Ashland's growing elderly population and rising expenses continues to put the squeeze on the local ambulance service, leaving city officials facing an estimated $1 million shortfall next year.

"Ambulance services throughout the U.S. are not generating sufficient revenue to meet inflationary pressures," said longtime Ashland Fire and Rescue Chief Keith Woodley. "The city of Ashland is no exception."

As for the department's financial outlook, Woodley said in a lengthy interview with the Tidings that he sees "a future of revenue constraints." He added that the city will have "make some difficult choices" over which programs should be discontinued to help balance the books.

"I believe the community will continue to support us if they understand what the needs are," Woodley said.

EMS Division Chief Greg Case, who has been an Ashland medic since 1980, when the local ambulance service was owned by Litwiller Funeral Home, said the city fire department is hemorrhaging red ink mostly because the federal government reimburses the city only a fraction of what it costs to transport elderly or poor patients.

So, with more retirement and assisted living facilities opening their doors in Ashland, the financial pressure on the city continues to mount, he said.

Nearly 60 percent of the 3,600 ambulance calls expected this year will be to care for patients covered by Medicare, Case said.

The problem, he noted, is that Medicare, the federal insurance program for people over 65, pays just half of what the city bills for a trip to the hospital, leaving local taxpayers to shoulder the burden.

"The city's demographics are changing," he said. "The percentage of patients that are on Medicare is increasing."

Already, the city slashed Ashland Fire and Rescue's budget by $300,000, a 5 percent decrease from the previous year.

Moreover, budget problems have forced the fire department to pare some of its community outreach efforts, including fire safety seminars at public schools and eliminate CPR trainings for the general public.

"You function with the budget you have," Case said, noting that even with less money the department is providing "an excellent level of service."

City Director of Administrative Services Lee Tuneberg said today that there is "significant strain" on the city from its growing Medicare population since there are agreements to what the city can charge for care and limits on what it is able to collect.

The City Council earmarked about $2.2 million for the Emergency Services Division for the current fiscal year. In the 2006 fiscal year, the city-run ambulance service is expected to accrue a $1 million shortfall, in part because of Medicare billing caps and the uninsured, he said.

The city's budget writers will consider how to overcome the shortfall when they begin drafting next year's budget in early 2008.

"This is a valuable service that we want to have, so now the question is how do we pay for it?" Tuneberg asked rhetorically.

Among possible fixes that have been suggested: raising property taxes and charging more for ambulance services to those who can pay. Former Ashland Mayor Cathy Shaw has suggested that Ashlanders be able to "subscribe" to ambulance services for $35 a year to help offset costs.

The mayor and six-member city council is expected to consider possible remedies at a work session scheduled for Jan. 14 &

a date that City Councilor Cate Hartzell said is too far down the road.

Hartzell, a member of the Citizens' Budget Committee, has requested that the city council take up the issue at an earlier date so any decisions to bridge the revenue gap can be made before the city's budget architects begin work on the 2008 spending plan.

"Our ambulance service is an asset that is very important to the community," she said. "The council needs to ensure the vitality of that service."

covers government for the Ashland Daily Tidings. You can reach him at csrizo@hotmail.com.