Avoid the Ambulance Industry’s “Fiscal Cliff”

Call to Action!

This week’s blog is a Call to Action!!

Earlier this week Stephen Williamson, President of the American Ambulance Association, sent out a stern warning concerning the looming expiration of the temporary Medicare ambulance add-on bonus payments that can disappear when 2012 draws to a close.

These add-on, bonus payments have boosted the National Medicare Ambulance Fee Schedule by 2% urban, 3% rural as well at the hefty super rural payments that the industry has enjoyed over the past several years. Each year, the industry becomes nervous and then at the last minute (or sometime in the New Year) Congress extends the payments for another year.

Well, this year may just be the year that the ambulance industry payments fall over our own “Fiscal Cliff.” The time is NOW to reach out to your Members of Congress in support of extending these important payments.


We know that the Government Accountability Office (GAO) has once again proven that ambulance service provider have a negative Medicare margin, however this year’s report from the GAO was not quite as definitive as the one several years ago. On the heels of this report, comes the disturbing vote from the Medicare Payment Advisory Commission (MedPAC) recommending that Congress allow the ambulance add-ons to expire.

MedPAC recommended an increase in reimbursement for some service levels, but coupled that with a call to reduce payments for all BLS Non-Emergency transports. That’s right, I didn’t mistype, reduce!

In addition, MedPAC also told Congress that they recommend the elimination of the permanent 1-17 rural mileage bump of 50% in order to cover the cost of creating a new, to be determined, low volume payment adjuster in extremely rural areas. The proposed adjuster would replace the super rural payment but only extend to those ambulance entities that serve very rural areas coinciding with an annual call volume of less than 600 transports.

Potential LARGE Reduction

Should Congress follow MedPAC’s proposal coupled with the loss of the bonus payments, the majority of the ambulance industry as a whole will see a LARGE Reduction in Medicare payments across the board. Of course, while this directly applies to Fee-For-Service Medicare, the losses would extend, naturally, to losses in Medicare Advantage Payments that are tied to the National Ambulance Fee Schedule and will also affect payments in States where reimbursements like auto insurance and/or workers compensation approvals are directly tied to the Medicare Fee Schedule amounts or used to determine the “usual and customary” rate criteria.

The Case for Congress

It’s up to you as ambulance administrators to make a case to Congress that dropping these payments rates will be detrimental to your operations as an EMS entity.

Contact your Member of Congress today and inform him/her of the following points…

  1. The ambulance industry believes that many of the assumptions made by MedPAC are flawed and lack the support of sufficient data to back up those assumptions.
  2. Urge your Member of Congress to extend the add-on bonus payments to provide the ambulance industry enough time to collect data that is sounder and adequately represents the true fiscal status of the industry.
  3. Provide your own examples of how any negative change in reimbursement dollars could affect your local service, such as reduced staffing levels, delays in major life-saving equipment purchases, etc.
    The time to act is NOW!!!

We are Monitoring for Developments

We will continue to monitor any developments as they unfold.  Keep watching this space for updates as we receive them.

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