Author: Mark Postma

President’s Perspective: April 2018

Dear Fellow AAA Member,

Spring has sprung, and the American Ambulance Association is busier than ever working on your behalf to build the future of EMS.

The AAA is pleased to announce that since our last Response Times update, Congress has passed the 5-year extension of the Medicare ambulance add-ons. The extension included the AAA’s preferred method of cost data collection that provides flexibility to the Secretary of HHS in developing the system. Consultation with the industry is required so that it strikes the appropriate balance between obtaining meaningful data and avoiding overly burdening or onerously penalizing the ambulance services. This legislation was a true victory for the AAA and the entire industry. Learn more►

This success would not have been possible without months of effort by AAA volunteer leaders, advocacy experts, and staff, as well as support from our key champions in Congress. In particular, the AAA would like to thank Senator Debbie Stabenow for spearheading our legislation and ensuring that the Senate language prevailed. In recognition of Senator Stabenow’s support, she has been named the AAA’s 2018 Legislator of the Year. The AAA would also like to thank Senators Schumer, Roberts, Collins, Leahy, Hatch, Wyden, Thune, and many others who will be receiving AAA Legislative Recognition Awards this year. The successful passage of this legislation would not have occurred without also having strong champions in the House of Representatives. The AAA is sincerely thankful to Representative Devin Nunes (2015 Legislator of the Year Award winner) for his continued leadership in the House on this issue. The AAA also wishes to thank Representatives Sewell, Upton, Welch, Walden, Neal, Brady, Pallone, and Speaker Ryan for supporting this crucial extension of the Medicare add-on payments.
Despite this success, the AAA is not resting on its laurels. AAA Committees, staff, and consultants are taking proactive steps to ensure that the new cost data system both collects meaningful data and is not overly burdensome on providers. The AAA will continue to update members as this process moves forward. Thank you, again, for your support. We truly couldn’t have made it this far without you!

Get Involved!

In mid-May, AAA will open the nominations process for our board of directors. (Full details and criteria for participation will be posted then.) In the meantime, I encourage you to consider becoming more involved with the American Ambulance Association by joining a committee with open positions, and following us on Facebook and Twitter.

Stars of Life

I look forward to seeing many of you in Washington, DC in June at Stars of Life. Stars recognizes EMS providers from across the nation who have served their communities with distinction. The Stars, accompanied by their executive-level Hosts, meet with legislators to shine a light on the importance of ambulance services to our healthcare network.

I hope you will enjoy meeting the 2018 class of Stars as we share their stories and accomplishments on our website and social media.

Haven’t yet nominated a Star? It’s not too late! The deadline has been extended to this Friday, April 20. Nominate a Star►

Education

The Education Committee has been hard at work developing the program for the 2018 AAA Annual Conference & Trade Show. We look forward to announcing the full agenda in June, and hope that you will join us in exciting Las Vegas September 6–8. (Yes, I said September! Our conference is two months earlier than usual this year.)

Regional & Online Education

In the meantime, why not learn from our experts at an AAA Supervisor SimLab workshop? If you’re short on time, AAA is also proud to offer a wide variety of live and on-demand webinars on human resources, reimbursement, compliance, and other topics.

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2018!

—POST
Mark Postma
President
American Ambulance Association
“Representing EMS in America”

Congress Passes Ambulance Medicare Add-Ons

 

It is my pleasure to share with you that—just minutes ago—Congress passed the 5 year extension of the Medicare ambulance add-ons. The extension was part of the two-year budget deal reached by congressional leaders and passed by the Senate early this morning and then shortly thereafter by the House. The ambulance provisions in the final deal differ from the provisions passed earlier this week by the House in one key area – the collection of ambulance cost data. This means that we are truly in the endzone of the add-on payment extension process.

While we ask your continued patience as we jump through one last procedural hoop, I am confident that the add-ons will be back in effect as soon as the President signs the legislation. In today’s deeply divided political climate, I am proud of what we have accomplished through collaboration as an association and industry.

Here are the specifics of the final package:

  • 5 year extension of the ambulance Medicare add-ons through December 31, 2022, retroactive to January 1, 2018.
  • AAA’s preferred method of Cost data collection that provides flexibility to the Secretary of HHS in developing the system. Consultation with the industry is required so that it strikes the appropriate balance between obtaining meaningful data while not overly burdening or onerously penalizing the ambulance services.
  • The penalty for failing to report required data would be a reduction in payment up to 10% for the year following the year in which the data should have been submitted. AAA objected to the house proposed penalty of up to a year of Medicare payments clawback or withholding of payments. A clause is included to wave the penalty in cases of hardship.
  • A “pay-for” for the 5-year extension of the add-ons with a 13% cut to non-emergent dialysis transports – the AAA had objected to the offset and pushed for a cut targeted to just those entities which abuse the dialysis transport benefit. We were successful in reducing the initial cut from 22% to 13%. The AAA is actively working on other pay-for options that would replace the 13% cut with something targeting dialysis fraud and abuse.

Next Steps

All that remains to bring the add-ons into effect retroactively to January 1, 2018 are a few administrative formalities and the signature of the President, who has indicated his support of the agreement. Given the government shutdown, we are cautiously optimistic that this will proceed quickly. However, bumps are always a possibility—we will keep you informed! (Follow AAA on Twitter at @amerambassoc or Facebook for instant updates.)

Thank You

This week’s tremendous progress would not have been possible without months of effort by AAA volunteer leaders, advocacy experts, and staff, as well as support from our key champions in Congress.

I’d like to personally thank the AAA Government Affairs Committee, including Chair Jamie Pafford-Gresham and Vice Chair Shawn Baird, as well as the entire AAA Board for their hundreds of hours of hard work on this issue. We are all truly grateful for your dedication to moving mountains to find sustainable funding for EMS.

Last but certainly not least, thank you to the dozens of state ambulance associations and thousands of individual members who wrote letters to their Members of Congress in support of the add-ons. We truly couldn’t have made it this far without your support.

Again, thank you, and please stay tuned for final updates!

Mark Postma
President
American Ambulance Association
“Representing EMS in America”

House Passes Ambulance Medicare Add-Ons

Moments ago, the U.S. House of Representatives passed legislation which includes a five-year extension of the Medicare ambulance add-ons. The House voted 245 to 182 to pass a Continuing Resolution (CR) to fund the federal government beyond the current expiration date of February 8. The CR included a package of Medicare provider extenders including an extension of the temporary Medicare ambulance add-ons.

The ambulance provisions in the CR include the following:

  • A five-year extension of the temporary Medicare ambulance increases of 2% urban and 3% rural to base and mileage rates and 22.6% to the base rate in super rural areas. The extension would be retroactive to January 1, 2018 and expire on December 31, 2022.
  • The requirement for ambulance service suppliers to submit cost reports. The language is based on H.R. 3729 as reported by the House Ways and Means Committee but with new language providing the CMS Administrator with the discretion to apply a payment suspension or overpayment as the penalty for suppliers that do not submit timely, accurate and complete data after the initial two years.
  • To offset the cost of the add-ons extension, a further reduction of 13% in Medicare reimbursement for BLS non-emergency transports to and from dialysis centers. The initial reduction was 22% but the AAA was able to help lower the estimated cost of the add-ons and thus lower the percentage of the offsetting cut.

The CR now goes to the Senate for its consideration. The Senate is likely to act tomorrow, February 7.

We will keep you posted of new developments. Thank you for your continued support of the American Ambulance Association.

Mark Postma
President
American Ambulance Association
“Representing EMS in America”

President’s Perspective: January 2018

Dear Fellow AAA Members,

Happy New Year from the American Ambulance Association!

This year promises to bring new challenges and opportunities for ambulance services. As your association, AAA, its experts, and the whole member community will be there to support you every step of the way.

Advocacy Update

If you’ve missed your recent member advocacy emails, you may be wondering “What is going on with the add-ons?!” I’d like to address this first and foremost.

Despite the best efforts of the American Ambulance Association and other industry stakeholders, the temporary Medicare ambulance increases expired December 31. However, please rest assured that the AAA lobbying team, volunteer leadership, and staff are working tirelessly around-the-clock to advocate for this critical EMS revenue.

The good news is that the end may be in sight. However, we must remain engaged, active, and unified as an industry to carry this effort through in the face of the today’s contentious and unpredictable political climate.

Republicans and Democrats in the House and Senate are working toward a long-term extension of the Children’s Health Insurance Program (CHIP).  As part of these negotiations, the House and Senate are working through the details of a Medicare provider extender package. Thanks to the work of our lobbying team and countless Hill visits, phone calls and letters by dedicated AAA members and our supporters on Capitol Hill, both the House and Senate proposals include five-year extensions of the ambulance increases retroactive to January 1, 2018.

We are cautiously optimistic that Congress will include CHIP in the next Continuing Resolution (CR) on or around January 19. Depending on the outcomes of last-minute discussions, the Medicare provider extender package may be attached to the CHIP bill or moved forward separately shortly thereafter.  However, of course, Congress in 2018 is predictably unpredictable: we ask for your patience, and your continued confidence that AAA is doing everything possible on this issue.

To support this effort, AAA joined forces with other healthcare industry groups to send a letter to Congress urging them to pass the larger Medicare provider extender package. The AAA has also made the case to Congress that it must act now on the ambulance extension as ambulance service providers and suppliers are first responders and cannot afford to hold claims for prolonged periods of time. Congress must therefore move immediately to ensure that our nation’s health care safety net is not put at risk. We pointed out that submitting claims with the increases paid retroactively could result in long delays in providers and suppliers getting the additional funds, an unacceptable risk for an EMS network made up primarily of small providers. As a last resort, we have asked that if Congress cannot address a Medicare provider extender package by January 19 that they pass a short-term extension of the ambulance increases to sustain our operations.

The AAA is also working with congressional offices and committees of jurisdiction to implement a workable system for collecting cost data from ambulance service providers and suppliers and on an offset focused on reducing reimbursement just for those entities which abuse the dialysis transport benefit. The reality is that ambulance services will have to report their costs to the federal government. However, AAA will work to ensure that the system implemented is fair and does not place undue burden on ambulance services or subject ambulance services to standards and penalties that are not applied to other Medicare providers.

While we believe we may be approaching the endzone on the extender renewals, we must continue to push Congress to do what is right for EMS. Now, more than ever, we need you to add your voice to those of AAA, state-level ambulance associations, and thousands of your peers. Please take a moment today to send Congress your message of support for the Medicare ambulance add-onsit takes just two clicks. Write a letter now>

Our advocacy team will continue to provide frequent updates as we work to keep this issue at the forefront.

Stars of Life

Despite the challenges on the Hill, I look forward to seeing many of you in Washington, DC in June at Stars of Life. Stars recognizes EMS providers from across the nation who have served their communities with great distinction. The Stars, accompanied by their executive-level Hosts, meet with legislators to shine a light on the importance of ambulance services to our healthcare network. Nominate your Stars today, and help AAA celebrate the best in EMS! (Early bird registration rates end March 31.)

Renew Your Support of AAA

Has your organization renewed its AAA membership? Your continued support is critically important as AAA fights for fair ambulance reimbursement. Membership also include benefits such as free use of the Savvik Buying Group, complimentary CISM and EAP-based counseling for your employees, and access to industry experts on Medicare, operations, and HR.

If you have already renewed, please accept our most sincere thanks. If you have not yet submitted payment for this year’s membership, I encourage you to renew online or reach out to staff at info@ambulance.org for assistance.

AAA Annual Conference & Trade Show

The 2017 AAA Annual Conference was an overwhelming success. In addition to powerful industry-centric presentations on leadership, reimbursement, and operations, this year’s AAA Annual Conference & Trade Show featured three inspiring keynotes—Steven M.R. Covey, Mel Robbins, and Dr. Zubin “ZDoggMD” Damania. Additionally, we honored AMBY Award winners and those who responded to the tragic Route 91 shootings. Check out the photo album for AAA 2017 on our Facebook page.

I hope that you will join me and hundreds of our colleagues for networking, learning, and fun in Las Vegas at next year’s Annual event September 6–8Early bird registration is open now!

Webcasts & Regional Workshops

AAA is working hard to make it easier than ever to educate your team. Join us in 2018 for a variety of live and on-demand webcasts as well as convenient regional workshops. Upcoming webinar topics include sexual harassment, CMS low volume settlements, and cybersecurity. This year, we are also proud to host one-day workshops in each of AAA’s five regions (calendar soon to be announced).

Thank You, Members!

I would like to give special thanks to the members who dedicate their time and thought to AAA’s board, committees, and task forces. We literally could not do it without you.

It continues to be my pleasure to serve these individuals, as well as the many other talented, dedicated healthcare professionals who make up the AAA membership. We deeply appreciate your continued support, participation, and unity. Thank you!

—POST!
Mark Postma—President
American Ambulance Association
Representing EMS in America

 

Build Your Future with a Career in EMS

The U.S. Bureau of Labor Statistics expects career opportunities for EMTs and Paramedics to grow another 15 percent by 2026, far outpacing most other professions… With EMS agencies hungry for skilled providers, there has never been a better time to chart your career path in mobile healthcare.

This week, an editorial from AAA President Mark Postma was featured in a special Media Planet section on healthcare careers. Read the full article►

Medicare Extender Update

As president of your association, keeping you informed of our advocacy efforts is one of my top priorities. In keeping with this approach, I would like to share with you an update on the American Ambulance Association’s latest efforts on Capitol Hill. The temporary Medicare ambulance increases are currently scheduled to expire on December 31, 2017. And once again, Congress is waiting until the last minute to extend them. Thankfully, a long-term solution is on the horizon.

The House and Senate are in the process of negotiating the details of a Medicare provider extender package including our ambulance provisions. The House and Senate positions both include a five-year extension of the 2% urban, 3% rural, and super rural increases. Where their positions differ reflects the respective preferences of the Senate Finance and House Ways and Means Committees on how best to collect cost data from ambulance services suppliers and providers.

The Senate position is based on a Senate Finance Committee Discussion Draft from October 26 which includes the five-year extension of the increases as well as a data collection system based on the one from the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967). The provision would direct CMS to collect data from a statistically significant number of ambulance service suppliers and providers. This would occur each year for the first three years, then a minimum of every three years thereafter. The penalty for not reporting data if selected would be a 10% cut in Medicare reimbursement for the following year. The language gives CMS flexibility in designing the system, and would place minimal burden on small ambulance service suppliers. The outcome would be usable data to further substantiate the need for rate increases and reform of the Medicare ambulance fee schedule.

The House position is based on H.R. 3729, which also includes the five-year extension of the increases. However, it adds mandatory annual cost reporting for ambulance service suppliers and providers as well. The AAA worked with the bill sponsors and Committee staff to modify the cost reporting language to reflect the unique nature of our industry. However, since ambulance service suppliers and providers aren’t paid based on cost reports, and cost reporting requirements are very stringent, there are several compatibility issues when attempting to apply this model to our industry. The primary problem is the penalty for not reporting timely data, as well as a new standard requiring the data to be accurate and complete. As a result, after the first two years of reporting, the penalty of an overpayment for not reporting timely, accurate, and complete data could be an entire year of Medicare payments. The AAA therefore prefers the Senate language due to its flexibility for our industry as well as its less severe penalty.

The good news is that the House and Senate are in agreement on a five-year extension of the increases. As part of the increase package, our industry will also have a data collection system to demonstrate that we are reimbursed below cost, and to make data-driven decisions on reforming the Medicare ambulance fee schedule. However, it is critical that we get the data collection provision right so that it provides useful information and is not overly burdensome for our members.

Thanks to our champions on Capitol Hill, member advocates, and our lobbying team, the super rural bonus payment has been in effect since 2003, and the urban and rural increases since 2008. Subsequently, we have successfully advocated for Congress to extend the increases eight times, including the current 33-month extension. However, with Congress pressed to address a number of priorities by the end of this year, a Medicare extenders package may not occur until early January.

Securing a five-year extension will require the action of our entire membership. I urge you to please write your members of Congress today in support of the Medicare ambulance increases!

Contact your members of Congress now>

AETNA/CVS Deal Along with Uber Concepts May Finally Change Ambulance Industry

Mark Postma, AAA President & Asbel Montes, AAA Payment Reform Chair

The recent merger of Aetna/CVS may be the catalyst that finally brings the change that the ambulance industry has been advocating for over the past several years. This new healthcare strategy supports the ambulance industry’s ideas that alternative patient destinations are needed in EMS.

To explain this better, one must understand the current state of ambulance reimbursement via the 911 system or equivalent. At this point in time most commercial payers of healthcare (Insurance) as well as Medicare will not pay for 911 ambulance transportation to any destination other than the “nearest appropriate” hospital based emergency room; arguably, the most expensive and least efficient form of healthcare. The continuation of this policy discounts the advanced capabilities of both EMS and new clinical settings and the savings that can be achieved through innovative change. In addition, at the same time that the cost of healthcare in general is increasing, reimbursement from all payers is decreasing, creating a significant challenge for providers. Medicare consistently pays providers below cost for providing life-saving services and state Medicaid agencies are consistently underfunding the critical services to the un- and under-insured populations that have allowed intermediaries to delay or not pay ambulance services.

Much of the U.S. population believes that vital 911 EMS services or the equivalent are provided free or included in their local property taxes. This is generally not the case. While EMS services must be at the ready on a 24/7/365 basis, they are not paid for being on call, but only when the service is used.

Many communities have governing rules that require 911, or the equivalent, paramedic services to arrive on-scene within 8-12 minutes of receiving the call. This cost of readiness is VERY expensive. Skyrocketing personnel costs, ambulances, equipment, and other high cost drugs only exacerbate an already fragile reimbursement structure. Although recent articles about calling Uber or Lyft sound intriguing, these drivers and cars are not prepared for any type of injury. Nor can they alert the hospital in critical situations to have the heart cath lab ready or a trauma surgeon on standby, shortening the time to definitive care when time matters most. Emergency paramedics are highly trained, are nationally and/or state certified, and provide services on state regulated ambulances equipped to manage all types of emergencies. Ambulances are also often strategically placed to arrive in that 8-12 minute response time requirement. However, there is one piece missing from the ambulance scenario that allows for Uber/Lyft to succeed; your personal credit card is on file with them. NO GUARANTEED PAYMENT, NO TRANSPORT. The cost of providing ambulance services “on call” with life-saving equipment, medications, and personnel at the ready is steep. When you consider the many regulations providers must adhere to outside of patient care, the cost increases even more. This misunderstanding of the cost often results in patients being stunned when they receive a bill for services provided and feel that it is excessive. However, comparing the cost of a life-saving ambulance transport to an Uber/Lyft ride is like comparing the cost of building a house to putting up a tent.

On the other hand, these highly trained paramedics, with vehicles that are comprehensively (medically) equipped to meet the highest safety standards, have no credit card on file. They do not treat you based on your ability to pay. In fact, approximately less than half of ambulance patients have insurance, and when commercial insurance does pay, they are increasingly paying only a percentage of the total bill, leaving their insured left to pay the balance. In a time of an emergency, insurers should not place an additional burden on their insured through underpayment or claiming out of network status. In addition, although many emergency 911 calls begin as a “frantic call for help,” not all are life threatening and require the highest level of care; however, they do need some type of a health care intervention.

It is this high volume of low acuity patients who do not have primary care physicians and who currently by law must be transported to hospitals that continue to bottleneck emergency rooms. This bottleneck then requires ambulances to be “on the wall” at local hospital emergency rooms. The cost to the 911 EMS system rapidly begins a domino effect where all the patients begin to be diverted/directed to other hospitals causing an overflow to the next hospital. In large EMS systems, this domino effect can bring emergency rooms at all available hospitals to capacity quickly. EMS units are unable to go on additional emergency calls because they are caring for a patient while waiting on hospital staff to become available to take over. They also cannot leave that hospital with the patient to go to another hospital due to federal laws that prohibit this movement.

So why does the AETNA/CVS excite the leaders of EMS organizations? Most people assume that since this acquisition just occurred, Walgreens will probably follow suit with another insurer. Other local pharmacy “CVS types” may partner with local hospitals or medical insurance cooperatives as well. This leads the ambulance industry to believe that the capacity to transport patients to alternative locations could greatly change the landscape of EMS. The idea that local CVS/Walgreens/clinics could receive low acuity patients breaks open the bottleneck and can provide several benefits for the ambulance service and patient. One benefit is that adding these stores/clinics greatly increases the resources for caring for low acuity patients and could potentially double the locations an ambulance can transport to, which will allow for quicker transport times and increase efficiencies. Lastly, and most importantly, diverting the low acuity patients to these additional community resources would reduce overflow in the emergency departments and allow true emergency patients to be transferred over more quickly to receive the higher level of care they require. This scenario is also a win for the patient. They could be transported to the most appropriate location to care for their needs and therefore can be billed more accurately for services they require rather than the emergency department fees which are usually costlier.

To make this happen, obviously the CVS system needs to evolve to receive these patients. More importantly, ambulance reimbursement by federal, state, and private payers must evolve to meet the demands of the market. Due to the complexities of how EMS services are provided because of state and local regulations, mandatory response times, service area parameters, and others, reimbursement for these services must be adequately paid for by Medicare, Medicaid, and private insurers. Today EMS agencies can only “hope” that their patients have a source of payment!

Although one would think that this state of concern for EMS services is being monitored, it currently has only a very small voice in the healthcare continuum. Federal agencies seem to want to look at what EMS will look like in 10 to 25 years rather than where EMS is today and where it can develop over the next few years. EMS reform needs to happen soon to save these systems from bankruptcy and/or the public from higher taxation.

We hope that this merger will be the beginning of alternative EMS/ambulance destinations with allocated reimbursements that meet the costs of providing high quality, efficient, and necessary 911 ambulance services.

Mark Postma, COO, Sunstar Paramedics
American Ambulance Association, President
Works for Sunstar Paramedics, Florida’s largest EMS provider
MPostma@sunstarems.com, 727-224-0295

Asbel Montes, Vice President, Acadian Ambulance Service, Inc.
American Ambulance Association, Chair-Payment Reform Committee
Works for Acadian Ambulance Service, Inc., Louisiana’s largest EMS provider
Asbel.Montes@acadian.com, 337-291-3310

Response to Kaiser Health News Ambulance Billing Article

Below is the American Ambulance Association’s Response to a recent Kaiser Health News article on ambulance billing. It was reprinted in several metropolitan areas on November 20, 2017.

To the Editor:

I write today in response to Melissa Bailey’s November 20 piece about ambulance balance (“surprise”) billing. While we disagree with the characterization of ambulance services in the article, we welcome the ongoing public dialogue about how unsustainable reimbursement for emergency medical services results in cost-shifting to patients.

Missing from the article is a true understanding of the sky-high cost of readiness for emergency medical services. Ambulance service providers offer their communities 24/7/365 on-demand mobile healthcare. Skilled staff and ambulances—high-tech emergency rooms on wheels—are ready to respond to a 9-1-1 call at a moment’s notice to help patients with issues ranging from stroke to heart attack to trauma to childbirth. EMS is also on the very front lines of the surge in opioid overdoses, providing naloxone (Narcan) to hundreds of patients each day. Keeping supplies, medications, equipment, and personnel at-the-ready requires a significant ongoing investment, regardless of whether or not an ambulance is out responding to a call. Cost comparisons between EMS and the rideshare app Uber may make for catchy sound bites, but they are misleading and misguided.

The piece states that our nation’s 14,000 ambulance service providers received 1,200 Better Business Bureau complaints spread over three years. While certainly not optimal, this is a tiny, unrepresentative fraction of the tens of millions of responses ambulance service providers conduct annually. In fact, BBB 2016 statistics show that ambulance services receive far fewer complaints than hospitals, physicians, dentists, and many other trusted healthcare providers.

The article also offhandedly mentions that balance billing occurs when private insurers and ambulance service providers are unable to agree about fair reimbursement rates. This glosses over the dark reality that it would be hard to categorize the process that occurs between the insurer and ambulance services as a “negotiation.” Instead, insurers often present an all-or-nothing proposition to force ambulance service providers to accept contracts at unsustainably low reimbursement rates. Unlike the multi-billion dollar insurance behemoths, most ambulance services are small and operate on razor-thin margins. In fact, 73% of ambulance services provide fewer than 1,000 Medicare transports per year—just three per day. Ambulance services do not turn down insurance network contracts out of greed, but instead out of necessity. Facing reimbursement rates below the cost of the services they provide, they must decline these agreements in order to keep their doors open and continue to provide healthcare to their communities. Unfortunately, this sometimes creates a situation where out-of-network ambulance costs are shouldered by patients via balance billing, instead of insurers.

In addition to challenges receiving fair compensation from private insurance, EMS is stretched thin by ultra-low Medicare and Medicaid reimbursement rates. In fact, in 2007 and 2012 GAO studies showed that without temporary, Congress-authorized percentage increases in EMS payments, ambulance services would receive reimbursement from government payors below the cost of operations. These are often the very same unsustainable rates that private insurers are attempting to strong-arm EMS providers into accepting for network contracts.

Finally, when someone calls 9-1-1 in need of emergency medical care, it is key to recall that, unlike in other industries, an ambulance responds regardless of the patient’s ability to pay. In many cases, the patient does not have insurance and is financially unable to reimburse the ambulance service provider. Therefore, EMS provides a significant amount of uncompensated care, the cost of which must be spread across all payors in order for them to continue their life-saving operations.

Ambulance services provide an essential, on-demand healthcare benefit to their communities. Unfortunately our current healthcare payment structure means that much of this care is not compensated equitably, resulting in the necessity of balance billing patients. While there are no quick fixes for this issue, we encourage consumers to educate themselves about their own insurance coverage. We also ask for your support of legislation that provides sustainable reimbursement for ambulance providers, including the bipartisan US Senate Bill 967. Together, we can ensure the future of mobile healthcare in our great nation.

Mark Postma
President
American Ambulance Association
“Representing EMS In America”

 

President’s Perspective: July 2017

Dear Fellow AAA Member,

I am proud to share with you that just yesterday legislation was introduced in the House on a long-term extension of Medicare ambulance add-ons. The House bill follows introduction of the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 967) in the Senate, giving us a bill in both houses of Congress.

The Ambulance Medicare Budget and Operations Act (H.R. 3236) would extend for five years the 2% urban, 3% rural, and super rural bonus increases. The bill would also direct CMS to collect cost data from ambulance service suppliers. The AAA has been working with Congressman Nunes (R-CA) and Upton (R-MI) as well as the House Ways and Means and Energy and Commerce Committees on the bill language. You will soon receive a Call to Action to reach out to your Representatives to cosponsor the new House bill.

  1. 967 would make the add-on payments permanent and direct CMS to collect cost data from ambulance service suppliers using a survey methodology. Since its introduction, four additional Senators have signed on to co-sponsor S. 967, Senators Sanders (VT), Cochran (MS), Tester (MT) and Gillibrand (NY), bringing the total number of cosponsors to nine. While this is good progress, we need our member’s continued assistance in getting more co-sponsors on both of our bills.

While both bills meet the needs of our industry, the language in the two bills is different. That being said, it is not uncommon for the Senate bill and the House bill to have minor differences in their respective language that have to be worked out before getting final approval. When this happens, a special conference committee made up of members from both houses will work together to come to consensus about the different provisions in the bill. It is unlikely that our bills will be passed as stand-alone legislation. Instead, our provisions will likely be included in a larger bill similar to how the extenders were passed last time as a part of the CHIP (Children’s Health Insurance Program) Reauthorization Act. It is crucial that we have as many co-sponsors on both of our bills so that we can again be included on a larger piece of legislation.

The Medicare ambulance add-on payments will expire on December 31, 2017. To ensure continued access these critically-necessary extenders, we need the collective advocacy of ambulance services across the country. We ask that you please add your voice to the AAA’s by writing your Senators in support of Bill S.967. Additionally, you will soon receive a Call to Action to reach out to your Representatives to cosponsor the new House bill.

As always, the AAA Board, Government Affairs Committee, advocacy consultants, and staff are working diligently to build support on Capitol Hill to ensure that this vital revenue remains in place. If you missed our June 29 government affairs update webinar, I invite you to watch it on-demand now.

Annual Conference

The Education Committee recently finalized programming for the 2017 AAA Annual Conference & Trade Show. This year, we welcome three exciting keynotes—Steven M.R. Covey, Mel Robbins, and Dr. Zubin “ZDoggMD” Damania—as well as dozens of industry leaders and experts. I hope that you will join me and hundreds of our colleagues in ambulance leadership in Las Vegas in November! Online registration is open now.

Educational Events

AAA will host its inaugural SimLab workshop in Tulsa, Oklahoma on September 28. We are excited to share with members this immersive learning experience. AAA SimLab content will also be featured at the Mississippians for EMS Conference October 2–4 in Biloxi, Mississippi.

Save the date for AAA’s newest educational partnership, the Midwest EMS Expo May 2–3, 2018 in La Crosse, Wisconsin. Co-hosted with the Minnesota Ambulance Association and the Professional Ambulance Association of Wisconsin, the Midwest EMS Expo will bring together the best in national and regional education.

AAA is also proud to offer learning on-the-go, in the form of engaging webinars on human resources, reimbursement, compliance, and other topics. Don’t miss upcoming sessions on drug use, the OIG Safe Harbor on Cost Sharing, and the management of airborne medical emergencies.

Website

I am happy to share with you that AAA has a new URL, www.ambulance.org. This updated domain should assist us in clearly communicating our identity to the world, as well as in attracting new members not previously familiar with our organization.

Capital Campaign

To date, we have raised more than $255,000 of our $1mm Capital Campaign goal through the generous contributions of our fellow members. Our deepest thanks to all who have given. If you have not done so already, please consider donating today. Funds contributed to this campaign are managed separately from operating accounts, and can only be accessed after a full Board vote.

Stars of Life

It was a privilege to see many of you at Stars of Life in Washington in June. This year’s Stars program recognized 108 EMS providers from across the nation who have served their communities with distinction. The Stars, accompanied by their executive-level Hosts, met with their Senators and US Representatives to shine a light on the importance of ambulance services to our healthcare infrastructure. Nominations for the 2018 class of Stars will open in January. We hope to meet your Stars in D.C. next year.

As always, please don’t hesitate to contact the AAA at 703-610-9018 or info@ambulance.org if we can be of assistance to your service.

Thank you for your service to your communities, and have a great summer.

Mark Postma
President
American Ambulance Association
“Representing EMS in America”
www.ambulance.org

Support AAA’s Medicare Relief Legislation, S. 967

Dear Fellow Members,

As you know, the Medicare ambulance add-on payments are set to expire on December 31, 2017. I’m proud to share with you that today, due to AAA advocacy efforts, permanent ambulance relief legislation was introduced by Senators Stabenow, Roberts, Schumer, Collins, and Leahy.

This bill, S.967, “Medicare Ambulance Access, Fraud Prevention, and Reform Act” would make permanent the vital urban and rural Medicare add-ons and super-rural bonus payments. Although some changes are likely during the committee markup process, we are cautiously optimistic that it will also carry through proposals to reclassify ambulance organizations as providers of health care (not suppliers of transportation), as well as a cost data collection system that does not place undue burden on ambulance services.

On behalf of the AAA, I’d like to extend my deepest thanks to Senators Stabenow, Roberts, Schumer, Collins, and Leahy for sponsoring the legislation, as well as the AAA Board, Government Affairs Committee, advocacy consultants, and staff who worked so diligently to build support on Capitol Hill.

Over the coming months, AAA will continue to connect with policymakers to build support for sustainable ambulance Medicare reimbursement. However, we need your help to ensure that this critical revenue remains in place. We ask that you please contact your Senators to voice your support for S. 967. AAA makes it easy to connect with your legislators through our online advocacy tool—please use it today to quickly send messages expressing the importance of the legislation to your ambulance service and the communities you serve.

If possible, we ask that you also work with fellow ambulance providers in your area to schedule in-person meetings with your legislators’ offices. If you arrange a meeting in your home state, please contact AAA staff at info@ambulance.org for talking points to support your conversation.

Now, more than ever, we need the active participation of each member organization to ensure our collective future! Thank you in advance for your assistance with advocacy outreach, as well as for your continued membership to the American Ambulance Association.

Mark Postma
President, American Ambulance Association
“Representing EMS in America”

President’s Perspective April 2017

Dear Fellow AAA Member,

As you know, the Medicare ambulance add-on payments are set to expire on December 31, 2017. The AAA Board, Government Affairs Committee, advocacy consultants, and staff have been working diligently to build support on Capitol Hill to ensure that this critical revenue remains in place.

As we continue to connect with policymakers in preparation for the introduction of our legislation, I ask that you pay special attention to the requests for advocacy action you receive from the AAA. Now, more than ever, we need the active participation of each member organization to ensure our collective future!

Capital Campaign and Financial Status

In addition to representing our members’ current interests in Washington, AAA strives to serve ambulance providers over the longer term. It is key that the Association build a pool of capital for use in case of an unexpected legislative or regulatory threat, or once-in-a-blue-moon strategic opportunity. For these reasons, I announced the creation of a Capital Campaign the day I assumed the office of President. Funds contributed to this campaign are managed separately from other assets, and can only be accessed after a full AAA Board vote.

To date, we have raised more than $250,000 of our $1mm goal through the generous contributions of our fellow members. My deepest thanks to all who have given. If you have not done so already, please consider donating today.

In addition to the Capital Campaign, we continue to build the overall financial strength of our association. Through close management of the budget, streamlined regional meetings, and increased membership, AAA continues to thrive. Thank you to Shawn Baird, Finance Chair, and David Tetrault, Membership Chair, and both committees for your hard work. It is paying off!

Stars of Life

I look forward to seeing many of you in Washington, DC in June at Stars of Life. Stars recognizes EMS providers from across the nation who have served their communities with distinction. The Stars, accompanied by their executive-level Hosts, meet with legislators to shine a light on the importance of ambulance services to our healthcare network.

I hope you will enjoy meeting the 2017 class of Stars as we share their stories and accomplishments on our website and social media.

Education

The Education Committee has been hard at work developing the program for the 2017 AAA Annual Conference & Trade Show. We look forward to announcing the full agenda in June, and hope that you will join us in exciting Las Vegas this November.

In the meantime, why not learn from our experts at an AAA Live! Workshop here at Sunstar Paramedics on May 3, or at Superior Air-Ground Ambulance in Illinois in July? If you’re short on time, AAA is also proud to offer a wide variety of engaging webinars on human resources, reimbursement, compliance, and other topics.

It continues to be my pleasure to serve so many talented, dedicated health care professionals. Thank you for your service to your communities, and I wish you continued success in 2017!

Mark Postma
President
American Ambulance Association
“Representing EMS in America”

 

HHS Letter to Governors on Medicaid Changes

On Monday evening, the Senate confirmed Seema Verma, MPH, as the new Administrator of the Centers for Medicare and Medicaid Services (CMS). She has a strong background in Medicaid, and prior to her appointment worked as a consultant to several States seeking Medicaid waivers.

One of her first acts was to issue a letter to governors with Secretary Tom Price, MD, regarding the Medicaid program. The letter highlights several initiatives on which they are focusing with regard to Medicaid. Perhaps of most importance to the ambulance community is the section on “Aligning Medicaid and Private Insurance Policies for Non-Disabled Adults.” In this section, the Secretary and Administrator suggest that States:

may consider creating greater alignment between Medicaid’s design and benefit structure with common features of commercial health insurance, to help working age, non-pregnant, non-disabled adults prepare for private coverage. These state-led reforms could include, as allowed by law: …waivers of non-emergency transportation benefit requirements.

While it may be meaningful that the reference does not include “medical,” before transport, it is critically important that the AAA work to protect Medicaid beneficiary access to medically necessary non-emergency medical transports. Thus, the Medicare Regulatory Committee is developing a letter and considering additional engagement with CMS to clarify that the reference is to programs related to providing beneficiaries with the cost of taxis, buses, or other transportation options, but not to medically necessary non-emergency ambulance transports.

It is important that AAA members speak out on this issue with their governors and State Medicaid officials. The AAA has developed draft talking points to assist with these contacts as well.

Thank you for your attention to this critical issue.

Mark Postma
President, American Ambulance Association
Representing EMS in America

Thank you to AAA Consultant Kathy Lester, JD, of Lester Health Law for the analysis of this issue.

Medicare Relief and Reform Letter by President Postma

This is a critical year for the legislative efforts of the American Ambulance Association and our members.  First and foremost, our temporary Medicare ambulance increases expire at the end of the year.  It is vital that we ensure the new 115th Congress makes these increases permanent, or at the very least approves another long-term extension.  To be successful, we will need all of your help in reaching out to your members of Congress in support of the increases.

The AAA and our partners have been also working to further the reform of the Medicare ambulance fee schedule.  To accomplish the first steps in this process, ambulance services need to be treated as providers of health care services rather than only suppliers of medical transportation.  In addition, we will need the cost data necessary for Congress, Centers for Medicare and Medicaid Services and the AAA to make data-driven decisions regarding the reform.

To achieve these goals, we are working with our champions in Congress to reintroduce a version of the Medicare Ambulance Access, Fraud Prevention and Reform Act (HR 745, S. 332 – 114th Congress).  We hope to have a bill reintroduced in the House and Senate in the coming weeks.  Only with your help in sustained outreach to your legislators will we be able to get the provisions of this bill passed.

Our absolute top priority this year is preventing the expiration of the Medicare add-on payments.  Building the increases into the base rates is also vital to the future of reform, as is provider standing and cost data collection.  These changes will lead, we hope, to the demonstration of the need for additional reimbursement as well as recognition of the role ambulance services can play in the larger health care picture.  The subsequent goal is coverage for services such as mobile integrated health and alternate destinations.

The AAA will also be closely following the debate and implications for our industry around repeal and replacement of the Affordable Care Act, potential Medicare and Medicaid reform, and other health care and broader initiatives of interest to us.  We will keep you posted of new developments as the process unfolds.

Since this is such a vital year for us in Congress, I ask that each of you respond to our Calls to Action for help with your members of Congress on the Medicare increases and other legislative priorities.  We will only be successful if we all push as one.

President’s Perspective January 2017

Happy New Year from the American Ambulance Association. 2017 promises to bring many changes to the health care landscape, and AAA will be there with you and your ambulance service the whole way. As we launch our 2017 initiatives, I wanted to share the updates below from AAA’s board and headquarters.

Advocacy Priorities

In 2017, we will continue to work tirelessly toward our primary advocacy goal: making the CMS temporary ambulance add-on payments permanent.

This effort fits seamlessly into our longer-term payment reform plan, which includes seeking a change in our CMS status from “Supplier” of services to “Provider” of health care. We plan to back this effort with cost data obtained through a rotating, statistically valid survey of ambulance providers, rather than burdensome universal annual reporting. This Provider status would open the door for future innovations in our field, including mobile integrated health (MIH).

Our Government Affairs, Medicare Regulatory, and Payment Reform Committees, along with our paid staff and consultants, have been extremely engaged and active on these issues. To add your voice to AAA’s, please visit our advocacy page to quickly and easily contact your elected officials.

Capital Campaign

I am proud to share that the $1 million capital campaign we kicked off at the 2016 Annual Conference & Trade Show is progressing nicely, with $150,000 raised to date. These funds will be restricted, and only used after a full board vote. I ask that you consider donating as we are in uncharted waters on Capitol Hill.

Committees and Task Forces

AAA thrives on the dedication of its committee chairs, vice-chairs, and members. We have seen a recent surge in volunteerism from our active members. One of my campaign goals was to get more participation from members, what a great thing to see this happening! If you would like to be considered for committee membership, please complete AAA’s short online form.

In addition to our standing committees, we have launched three mission-critical task forces: BLS Non-Emergency, Social Media/Communications, and Small Providers. A large group of ambulance services participated in a recent Chicago meeting for the Non-Emergency task force, with another meeting planned in the Northeast in the near future.

2017 Membership Renewal

Membership is the lifeblood of AAA. Dues are the fuel that powers our advocacy engine, and enables us to offer the innovative benefits your service has come to rely on. If you have already renewed, please accept our most sincere thanks for your continued support. If you have not yet submitted payment for this year’s membership, I encourage you to renew online or reach out to staff at info@ambulance.org for assistance. Again, AAA needs your support through membership to continue our industry-advancing work.

It continues to be my pleasure to serve so many talented, dedicated healthcare professionals. Thank you for your service to your communities, and we wish you a successful and productive 2017!

Mark Postma—President
AAA
Representing EMS in America