Officials: Paramedic service takeover will help seniors

Lent during a pandemic brings new practices, faith leaders say

SHELTON — Echo Hose Ambulance’s agreement with Valley Emergency Medical Services will stem what city officials called a growing health emergency spurred by the cost of a paramedic.

“The city was concerned that our residents who were covered by Medicare were not calling 911 for medical emergencies or refusing the paramedic service due to the (separate paramedic) bill,” said Mayor Mark Lauretti. “The agreement will stop the second bill that a medicare recipient would receive and was not covered by insurance.”

Echo Hose Ambulance and VEMS late last week reached an agreement making Echo Hose the primary paramedic service for the city beginning in January 2022. The deal also allows for bundle billing, meaning individuals who require ambulance transport and a paramedic will no longer receive two bills.

Before the agreement was in place, city officials said, patients would receive a bill from Echo Hose for ambulance transport then another bill from VEMS — between $800 and $900 — for the paramedic service. Those who felt the budgetary impact the most were senior citizens on Medicare, officials said.

The result, according to Lauretti, was residents covered by Medicare choosing not to call 911 when in medical distress to avoid the paramedic bill from VEMS.

Emergency Management Director Michael Maglione said the city has no specific numbers on how many of the city’s Medicare patients — mainly senior citizens — had complained about the paramedic bill.

Anecdotally, Maglione said he knew of people who chose to drive to an UrgentCare instead of calling 911, others who would call the ambulance but refuse paramedic service and others still who told him they simply refused to call for fear of receiving a bill they could not pay.

“We were concerned that a health emergency was being created through people refusing the service,” Maglione said.

VEMS Board President Jared Heon said the issue of residents being concerned about not calling for an ambulance due to a paramedic bill was also not addressed with VEMS at any meeting by the City or Echo representative.

“VEMS would like to be clear that anyone using the service should do so with out reservation of financial strain,” Heon said. “We are dedicated to serving all citizens and work with our patients daily to forgive or implement a payment plan that is acceptable to both the patient and VEMS. Any request for forgiveness on a bill that has been received has always been granted when presented with a hardship.”

Lauretti said he would receive dozens of complaint calls each year about the paramedic billing, and resolving the matter was the “driving force” behind the move.

“Senior citizens have a lot of pride ... they want to pay their bills and be financially independent,” Lauretti said, adding that the second bill was too much of a burden

for many to handle.

Heon said three of the Valley towns have bundle billing agreements in place where the town or city would make the difference up out of their regular fiscal budget.

“This was the case as well in Shelton until 2012 when the bundle billing agreement was terminated at the request of the city,” Heon said. “At this point conventional billing practices resumed, which VEMS is bound to by CT regulations and the CMS program.”

Heon said Echo Hose Ambulance contacted VEMS earlier this year to work on a solution to eliminate conventional billing. He added that VEMS, the city and Echo Hose Ambulance worked together to reach the bundle billing agreement that begins this month.

“Much to Mayor Lauretti’s credit, he has kept the needs of the rest of the Valley in mind and hosted numerous meetings with Valley officials to discuss this issue,” Heon said. “This effort has led to the cooperative agreement, essentially a bundle billing agreement, to rid the paramedic bill from Shelton residents on Medicare.

“Though this is for a period of 12 to 18 months,” Heon added, “it is the hope of the VEMS Board that a permanent solution can be found Valley wide and Shelton may reconsider once this is resolved to remain as part of the VEMS program.”

While a deal with VEMS has been reached, Echo Hose Ambulance still needs state Department of Public Health approval before it could assume the primary paramedic role.

Maglione and Echo Hose Assistant Chief Joe Laucella testified before a DPH hearing Thursday as the city moves to obtain the necessary license to provide primary paramedic services. The city would then shift that duty to Echo Hose, they said.

Maglione said Echo Hose offering the paramedic service would decrease response times and “eliminate the financial strain on residents.”

Regarding response times, Heon said VEMS has a “stellar record of response times in Shelton. The reference to response times improving was never an issue brought to VEMS’ attention, in fact at multiple meetings all

parties agreed that responses and Standards of Care were not the issue at hand, it was solely about billing.”

Residents have been faced with collection actions from VEMS trying to collect payment for paramedic services. Board of Aldermen President John Anglace Jr. said VEMS had nearly 40 liens on Shelton properties to collect past fees, which prompted the city in July to file a petition with the state DPH seeking approval to shift paramedic service from VEMS to Echo Hose.

Heon said VEMS does not aggressively collect on bills except in situations where a patient was paid by an insurance company directly and in turn chose not to pay their paramedic bill.

“The entire purpose to billing at VEMS is to keep our operations going while maintaining a low yearly subsidy for each of the member towns,” Heon said. “Just a month ago, the Board was informed their were liens on properties due to non payment of bills. This is not the practice that VEMS followed, and once informed we determined that a previous vendor who did not have permission to

place liens had in fact done so.

“The administration at VEMS is now working with our legal counsel to release all liens,” Heon added. “The company providing this service was replaced in 2018. The Board of Directors adamantly objects to any liens being placed on a patients property. This is currently being addressed and will be fixed immediately at no cost to our patients.”

The agreement creates a bundle billing deal so patients receive only one bill, which would be covered — all but the deductible — for those on Medicare. The deal states that the bundle billing will begin Feb. 26, 2021.

“The bottom line is a large expense for Medicare patients goes away,” Maglione said.

As part of the agreement, VEMS would receive $1,750 from Echo Hose each month until January as VEMS transitions its business operation covering the Valley without Shelton in the mix. The agreement gives VEMS the option to extend the bundle billing portion of the deal for an additional six months to June 30, 2022.

The season of Lent, often seen as a time of sacrifice, of giving up something, may just feel like too much to ask after a year of isolation, maskwearing and losses of friends or family members.

The season between Ash Wednesday and Easter represents Jesus’ 40 days fasting in the desert before beginning his public ministry. But the tradition of self-denial and giving to others as a way of imitating Christ may just feel like too much right now, faith leaders say. Instead, those leaders say, Christians may need new ways to look at these 40 days and find new practices to deepen faith and give personal meaning to the season.

“I do think that Lent is a really great time for us to recognize that there really is … fatigue from sacrifice. We’ve given up hugs and we’ve given up visits to Grandma,” said Patrick Donovan, executive director of the Leadership Institute in the Roman Catholic Diocese of Bridgeport.

“I think last year we were in such shock and we were in duck-and-cover mode. We experienced Lent and we didn’t realize it,” he said. In 2020, Ash Wednesday fell on Feb. 26, about two weeks before the country went into lockdown because of COVID-19.

After being afraid to go to the grocery store, learning to wear masks, living professional and social lives on Zoom, not being able to go to a movie or ballgame, “we’re just exhausted,” Donovan said.

‘Call for innovation’

“We are an impatient country … and we don’t like to sacrifice. We are a nation of excess, a people of excess,” he said. Lent is a time to pay attention to how faith is practiced, he said. The message can get lost if by giving up eating meat on Fridays but having shrimp instead.

Instead, Lent is about “eating simply and giving what you might have spent on dinner into the rice bowl for Catholic Relief Services, which is on the table,” he said.

Donovan said giving up something for Lent has actually brought his family spiritual gifts. Katie, 12, for instance, gave up watching YouTube, “which is huge for her,” he said. Their conversation was about “when you’re not doing YouTube, what are you going to be doing?” he said. “For Katie, it’s about filling it with something else, so she’s reading a book, she’s playing with the dog, she’s painting. … She’s not as distracted as she was.”

His 13-year-old son, Liam, shoveled a neighbor’s sidewalk, unasked, when it recently snowed. “He knew it was the right thing to do,” Donovan said. “I have to believe that the conversations we’re having at home about Lenten sacrifice motivated him to do that. It’s really a good time to really practice what we hope to be the rest of the year.”

Donovan’s Lenten practice has been aided by a new puppy, “getting up in the morning and spending 30, 40, 50 minutes outside in the cold in silence. … My Lenten practice right now is to keep that up but begin to fill it with prayer.”

“I think part of the challenge is this Lent is a call for innovation. We’ve got to get creative with our sacrifice,” using our time to do something like checking on a neighbor, he said.

The Rev. Mary Barnett, priest-in-charge of the Episcopal Church of the Holy Trinity in Middletown, said the pandemic has been so hard on people that “sometimes we have a harder time feeling pleasure and finding some bit of that, and that too can be part of our relationship with God, and it’s not just giving things up.”

She suggested to “be good to yourself and really think about what’s good,” filling a need by spending time with a loved one.

“I feel like paying attention to the signals your body gives you rather than just your brain is really helpful,” Barnett said. “It’s important to listen to how sad we are and the losses we’ve had. It’s really hard.”

The Rev. Ryan Lerner, chaplain at the St. Thomas More Chapel and Center at Yale University, said the pandemic has posed the question of “what does it mean to take up one’s cross … when the cross enters into our life in a way that we would not choose? … All of us have been asked to sacrifice or called to sacrifice in ways we never would have chosen or never would have imagined.”

But Lent gives us the opportunity of “letting go of those things that we sometimes cling to that clutter up our lives, to make room for God,” Lerner said.

Cultivating “a sacrificial spirit … frees us up. That is a positive thing,” Lerner said. “To be in dialogue with God, to recognize God’s presence in our lives and to give to others, whether it be our time, our attention, our prayers.”

Lerner and three others from St. Thomas More sprinkled ashes on people’s heads on Ash Wednesday. “The first real in-person thing we’ve done may be the only thing for the foreseeable future,” he said. Besides Yale students, faculty and staff, “we also had students from the University of New Haven and Southern who also came,” he said.

He said receiving ashes is more than just a tradition. “Go out with that ash on your forehead. How are you going to be ambassadors for Christ?” he said.

And he urges Christians to stay flexible and be present to opportunities to give to others. “It’s easy to be stuck to your calendar and your schedule,” he said.

Members of St. Thomas More also were given a Lenten kit including a booklet containing daily Scripture readings through Easter, a small jar of sand as a meditative tool, the Catholic Relief Services “rice bowl” for almsgiving and a copy of “Sacred Space for Lent 2021,” with daily prayers by the Irish Jesuits.

Aside from giving up something himself, which he doesn’t disclose, Lerner said he is praying throughout the day at the liturgically appointed times.

“As priests and religious, we make a promise to pray the liturgy of the hours. It’s very easy on a busy day to blast through it in the morning,” he said. “You’ve got to carve out a little bit of time during the day.”