Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 4
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34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
funding and no federal funding are provided to offset uncompensated care and charity
care.
13. The Medicaid coverage expansion required under the Accountable Care Act will reduce,
but not eliminate, charity care for EMS and does not address below-cost reimbursement
by Medicaid and Medicare. The significant cost burden of uncompensated care will
continue to be shifted to commercial insurers unabated because of severe underfunding.
All of these factors contribute to the complexity of financing EMS Systems. In a fee-for-service
setting, uncompensated care has always been a great challenge. While the recent federal health
care reform initiative (i.e., the Accountable Care Act, known as the ACA) intends to reduce
uncompensated care, it has created a burgeoning level of under-compensated care. A pathway to
adequately assess EMS System costs and develop standarized financing methodogies for EMS
System performance is needed.
B:
References
Below are the major studies and reports reviewed by the Committee:
Faul, Wald, Sullivent, Sasser, Kapil, Lerner, Hunt. “Large Cost Savings Realized from the
2006 Field Triage Guideline: Reduction in Overtriage in U.S. Trauma Centers.” Prehospital
Emergency Care. January/March 2012.
The purpose was to examine the potential cost savings associated with overtriage for the 1999
and 2006 versions of the Field Triage Guideline.
Weaver, Moore, Patterson, Yealy. “Medical Necessity in Emergency Medical Services
Transports.” American Journal of Medical Quality. December 2011.
The purpose was to generate national estimates of the prevalence of medically unnecessary
emergency medical services (EMS) transports to emergency department (EDs) over time and to
identify characteristics that may be associated with medically unnecessary transports.
Millin, Brown, Schwartz. “EMS Provider Determinations of Necessity for Transport and
Reimbursement for EMS Response, Medical Care, and Transport: Combined Resource
Document for the National Association of EMS Physicians Position Statements).” Prehospital
Emergency Care. October/December 2011.
The purpose was to outline the literature examining EMS provider determinations of medical
necessity and the provision of on-scene medical care without transport, and to serve as a resource
document to the National Association of EMS Physicians (NAEMSP) position statements on
“EMS Provider Determinations of Medical Necessity for Transport,” and “Reimbursement for
EMS Response, Medical Care, and Transport.”
National EMS Advisory Council. “EMS Makes a Difference: Improved Clinical Outcomes
and Downstream Healthcare Savings: A Position Statement of the National EMS Advisory
Council.” NEMSAC. December 2009.
The purpose was to summarize the substantial evidence base documenting improved patient
outcomes resulting from prehospital interventions and emergency medical services (EMS)
systems.
March 29,2012
Draft Advisory
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