Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 11
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34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
o Emergency
o Air Ambulance
o Transport to Alternative Destination
• Disaster Management
o Planning
o Response
o Recovery
o Surge Capacity
• Mutual Aid
• Medical Standbys
• Hospital Interface
• Community Paramedicine/Population Health/Follow-up Care
Review of EMS Functions By Discipline. EMS is often reported to be at the interesection of
health care, public health, and public safety. According to the list created above, EMS also
provides emergency management as part of the EMS system design and was added as another
category. The next step of the process included developing a method to evaluate the percentage
of EMS functions which fall into these respective four disciplines. Through a consensus-based
process, the Committee determined health care functions exceeded any other discipline by a
nearly 3:1 margin. (See Appendix A, “EMS System Functions by Discipline”). Please note:
these classifications are based strictly on the number (count) of the defined functions performed
by EMS and not the dollars spent on each function nor the priority of functions.
Review of EMS Funding Sources. The next step of the process included matching the lists of
functions to the current payers of EMS. Payers in the analysis included:
• Direct Funding by Local Government
• Direct Funding by State Government
• Direct Funding Federal Government
• Direct Funding by Payers (Medicare, Medicaid, Commercial Insurance, etc.)
• Direct Funding by Users
• Direct Funding by Health Care Facilities
• Indirect Funding by EMS Agencies
• Other
A matrix was developed to identify primary and secondary payers for each EMS function as it is
today and a proposed future direction for EMS funding. Tertiary payers and other entities that
only occasionally pay for services were not calculated in the matrix (See Appendix B,”EMS
System Finance Matrix – Current and Proposed”). Future payer recommendations were
developed using the matrix, reference materials, and crosswalk standards along with the business
knowledge and experience of the Finance Commmittee.
Review of Medical Necessity Criteria in Emergency Medical Services. In existing and future
fee-for-service-based funding models, it is critical that the medical necessity criteria for both
response and payment be linked. Yet, this is a policy that is contributing to the funding crisis of
EMS Systems.
March 29,2012
Draft Advisory
11
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