Vermont EMS advisory chair: statewide assessment finds $98M system, reimbursement gaps and flat workforce despite 6% call growth

Drew Hinton, chair of the Vermont EMS Advisory Committee, told the Senate Committee on Government Operations on May 22 that the advisory group’s statewide assessment estimates roughly $98 million a year is spent to provide emergency medical services in Vermont and that the system faces notable funding and data gaps.

Hinton said the advisory committee contracted a consultant and supplemented that work with verification by committee members. The resulting December assessment — which the committee continues to refine because of inconsistent data — counted more than 100,000 EMS calls annually, roughly 6% year-over-year growth in demand, about 30,000 facility-to-facility transfers and another roughly 30,000 non-transport home visits. “We’re spending about $98 million a year to provide EMS services in Vermont,” Hinton said.

The assessment, Hinton told senators, shows a mixed picture on performance and access: some districts perform above national averages, some below, and data collection gaps make comparisons difficult. The advisory committee will recommend clearer data definitions — notably for “interfacility transfer” — and improved monitoring tied to a five-year plan to raise clinical and operational outcomes.

A major finding concerns financing. Hinton said about half of EMS revenue statewide comes from direct reimbursement (insurance) and the remainder is largely supported by local property-tax appropriations and municipal funding. For a set of providers serving facility transports, Hinton gave average cost-per-call and reimbursement figures that illustrate the gap: “Their average cost per call is $1,168. Average reimbursement is about $476,” he said, framing a shortfall many services absorb locally.

The advisory committee also analyzed services by organizational type and size. Small services had higher per-call and per-capita costs (Hinton cited roughly $800 per call and about $75 per citizen in some small-service areas), while larger regional services showed lower per-capita burdens and closer parity between cost-per-call and reimbursement. Hinton noted the group produced an interactive map showing per-call and per-capita estimates for every town.

Workforce and education were prominent themes. Hinton said the state’s EMS provider count has stayed near 3,000 for years despite rising demand. The committee examined education access, instructor roles and geographic distribution of courses and will include workforce-development and education recommendations in the five-year plan.

On oversight and structure, Hinton described the advisory committee as a legislatively created body with representatives from all EMS districts, hospitals and professional organizations; the committee expanded membership with alternates to speed work through multiple weekly workgroups (governance, finance, education). Hinton said he expects the advisory committee to deliver the five-year plan on time and on budget and reported broad agreement on initial consent items: “Out of the 21 consent items here, there was a total of two nay votes,” he said.

Committee members asked whether the committee would recommend statewide licensure for people operating in Vermont. Hinton said the advisory committee will recommend requiring operators to be licensed in Vermont, adding that the broader EMS community supports that direction but that implementation will require attention to costs and workforce effects.

On regional models, Hinton described active governance workgroup discussions and cited a sheriff-led regional consortium pilot as an example of moving assets across towns to preserve coverage: "All five of those emergency calls got ambulances. They all got ambulances within a very short period of time because we were moving assets,” he said, describing a consortium that reports not having missed an emergency call in over a decade.

A committee member asked whether the finance group had an estimate of federal funds left unclaimed because of current funding structures. Dr. Oski (asked to respond) said he did not have that number immediately but the finance workgroup is trying to quantify it.

Hinton provided printed copies of the slideshow and the committee’s assessment report for members. He repeatedly characterized many numerical figures as approximate and said the advisory group will refine estimates as data quality improves. The committee signaled continuing work on clearer definitions, education access, workforce development and funding structures as Hinton and his colleagues prepare the formal five-year plan for the Legislature next year.

The committee’s next procedural step is to review the advisory group’s consent items and the draft plan as it becomes available; Hinton said the advisory committee intends to present legislation next year to implement elements of the new EMS system.