Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 17
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34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
Conclusion 5. The public expects the around the clock availability of high quality EMS
response. In many communities, EMS response is the only available health care safety net
service. Unfortunately, EMS is not considered an essential service by most policy makers.
This failure to be recognized as an essential service also contributes to the chronic
underfunding of EMS Systems. Therefore, EMS should be considered an essential service,
and as such, appropriate steps must be taken by all stakeholder communities to ensure
continued sustainable funding mechanisms for EMS Systems
Conclusion 6. Emergency services must be ready to respond 24/7. There is simply no way
to determine prior to arrival what the request for service will entail with certainty. Yet, EMS
reimbursement is restricted by the healthcare system’s medical necessity rules. The medical
necessity rules are inappropriate when determining reimbursement for EMS response.
Therefore, EMS response reimbursement should be based upon the prudent layperson
standard and should not be denied or reduced based on retrospective medical necessity
review.
Conclusion 7. EMS must be fully and effectively integrated into the broader health care
system to fully realize improved patient outcomes, efficiencies, and patient satisfaction.
Conclusion 8. New service delivery paradigms, including community paramedicine,
advanced practice paramedics, continuum of care coordination by medical communications
(9-1-1) centers and other components of preventative care provided by EMS have shown
promising early results. These programs appear to deliver better patient outcomes,
efficencies, decreased costs, and improved patient satisfaction within the health care delivery
systems in areas that have launched these innovative programs. These programs should be
encouraged, studied, and financed to provide definitive confirmation of program success. If
proven by demonstrated efficiencies and quality metrics, these programs should be expanded
across the continuum to better impact the overall health care delivery system.
Recommended Actions:
National Highway Traffic Safety Administration
• Recommendation 1: NHTSA should adopt the proposed Pathway in the Committee’s
conclusions to develop a roadmap for more sustainable readiness-based funding and
reimbursement model.
• Recommendation 2: FICEMS should sponsor a comprehensive EMS System finance
study that accounts for all costs and revenues and includes the following:
1. EMS System Components. Pre-established minimum standards for what constitutes
an EMS System.
2. Total EMS System Costs. The cost components will use EMS functions at a granular
enough level to adequately reflect true system costs regardless of EMS system design.
a. Recommend using the proposed EMS Function list contained herein as a model
and the proposed definitions as a reference for the finance study
March 29,2012
Draft Advisory
17
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