MedPAC Examines Beneficiary Use of Emergency Departments

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...

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 Ambulance Payment Reform Whiteboard Video

The American Ambulance Association needs your help to build the future of EMS—an innovative industry compensated fairly and recognized appropriately for the critical healthcare it provides. Learn more in the video below, then visit our Payment Reform page to get involved! Ambulance services across the country are struggling to survive in the face of falling reimbursement, short-sighted regulations, and rising costs. EMS providers of all sizes must share critical cost data, meet with legislators, and speak with one voice as we work to surmount these obstacles and position ambulance services for success today and for many years to come.

EMS Today: Payment Reform Town Hall

Maximize your time at EMS TODAY by adding half-day or full day pre & post-conference workshops to your Gold (3-day) or Silver (2-day) full conference registration. These unique, CE certified workshops are designed to provide in-depth clinical and hands-on instruction to students and will take place on Wednesday, February 22, 2017. These workshops are taught by recognized experts in the world of EMS. ADD 1 or 2 today! Don’t forget that complimentary lunch is provided for all attendees registered for two onsite 4-hour workshops or one 8-hour workshop! FEATURED WORKSHOP American Ambulance Association’s Town Hall Meeting on Payment Reform (#16200) Wednesday, February 22, 2017: 1:00 PM – 5:00 PM Workshop Description The AAA has been leading efforts on Capitol Hill to take the initial steps necessary to reform the Medicare ambulance fee schedule. It began with the successful securement and multiple extensions of the 2% urban, 3% rural and super rural increases in Medicare payments for ambulance services. Through the Medicare Ambulance Access, Fraud Prevention and Reform Act (S. 377/H.R. 745), those increases would be made permanent and set the foundation for future reform by changing the status of ambulance service suppliers to that of providers, collecting data on the (more…)

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

MetroWest’s JD Fuiten on Mobile Integrated Health

Telling Our Story

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 (more…)

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

Cataldo Ambulance’s Ron Quaranto on Mobile Integrated Health

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

Life EMS’s Jimmy Johnson on Sustainable Reimbursement

EMS serves all Americans—24 hours per day, 7 days per week, 365 days per year. This is especially important in rural communities like mine, where hospitals and clinics may not be accessible to some of our most vulnerable populations, including the elderly, disabled, and chronically ill.

The American Ambulance Association’s legislative effort to ensure that government cost reporting requirements do not overly burden these mostly small healthcare providers has bipartisan support from coast to coast. At present, it is cosponsored by 30 representatives from 18 states as well as nine senators from both sides of the aisle. The same piece of legislation, the Medicare Ambulance Access, Fraud Prevention and Reform Act (H.R. 745, S. 377), ensures permanent, sustainable reimbursement for ambulance services, allowing us to stay focused on the most important part of the job—caring for you and your family in your time of need.

Please consider encouraging your members of congress to support the AAA’s legislation. A vote for AAA’s bill is a vote for the future of EMS in America.

— James (Jim) Finger
CEO, Regional Ambulance Service
Past President, AAA Board of Directors
Rutland, VT

Regional Ambulance Service’s Jim Finger on AAA Advocacy

“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

Acadian’s Asbel Montes on Ambulance Payment Reform