Posted by Bob Mellen
Facing imminent insolvency, the Avon ambulance service is about to turn over operations to Livingston County Emergency Medical Services (LCEMS), with the support of the Town and Village boards. The parties have been in talks about how best to assure high quality ambulance service to the town for some months, as the financial situation of the ambulance deteriorated. This will result in LCEMS being the primary agency dispatched to all calls for an ambulance in the town and village of Avon. Following the current practice, other local agencies in the area (Lima, Livonia, Honeoye-Falls and CHS) will continue to respond to calls as needed to ensure the needs of the community are met.
The change is expected to happen the evening of April 6, said Kevin Patrick, president of the ambulance board of directors. County ambulances actually have been responding to many Avon calls for several weeks but because of finances the board is ready to turn the entire operation over to LCEMS.
“We are about out of reserves,” Patrick said. “We will have enough to get through, but only just, with the county taking over as quickly as it is.”
When that happens, “townspeople shouldn’t notice anything different,” he said, other than the words painted on the ambulance. Nor will response time to a call change.  LCEMS will station one of its ambulances at the Avon ambulance base on Lake Road, and will have staff there 24/7.
“The county has been there for us in a very big way for the last several weeks,” Patrick said. Throughout the changeover, “the primary thing is to make sure that there is coverage.”
The Avon ambulance service is private and receives no income from the town or village. Over the years, the Avon Rotary and Lions Clubs have contributed thousands of dollars, but the clubs do not own the ambulance service or have responsibility for its operations.  The name is in tribute to the vision of key members of the service clubs in founding the ambulance more than 60 years ago.
In the past, the ambulance was able to serve Avon using volunteer EMTs and paramedics, but now needs to pay EMTs and paramedics in order to attract them to work for Avon.  Avon is at best a secondary employer for most of its staff. In fact, many can only work for Avon during night hours, when Avon has very few calls and therefore little potential revenue from billing.
It’s a business model that has been criticized as no longer sustainable. A 2013 study of Monroe County emergency services, for example, found that at least 17 Monroe County ambulance agencies responded to fewer than 1,000 calls per year. Avon typically has about 750 calls annually. The study said that “calls do not always result in a transport, which further undermines financial sustainability. The low call volume makes it difficult for these ambulance services to afford to staff ambulances 24 hours a day, 365 days a year without receiving some form of tax subsidies and/or a heavy reliance on unpaid volunteers.”
Due to regulatory changes made at the state level, expenses have increased over the years, and revenue has gone down. A very high percentage of Avon’s patients are either on Medicaid or Medicare, which have very low reimbursement rates.
  Patrick said that the annual budgetary shortfall just to operate the service is at least $60,000, and that assumes no unanticipated expenses. “Without government support it’s not a sustainable (business) model. The ambulance board, the town and the village recognized that it makes far more sense for the county to take over simply because the county has the economies of scale to do this in a way that is going to be best for the town of Avon,” Patrick said. LCEMS is currently also the primary ambulance service for the Towns of Leicester and York.
According to Dave LeFeber, County taxpayers already support LCEMS. The changeover will spread the cost over a much bigger tax base than Avon. Whether and how much that’s going to increase because it will be the primary supplier of EMS services to Avon will be determined in the county budgeting process for next year.
The details of how the Avon ambulances, the fly car and the base on Lake Road will be disposed of will be worked out over the next few weeks. Patrick said, “we are happy to transfer them to the county at no cost, if that makes the most sense. After all, we are not-for-profit.”
A village hall meeting is being planned for Avon residents to hear more about the changes from the ambulance board, and town, village and LCEMS representatives.
Written by Rotarian Bob Mellen for the LCN