GUILDERLAND — The Altamont Rescue Squad will no longer provide ambulance service to Guilderland and Knox. 
A Dec. 1 letter to Guilderland Supervisor Peter Barber stated the rescue squad “will be discontinuing providing basic life support emergency medical services within the Town of Guilderland, portions of the Town of Knox currently served under the existing contractual terms and any mutual aid situations.”

The letter goes on to say, “This shutdown will occur not later than December 31, 2023, at midnight.”

Warren Quinn, the not-for-profit ambulance organization’s director of operations, declined to comment on the situation. 

Guilderland Emergency Medical Services Director Jay Tyler told The Enterprise this week that his organization, known as GEMS, would soon be handling all basic life support, advanced life support, and the transportation for Guilderland, including the village of Altamont, to which Tyler said GEMS has been providing advanced life support since 1986.

The Altamont Rescue Squad had previously handled basic support and transportation for the town, covering all of the village to the Normanskill Bridge, near Tawasentha Park.

As for the rescue squad’s remaining coverage area, a portion of Knox, Tyler said GEMS had contracted with the town to provide basic life support and transportation. 

Knox Supervisor Russell Pokorny told The Enterprise on Friday that the town had been planning for the rescue squad’s closure. 

“We didn’t know exactly when they were going to do that,” he said. “So we’ve been talking to Guilderland.”

Pokorny noted GEMS had already been providing all of Knox with advanced life support services, which Tyler said it had been doing for over 20 years, in addition to providing basic services when the Altamont squad wasn’t available. 

“So we’ve been working on the paperwork,”  Pokorny said.

The cost for two ambulance services to cover Knox will be similar to the cost for three squads to cover the town, he said.

Guilderland, in addition to providing town-wide advanced life support, will take on the Altamont Rescue Squad’s previous duties: basic life support and transportation. The total cost for all services will be about $80,000.

Basic life support, which is handled by an emergency medical technician, or EMT, involves things like cardiopulmonary resuscitation, or CPR, and bleeding control, among others while advanced life support involves a paramedic who can do procedures such as installing IVs, administering medications, intubating patients, and more.

Knox’s contract with the all-volunteer Helderberg Ambulance service is about $50,000, according to Pokorny.

“So, $50,000 and $80,000, $130,000, right?” he said. “I think that the three of them together were about that.” 

Pokorny said, “So price stays the same and the services — you know, we’re sorry to lose Altamont, that’s for sure — but Guilderland has assured us that they’re going to be able to make up for it. So we’re hopeful.”

Altamont 

Guilderland is in the process of building a third ambulance station in town, near its golf course at the intersection of routes 146 and 20, approximately 7 miles from Altamont.

But to cover the village, Tyler said GEMS would continue to use space provided by the Altamont Fire Department, at the village hall on Main Street. “Until we find a more permanent solution for the village, we’ll be operating out of the fire department there,” he said. 

The rescue squad owns its current Main Street location in the village; the property is assessed at $412,400. 

Altamont is very early in the process of trying to build a new firehouse. 

In July, village trustees were shown findings from a feasibility study commissioned last year to look at the possibility of a new, stand-alone Altamont firehouse. 

The study recommended the new building be placed at the site of the former Doctor Crounse House, which was demolished by the town and village in 2021.

Trustee Nicholas Fahrenkopf in July offered The Enterprise a ballpark figure of between five and 10 years for the project’s timeline. 

As for Altamont Rescue Squad itself, Tyler said, “We’ve made every attempt to hire any … EMT that wanted a job,” with the caveat that his offer had been “off the top of my head” and that there were Civil Service requirements that had to be met as well as pending background investigations. Tyler said the town had four open EMT positions, but he didn’t immediately know “who is actually affiliated with the Altamont Rescue Squad.”

What happened

The future of the Altamont Rescue Squad came into question earlier this year following a policy change by GEMS. 

The change led to a 70 percent decrease in Altamont’s transports, Quinn told the Knox Town Board in September. In addition to subsidies from the municipalities it serves, the Altamont Rescue Squad generates revenue by billing the insurance companies of the patients it transported to the hospital in its ambulances.

The policy in question involves how GEMS and the Altamont Rescue Squad, two organizations with different capabilities, collaborate on service calls. GEMS offers advanced life support from a paramedic while the Altamont Rescue Squad provided only basic life support, handled by an emergency medical technician. 

The town of Knox pays for Guilderland's advanced life support services, but had contracted with the Altamont Rescue Squad as well as Helderberg Ambulance for basic life support service.

The new policy, implemented in March, states that patients requiring advanced life support are to be transported on an advanced life support-equipped ambulance, specifically Guilderland’s ambulances; while basic life support patients will be transported on a basic life support-equipped ambulance.

For calls in Zone 3, which includes the Altamont area, two ambulances are required to respond, and a paramedic determines the necessary services. 

As a result, the new policy ensured that Guilderland no longer placed their own paramedics on an Altamont ambulance but instead transported patients according to their needs.

Billing

Tyler this week also responded to previous criticisms related to GEMS billing practices, noting that it should no longer be an issue. 

During the September Knox meeting, attendees said GEMS, unlike Helderberg and Altamont Rescue, “hard-bills” its patients, meaning any expenses not covered by insurance are billed directly to the patient, with debts aggressively pursued. Tyler at the time denied this.

On the other hand, “soft-billing” refers to the practice of accepting only what the insurance company offers and not asking the patient for more.

“So this has been a long-going, standing issue,” Tyler said, and as he previously told The Enterprise, “we don’t consider what we’re doing hard billing.”

Tyler said, with hard-billing, someone typically gets taken to collections court, where there’s a hearing and a judgment is handed down and the person’s credit is impacted. 

“We’ve never taken anybody to collections court,” Tyler said. “We’ve never harmed anybody’s credit.”

The entire point of the collections attempts, Tyler said, “was to get… the revenue that somebody had received from their insurance company but has not forwarded to the EMS agency.”

Tyler said after the previous Enterprise article was published he was asked by other local media outlets to discuss the issue. The Enterprise editorialized in favor of a bill that would allow EMS to be paid directly.

Tyler went on television to discuss getting the governor to sign into law the direct-pay bill, which would authorize insurance companies to pay ambulance services directly, which the governor eventually did. 

“It’s law now,” Tyler said, adding that criticisms of GEMS billing practices “may be a moot point at this moment,” although the law has yet to take effect.