Tag: payment reform

MedPAC Examines Beneficiary Use of Emergency Departments

Written by Kathy Lester on October 9, 2018. Posted in Medicare, Member Advisories, Member-Only, Regulatory, Reimbursement.

During its October meeting, the Medicare Payment Advisory Commission (MedPAC), reviewed Medicare’s current policies related to non-urgent and emergency care, as these topics relate to the use of hospital emergency departments (EDs) and urgent care centers (UCCs). The Commission is examining this topic because the use of ED services in recent years has grown faster than that of physician offices. At the same time, the share of ED visits that are coded as high acuity has increased.

The Commission is exploring Medicare beneficiaries’ use of EDs and UCCs for non-urgent services. In addition, the Commission is analyzing ED coding to determine if the increase in coding high-acuity visits reflects real change in the patients treated in EDs. This slide deck shows the potential savings Medicare could realize if beneficiaries shift certain care to the UCC setting.

During the meeting, the staff sought feedback from Commissioners for developing next steps. This topic will likely continue to be addressed in future meetings.

From the perspective of ambulance payment reform, the observations made by the Commissioners and staff would also seem to support incorporating scope-appropriate ambulance services in the context of community paramedicine or treatment at the scene with referral. While additional work needs to be done by the ambulance community before these services can be incorporated into the Medicare reimbursement program, discussions like the one at MedPAC last week, show the importance of getting the details right so that ambulance services can be part of new payment models likely to be considered.

The American Ambulance Association is leading the effort with the Medicare program to develop appropriate models that account for the cost of providing services through sustainable reimbursement rates, rather than the use of temporary grants. We are also focused on ensuring services align with the scope of practice laws. Led by the Payment Reform and the Medicare Regulatory Committees, our efforts include regular meetings and discussions with leaders at the Centers for Medicare & Medicaid Services, as well as key Members of Congress. Follow us on Facebook and Twitter to learn more about our ongoing efforts.

MetroWest’s JD Fuiten on Mobile Integrated Health

Written by JD Fuiten on October 13, 2016. Posted in Patient Care, Reimbursement.

Metro West Ambulance’s Mobile Integrated Heath Program is a leader in the emerging world of community paramedicine and MIH. The successes in our programs have been centered on the strong relationships we have built with our health system partners. This partnership allows Metro West Ambulance MIH paramedics to better participate in the longitudinal care of our patients instead of the focused, episodic care of traditional EMS. We have now positioned ourselves as an integral part of the health care team. The value of an MIH paramedic continues to expand as the skills, tools and knowledge of the paramedic profession as a whole continues to increase.

As the success of the MIH programs across the country continue to prove their value, we look forward to full recognition by CMS as a valuable patient care service that should be recognized outside of the traditional transport fee for service.

JD Fuiten
CEO, Metro West Ambulance
Director, AAA Board
2015 AAA Distinguished Service Award Winner
Hillsboro, OR

Telling Our Story

Written by Maria Bianchi on October 11, 2016. Posted in Government Affairs, Legislative, Regulatory.

To this day, ambulance services in the United States are still the only health care provider that delivers care regardless of a patient’s ability to pay. When you call 911, the medics show up and immediately begin providing health care. No one asks for an insurance card, or a credit card. They ask questions regarding the patient’s medical history… anything they need to know to provide better patient care.

Ambulance services provide more uncompensated care than any other health care professional in the United States. They must be ready to provide that service any moment, any hour of any day. There are no “office hours” or closed signs.

For many patients and their families, they are the best things to happen on the worst day of their lives. They take care of us.

But for whatever reason, some legislators, regulators, insurers look at our providers as transportation services, a commodity, and a supplier of services like durable medical equipment. They assume our costs are related to each trip and rarely consider that we always have to be ready to respond and only get paid when we transport. That is until someone they love needs us.

The AAA leadership is committed to changing all that. We refuse to let our industry be defined by stakeholders who may not understand the complexities of our world, of our medicine, our protocols and our services. We are looking to change the course of our future by mandating that we be viewed as providers and not suppliers or widgets. We fervently and wholeheartedly believe that we make an even greater difference to the health and well being of the communities we serve because of our distinct nature of our services: we are mobile, we are everywhere, we are underutilized because of a reimbursement structure that only allows for compensation when transporting. Therefore, the only way for ambulance services to not just survive but thrive in any future health care system is to attain provider status. It is the game changer. It puts us in the drivers seat regarding the type of service we should provide (treat and refer, alternative destinations, collaborative models of care). It makes our services more nimble, efficient, and better able to serve our communities.

Because CMS will mandate cost reporting for anyone getting reimbursement through their programs, we are fighting hard to insure that our data is collected accurately, allowing our industry of primarily small, rural providers who at times are the only ones within 100’s of square miles providing health care the least burdensome way of providing that data… and make no mistake, folks—we need data to prove what every ambulance service providers knows in the United States… we are significantly underpaid by Medicare and Medicaid. So I implore every ambulance service to join us in our fight for our future… to help us be identified by those who have influence on our regulations and reimbursement rates, that we have been and are providers of health care and as such need to be recognized and compensated for the lifesaving work we do.

We cannot do it without you.

Get Involved with AAA’s Advocacy Efforts

Maria Bianchi, CAE, is the executive vice president of the American Ambulance Association.

Cataldo Ambulance’s Ron Quaranto on Mobile Integrated Health

Written by Ron Quaranto on September 29, 2016. Posted in Operations, Patient Care, Reimbursement.

As a current mobile integrated health provider, we recognize the values of an MIH program which most importantly provides quality patient care to those in need, often in the comfort of their own homes. This is often done under the direction of the patient’s primary care physician in conjunction with the patient’s healthcare team. This allows for the patient to maintain their quality of life while receiving the medical attention they need—and ultimately reducing the healthcare expenses of hospitalization.

Ron Quaranto
COO, Cataldo Ambulance Service

Life EMS’s Jimmy Johnson on Sustainable Reimbursement

Written by Jimmy Johnson on September 28, 2016. Posted in Government Affairs, Legislative, Medicare, Reimbursement.

To address the importance of the work that the payment reform committee is doing, we must consider the value of the part that small providers play in the healthcare delivery system today, and how imperative it is that we accomplish goals such as moving from Supplier to Provider status for all ambulance services in order to set the table for reimbursement that is more creative than just fee for transports. For example, 73% of all ambulance services who are credentialed by Medicare do less than 1,000 transports per year, which does not add up to sustainability for ambulances services endeavoring to adhere to best practices in providing emergency medical care. A vast majority of those services represented in the 73% are the first line—and in many cases the only line—of emergency medical care in their communities.

—Jimmy Johnson
CEO, Life EMS
Past President, American Ambulance Association
Co-Chair, American Ambulance Association Payment Reform Committee
Enid, OK

Acadian’s Asbel Montes on Ambulance Payment Reform

Written by Asbel Montes on September 22, 2016. Posted in Medicaid, Medicare, Reimbursement.

“EMS is instrumental to the healthcare fabric of our country. As the healthcare industry continues to innovate, it is imperative to recognize the value that EMS brings to the pre- and post-hospital environment. EMS providers are the only gatekeepers to the healthcare system in many communities.

73% of all ambulance suppliers credentialed with Medicare bill the program less than 1,000 transports per year. It is imperative that any cost data collection system reporting requirements consider this to ensure the reliability of the data and the administrative burden to ambulance providers and suppliers.”

Asbel Montes
Vice President of Governmental Relations & Reimbursement, Acadian Ambulance
Co-Chair, American Ambulance Association Payment Reform Committee