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Medicare To Change Its Payment Model For EMS Next Year

Mar 20, 2019

[From Indiana Public Media]

A recent study found ambulance call volume went down by an average of 7 percent once Uber was introduced to a city.

David Slusky, assistant professor at the University of Kansas Department of Economics and Leon Moskatel, a physician in San Diego, co-authored the study in 2017.

Slusky says they’d both heard about people using Uber in place of an ambulance, and were curious to see if it was part of a larger trend.

During the study, Slusky noticed issues with how emergency transportation is structured.

“All we have is one very serious resource to use,” says Slusky. “We don’t have an option for you to call a regular car driven by an EMT with a first aid kit, an oxygen tank and defibrillator in the trunk.”

He says that means a large segment of calls could be helped just as easily and safely with a less intensive response vehicle, which drives costs for emergency care up.

Medicare and Medicaid did announce last week it will change its payment model so that participating ambulance services can provide Medicare beneficiaries treatment onsite, or transport them to cheaper treatment destinations, like a primary care doctor, and still be reimbursed.

Matt Zavadsky, president of the National Association of Emergency Medical Technicians, says the EMS industry has been pushing for this payment model for a long time.

“You’re seeing the national stories about people self-selecting to use ride share programs like Lyft or Uber because it’s cheaper for them to go to a hospital,” Zavadsky says. “Now, we flip the economics of this and if EMS comes out, they can evaluate, treat and navigate you.”

Zavadsky says that without a potentially costly visit to the emergency room as the only option, people will use emergency services more appropriately.  

The payment model is voluntary, and ambulance services have to apply with Medicare to participate. The  five-year performance period will start in 2020.

Zavadsky says all commercial insurers should adopt this model to save money and EMS resources.  

“There is significant incentive for all payers because everybody has the same issue,” he says.

Ambulance services only get paid if they transport patients, so they’re driven to transport people who may not be medically necessary.

Bruce Bare, former director of Emergency Medical Services in Indiana, says there is a liability factor as well.

“If they refuse to transport somebody and something does happen to them, they’re liable for refusing that transport,” Bare says.

Implementation of the new payment policy will be easier in some states than others.

Bare says that some state-level rules may have to change and medical directors will have to alter procedures.

Zavadsky says that though the federal government was able to set the policy, now state and local agencies will have to determine how that affects their operations.