and I should go ask Shamong Township.
Mr. Lee and Mr. Franzen didn’t participate in the discussion between Mayor Brown and Mr. Barton. Mr. Yates was absent.
Mayor Brown and Mr. Cramer also played the volunteer card, praising the the good work that volunteers do. Mayor Brown said:
When we [discuss the Agreement] in a public event, it gets blown bigger than what it should be at these events. And at that point we end up losing sight of the volunteers that are on the ground in front of everybody helping support the community and it looks negative upon them.
I’m sure that Tabernacle residents appreciate the people in town who freely give their time to coach, serve on public boards, provide fire and rescue services, pick up litter, attend public meetings and do all of the other myriad things that make our community better.
But praising volunteers is no substitute for good policy and responsible management. The concerns that Committeemen Barton, Lee and Yates voiced about the TRS/Shamong Agreement have nothing to do with volunteerism. Mayor Brown’s comments were a distraction from the problems that the Shamong Agreement reveals.
The Agreement shows the consequences of the Committee giving the EMS program to the TRS, funding it to the maximum and allowing the TRS to do whatever it wants without any Township management or oversight. The Committee shouldn’t have made the TRS its official EMS provider without exercising municipal control over its operations and revenues. The TRS still hasn’t submitted its 2014 Financial Statement that was due December 2014, and the Committee hasn’t done anything about it. The silence of the Mayor, the Administrator and TRS officers and the crazy chalkboard presentations all indicate that the Committee was happy and willing to keep the emergency services program outside of public view. That’s not a volunteerism problem, that’s a management problem.
Mayor Brown also tried to portray the Shamong Agreement as a plain vanilla, mutual aid agreement.“I’m looking at this agreement, in my mind it reads as a mutual aid agreement.” Mr. Barton disagreed and so do I.
A mutual aid agreement authorizes emergency responders from participating townships to assist responders in other townships when they request assistance. In Burlington County, the County government establishes mutual aid agreements with participating townships and requires that all requests for mutual aid be initiated with the County. Tabernacle adopted its mutual aid agreement with Burlington County on July 13, 2015. Shamong Township is also a party to the County mutual aid agreement.
Mayor Brown and Doug Cramer are very familiar with the County mutual aid agreement and they know that it’s an agreement between governmental entities. They’re not agreements between private entities like the TRS and the Shamong rescue squad. Tabernacle doesn’t have mutual aid agreements with the Medford Township Emergency Squad or the Hampton Lakes Emergency Squad or any other EMS companies who are part of the Burlington County program. Doug Cramer’s statement that he thought that the Shamong Agreement was between the TRS and the Shamong rescue squad doesn’t square with this established practice.
The Shamong Agreement is not a mutual aid agreement. It’s a billing agreement (see Page 3.3). It requires the TRS to provide transports to Shamong residents at no charge and it allows the TRS to bill the carriers of insured Shamong residents. Nothing in the County mutual aid agreement speaks about billing or providing free services for members of a township.
As Mr. Barton correctly pointed out, the Shamong Agreement is a one-way agreement. It’s signed by TRS President Jamie Wood and the Mayor of Shamong Township. It’s not signed by any official of Tabernacle Township. There’s nothing mutual about it. At the meeting when Shamong Township discussed the Agreement (October 22, 2013), the subject of mutual aid never came up.
Mayor Brown’s characterization of the TRS/Shamong Agreement as just another mutual aid agreement is an attempt to divert attention from the core issues:
1. The TRS knows that federal law requires that “where a municipality contracts with a private ambulance service for EMS, the ambulance service may waive out-of-pocket coinsurance costs only if the municipality makes payment to the ambulance service to cover the coinsurance otherwise owed by residents.” The township contribution has to be “reasonably calculated” to cover these costs. That’s what the TRS told Tabernacle and that’s what it told Southampton in its November 2013 bid proposal. But Shamong Township isn’t making any payment. It’s paying nothing! Tabernacle residents are paying all of these costs.
2. The TRS shouldn’t have entered into the Agreement without public discussion and approval by the Tabernacle Committee. It’s hard to believe that no Committee member or staff knew that theTRS made these commitments to Shamong Township. If they truly didn’t know, it shows a gross mismanagement of emergency services. If some of them knew, then they’ve deceived taxpayers. Both alternatives are unacceptable.
3. The fact that the Tabernacle Committee blew off questions about the Shamong Agreement for so long, shows their indifference to Tabernacle residents. At every Committee meeting Mayor Brown invites public comment and says that they will get answers to questions if they don’t have answers at the moment. She had plenty of opportunities to get answers about the Shamong Agreement, but didn’t bother.
4. Insurance billing revenues are an essential component of municipal emergency service programs and should be utilized for the benefit of taxpayers. In our region, insurance billing revenues are typically directed to the township general fund or privatized in exchange for free EMS coverage. In Tabernacle, we contribute $70,000 to the TRS, subsidize its rent, fuel insurance and other costs AND allow it to keep all of the insurance revenue. That doesn’t benefit Tabernacle residents.
The Tabernacle Committee refuses to reveal how much revenue TRS receives from insurance billing. It has never publicly discussed why it allows the TRS to keep all of those revenues instead of collecting the revenues itself or hiring a private ambulance service which would keep the billing revenues in exchange for free service. The amount of billing revenues must be publicly released and discussed in order to chart the best public policy for Tabernacle residents.
$how Us The Money!
The next township meeting is Monday, October 26 at 8pm.