Reimburse or Reduce: 3 Priorities to Help EMS’ Fragile State

By Fred Hornby | October 18, 2017

EMS is in such a fragile state that some departments are actually reducing the hours they operate. In Maryland, the Joppa-Magnolia Volunteer Fire Company agreed to convert one of its units to a “peak-time” unit operating only 16 hours a day. The Baltimore Sun reported the EMS side of their fire company operated at a loss of more than $98,000 in 2016.

Bake sales and pancake breakfasts are not sustainable methods for funding EMS. The ability to perform a service is directly related to being reimbursed for that service. Current funding is a mix of both state and federal resources. If an individual has Medicare, the service will be reimbursed 80 percent of the Medicare approved cost. The additional funding is through Medicaid, private insurance and self-pay. Medicare reimbursement for ambulance transports are currently below the cost to provide the transport, as detailed in the most recent GAO report. Seems like a no-brainer, but if that provider is not able to make budget, items such as new equipment, training and staff get cut.

Once a service closes, it puts additional stress on the neighboring communities and increases response times for both communities. If these three actions are prioritized by local, state and the federal governments, services could be saved.

1. Establish EMS as an essential service.

As strange as it seems, in Wisconsin only a township is required to provide ambulance service. Villages and cities are not required to provide this essential service per state statute. Our population is getting older and the number of EMS responses to care for this generation is increasing and it’s creating a snowball effect on reimbursement. The Wisconsin EMS Association (WEMSA) believes EMS should be seen as an essential service by our local and federal officials.

2. Stabilize adequate reimbursements.

Reimbursements must include patients who do not end up in a transport such as diabetics. In my state, an upwards of 50 percent of the reimbursements that a service receives are Medicare related. For private services and fire departments that do inter-facility transports, that number increases to 60 to 70 percent.

Since 2004, Congress has authorized supplemental or “add-on” payments to supplement money going to EMS, but these add-on payments are slated to expire on January 1, 2018. If this happens, the ambulance service will be doing these transports at a loss.

3. Educate our legislators.

Like most segments of healthcare, our lawmakers impact the funding needed to operate. EMTs and EMS providers must be vigilant about what’s ahead. The Medicare Ambulance Access, Fraud Prevention, and Reform Act of 2017 is up for debate and directs the Secretary of Health and Human services to deliver a report on stable ambulance reimbursement. The Comprehensive Operations, Sustainability and Transport Act of 2017 also addresses the stability of ambulance reimbursement, but adds caveats and decreases reimbursements for some transports such as dialysis. It is essential that providers reach out to their legislators.

With a lack of sustainable funding for ambulance transports, services and departments will have to adjust with actions such as reducing staff, eliminating or decreasing the purchase of life-saving equipment and downsizing operations. This will decrease the overall readiness to respond when summoned, and our communities should have this critical service at the ready, at all times of the day.

WEMSA is hosting the 32nd Working Together Conference & Exposition January 24-27, in Milwaukee, Wis., for EMS providers interested in education and networking. Medline can help EMS providers with their emergency medical supplies, inventory management and solutions for cost recovery.

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Fred Hornby

Paramedic Supervisor

Fred Hornby is the paramedic supervisor at Bell Ambulance in Milwaukee, Wisconsin. Hornby has been involved with EMS as a paramedic, educator and administrator for over 30 years. He has served as the paramedic and education coordinator at the Wisconsin EMS Office as well as ALS Director for Wisconsin’s largest ambulance service. Hornby previously conducted community outreach for the Wisconsin EMS Association.

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