The federal EMS on the Hill Day is approaching and there is a major shift in all things government that influence EMS, from billing to grant funding and, possibly, regulatory oversight.
Starting first with the Medicare extenders. For those not familiar with it, EMS providers have been paid a Medicare extender bonus. House Bill 10545 passed by the US Senate and the House of Representatives extended the temporary Medicare ambulance add-on payments of 2% urban, 3% rural and 22.6% super rural through March 31, 2025. Most ambulance operations have a payer mix of at least one-fourth or more that are Medicare patients. Colorado’s rural ambulance services stand to lose 22% of their reimbursement.
EMS should be outraged as these extenders have had the can kicked down the road for at least twenty years and EMS operations have gotten more expensive. These should have been made permanent a decade ago. Also at risk is the Ground Emergency Medical Transportation Program (GEMT) funding and supplement to Medicaid that added more than $42 million to Colorado publicly-based EMS operations. As some of the funding gets pulled back or if the block grant strategy becomes more prevalent, either way, GEMT will become a more significant State battle as priorities will need to be made for those who receive Medicaid funding.
Clearly, we need a different approach. As government efficiency and fraud get rooted out there will be an opportunity to consolidate all EMS into one federal agency in the name of efficiency. When it comes to ambulance reimbursement, is an ALS charge warranted when it is BLS care? If we analyze some of the President’s comments that are directed at the Department of Education, “We should return some of that money to the States.” If you have studied the history of EMS decades ago under President Ford, EMS was funded by block grants to the States similar to what is being proposed with some of the government agencies.
Does putting that money out where the rubber meets the road make more sense? We’ll see. The NERIS and NEMSIS databases will be collecting some of the same information on EMS. With the duplicity of doing a fire and an EMS report if you’re a fire-based EMS organization or just a single-role EMS provider we shouldn’t be surprised if the merging of these two systems happens.
Treatment In Place (TIP) and Transport Alternative Destination (TAD) are likely best positioned to get some traction from House Bill 8977 and Senate Bill 4500 from the 2024 Congress. As we know, taking a patient to the emergency room is not necessarily the most cost-effective option. Under the guise of efficiency TIP and TAD could be a big success this year within the Congress. There is a huge opportunity here to get a lot of structural changes in emergency services; it is just how potential disruption and reorganization is going to occur.