What the “Permanent Doc Fix” Means for EMS


Yesterday, March 26, 2015, the U.S. House of Representatives voted in favor of H.R. 2 to do away with Medicare’s sustainable growth-rate formula and to pass what is commonly known as the permanent doc fix.

What the “Permanent Doc Fix” Means for EMS

Uncertainty Remains

While the House passed the measure overwhelmingly, there’s still uncertainty as the bill moves to the Senate and Congress is working within a very short window of time before their next recess.

Will they pass the bill before they take a break? Will they allow the bonus payments to expire and then pay retroactively? Will they pass a short-term extension or even allow CMS to institute a 14-day claim hold in anticipation of a decision sometime in the next two weeks?

Gaining Momentum

Then there’s the pending Medicare Ambulance Access, Fraud Prevention, and Reform Acts (S. 377 and H.R. 745).

This is the group of Acts that promises to cement some lasting, permanent change for our industry with respects to Medicare. If passed, this bill will…

  • Permanently incorporate the current bonus payments into the Medicare ambulance fee schedule rates.
  • Mandate CMS to present a reformed ambulance payment system to Congress no later than July 1, 2019.
  • Change the payment process for transportation of dialysis patients. The Department of Health and Human Services (DHHS) will be required to set-up a process for the prior authorization coverage for these patients.
  • Classify all ambulance services as “providers” under Medicare.
  • Commit CMS to work with the ambulance industry to develop a data collection system for ambulance providers that defines ambulance entities and identifies the costs and data that will be required to be reported to CMS and ultimately Congress.

Our take…

What’s our take on all of this? Let’s just say we approach these announcements with caution.

Here’s why…

  • Yesterdays’ action is another band-aid. It’s been this way for a long time. We’re encouraged by the 33-month extension but it’s still only a stop-gap measure.
  • The pre-authorization project is a nightmare. So, let’s expand it to more States when the MACs can’t handle the workload in the States it’s already effective for? You must be kidding! The pilot program was rolled out too hastily and has been a disaster. The healthcare community outside of ambulance has no clue what this thing is because we in the ambulance industry barely understand it and that’s a problem because we need their help to obtain the pre-authorization. The result is that most of the pre-authorization requests are being denied. As a result truly medically necessary people are suffering without a means for transportation to and from their treatments because the medical review team refuses to issue the pre-authorization.  The pre-authorization denials have been both procedural (for example, missing a fill-in-the-blank on the request form) and clinical (the patient’s doctor delayed providing the necessary information needed to prove medical necessity because he/she wasn’t properly educated about the program and how withholding progress notes affects the pre-authorization process.)
  • Permanent bonus payment application would be wonderful. But are those payments even adequate to pay our costs to provide the service? Why not just re-tool the fee schedule, follow the reports that continually point to Medicare underfunding our EMS systems and pay us adequately for what we do?
  • Data collection and reporting? It all sounds good. But anytime the government asks for information it means time, energy, effort and money. What’s it going to cost to report what the government wants to know? Will your EMS agency have the people or the time to prepare and submit the information needed?

It’s gotta be a passion!

But…in the face of all of this…we are still are out there making EMS happen. It’s gotta be a passion!

Be it on the street or in the office, there are still lives to save, comfort to offer and a system to maintain. Stay tuned! We’ll let you know what’s happening every step of the way and we’ll be there to help you navigate forward into what comes next for the industry.

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