NJ-EMS

2011 EMS on the Hill DayNAEMT believes it is critical for Congress to ensure that Medicare reimburse EMS
services for the average cost of providing high quality prehospital medical services to Medicare
patients as recommended in the May 2007 Government Accounting Office (GAO) report to
Congress. Medical services provided by EMS services, including treatment and release of
patients (with no transport), treatment and referral, and treatment and transport to other
healthcare facilities should be reimbursable under Medicare.
To ensure equitable reimbursement levels in rural areas, Medicare reimbursement for rural EMS
services should be based on a four-tiered system using a zip code population-based methodology
generated by the RUCA coding system.
Background: The EMS system, the nation’s healthcare safety net, is utilized by an increasing
population of patients who rely on Medicare benefits to pay for emergency medical care.
However, Medicare reimbursement to EMS services per transport falls below the cost incurred
by the EMS service for providing this care.
EMS services continue to increase the level of life-saving emergency medical care provided to
patients in the prehospital setting. This higher level of care requires more expensive equipment
and additional training. High quality prehospital medical care improves patient outcomes,
including Medicare beneficiaries, resulting in a decrease in overall Medicare expenditures, as
noted in the December, 2009 National EMS Advisory Council report.
Medicare is the single largest payer for many EMS services, particularly in rural areas. However,
Medicare continues to reimburse EMS services below their cost for providing care to Medicare
patients, resulting in inadequate funding for necessary equipment and training. Many EMS
services are facing serious financial crisis due to chronically below-cost Medicare
reimbursement. As part of the Medicare Modernization Act (MMA) of 2003, Congress
requested that the GAO study the “cost, access, supply and quality of ambulance services”
provided to Medicare beneficiaries. In May, 2007, GAO reported that EMS services are paid
“on average 6% below cost and 17% below cost in remote or “super rural” areas to
provide ambulance services to Medicare patients.”
Adequate Medicare reimbursement to EMS services at the average cost of providing emergency
medical care will help ensure that paramedics and EMTs can continue to provide the highest
level of quality health care and is essential to assuring continued availability of emergency
medical services to Medicare beneficiaries, particularly in rural areas.