Fire Service Leaders and AAA Disagree on Approach to Cost Reporting

Locked Horns

Leaders from the top American fire service organizations and the American Ambulance Association recently, publicly locked horns over the proposed approach to the new Congressional Medicare cost reporting mandate.

Fire Service Leaders And AAA Disagree 11 02 2018

In a show of fire service solidarity, the International Association of Fire Chief (IAFC), the International Association of Firefighters (IAFF) and the Metropolitan Fire Chief’s Association (Metro Chiefs) teamed up to issue a stark communique opposing the American Ambulance Association’s (AAA) plan for Medicare ambulance industry cost reporting in favor of a design model that they claim is practically already in place.

Let’s Back Up…

Let’s back up and review the history.

If you’re a regular reader of this blog space, you are aware that we blogged about the Congressional move to cost reporting in February when we penned Cost Data Collection on the Horizon for EMS (2/23/2018).

If you didn’t already read that blog, take a minute to check it out for some background.

In short, February saw Congress pass the Bipartisan Budget Act (BBA) of 2018 which was signed by President Trump on February 9th. With the new law, the American ambulance industry breathed a sigh of relief given that the provision to extend the Medicare add-on payments was approved carrying a 5-year extension of those bonus payments.

However, along with the extension came an accompanying ambulance cost-reporting mandate.

The bill mandates that by the end of 2019, the Centers for Medicare and Medicaid Services (CMS) must present a plan to collect cost data from the ambulance industry with the first data to be tallied beginning in the year 2020.

In response, CMS has welcomed stakeholders to provide input on what that cost reporting process will look like.

Because the AAA took the lead in the lobbying effort that lead to the bonus payment extension, that organization immediately began to seek support from the entire ambulance industry, fire-based included, to back their Cost Reporting plan. The Association’s ask is for all entities to come together when seated at the CMS table to speak with one collective voice while lobbying for a specific cost reporting method developed as part of a AAA leadership group originally formed in 2012.

But, soon after the AAA sent out its appeal nationwide, the fire service leaders issued their own joint statement urging members of the three fire-based organizations to withhold their support of the AAA plan in deference to the basic reporting framework in place on the fire side.

May be harmful…

In its missive, the IAFC-IAFF-Metro Chiefs explained their reasoning to withhold support for the AAA plan noting potential harm for fire-based EMS under that plan. Fire service leaders cited the existence of a similar methodology that already exists within their service model that they believe can be easily adapted to the new Congressional mandate by the entire ambulance industry.

“The IAFC, IAFF, and Metro Chiefs have developed a fire-based EMS cost reporting work group to provide recommendations for CMS’ new cost surveying system.  We intend to recommend that CMS adopt a system similar to the cost reporting system, utilized by more than 1,000 fire departments across nearly a dozen states as part of the current Ground Emergency Medical Transportation (GEMT) program.

We ask that fire service leaders support the IAFC-IAFF-Metro Chiefs effort. We urge all state and local fire service leaders to reject overtures to sign on to the AAA alternative effort that may be harmful to fire-based EMS agencies.”

AAA Appeals for Open Dialogue

In response to the fire service communique, the AAA issued a rebuttal statement noting, for the record, that invitations to open joint dialogue on the matter with the IAFF and IAFC were declined by those organizations.

Newly inaugurated AAA President Aarron Reinert said this.

“Regardless of an ambulance organization’s service model, we collectively serve our communities with round-the-clock mobile healthcare. The collection and analysis of accurate cost data for ambulance providers of all types is essential to the future of our industry.” 

“The American Ambulance Association welcomes discussion with fire and other stakeholders. Our door is always open.”

 One Voice

In their statement, the AAA further explained the importance of this cost reporting initiative and its expected impact on future Medicare reimbursements rates.  They pointed out that the data collected as part of this cost reporting exercise will almost certainly

…be aligned with the costs Medicare has the statutory authority to reimburse…”

Appealing to all stakeholders, the AAA urged a one voice approach for the future.

“it is essential that ambulance providers speak with one voice on this critically important issue.  Inconsistencies in reporting and failure to standardize costs allowable under the Medicare statute will result in data being eliminated and will threaten the sustainability of the program.”

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