Millis fire chief warns ambulance-revenue funding may be unsustainable as calls surge

The Finance Committee heard a detailed presentation from the fire department on March 4, 2026, outlining sharp increases in call volume, pressure on on-call staffing and the department's reliance on ambulance-billing revenue to fund positions.

Fire Chief (identified in the record as Chief Barrett) told the committee that call volume has climbed sharply since 2019 and that, "over the last 7 years, our call volume has increased 82%," placing sustained pressure on both staffing and mutual-aid arrangements. The chief said the town currently supports ambulance staffing largely through ambulance revenue and that the account's balance has fluctuated: he reported a July 1 balance of about $1,100,000 that was later drawn down to roughly $580,000 to cover staffing costs.

Because insurance collections have become less reliable, the chief told members he is concerned that ambulance revenue—historically used to fund positions—may not continue to cover staffing indefinitely. He described growing insurer denials and disputes over whether specific transports qualify for full reimbursement and said the department routinely sees Medicare reimbursements that are much lower than actual ALS costs (he said an ALS workup can be billed at roughly $3,000 while Medicare often reimburses about $300).

To address short-term coverage gaps, the chief proposed increasing the on-call pay budget by $83,000 (from $100,000 to $183,000) to place call members in the station overnight for coverage. He presented this as a cost-effective, temporary measure compared with hiring four full-time firefighters (an estimated $500,000 annual cost) to achieve the five-per-shift staffing he views as necessary for sustained operations.

The chief also described capital needs driven by state requirements, such as new infusion pumps for ambulances (two units at roughly $7,000 each) and a routine multi-year replacement schedule for ambulances and cardiac monitors. He outlined modest facility fixes (about $30,000) to convert interior space to temporary bunkrooms and offices as a stopgap rather than pursue a larger, more expensive study or addition.

Committee members questioned the accounting treatment (whether above-service requests were already reflected in the FY27 figures) and asked for continued clarity on how analog revenue volatility may affect long-term staffing plans. The town administrator noted the HRGov consulting work used to set comparables for wage studies. The committee took the presentation for further review.