Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 5
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34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
Institutes of Medicine (IOM). “Future of Emergency Care in the US: EMS at the
Crossroads.” National Academy of Sciences. 2007.
The purpose was to examine the emergency care system in the United States, to create a vision
for the future of the system, and to make recommendations for helping the nation achieve that
vision.
U.S. Government Accountability Office (GAO). "Ambulance Providers: Costs and Expected
Medicare Margins Vary Greatly." Report to Congressional Committees. GAO-07-383. May
2007.
The purpose was to study ambulance service costs.
Lerner, Nichol, Spaite, Garrison and Maio. “A Comprehensive Framework for Determining
the Cost of an EMS System.” Annals of Emergency Medicine. March 2007.
The goal was to determine the cost of an EMS system in a community from a societal
perspective.
Mohr, Cheng, Mueller and Good. “Findings from the 1999 National Survey of Ambulance
Providers.” Project Hope. March 2000.
The objectives were to determine: the relative average costs of providing different levels of
ground ambulance services, how costs vary by urban/rural location and the major factors that
influence the costs of providers’ services.
U.S. General Accounting Office. Veterans Affairs: Limited Support for Reported Health Care
Management Efficiency Savings, GAO-06-359R. Washington, DC: General Accounting
Office, 2006.
(accessed March 18, 2012).
VA lacked a methodology for making the health care management efficiency savings
assumptions reflected in the President’s budget requests for fiscal years 2003 through 2006 and,
therefore, was unable to provide us with any support for those estimates. VA officials told us that
the management efficiency savings assumed in these requests were savings goals used to reduce
requests for a higher level of annual appropriations in order to fill the gap between the cost
associated with VA’s projected demand for health care services and the amount the President
was willing to request.
Further, VA lacks adequate support for the $1.3 billion it reported as actual management
efficiency savings achieved for fiscal years 2003 and 2004 because it lacked a sound
methodology and adequate documentation for calculating and reporting management efficiency
savings. Specifically, there was little consistency with respect to what VA’s regional networks
reported as management efficiency savings, how savings were calculated, and what type of
documentation was available to support the savings figures reported. In addition, VA’s regional
networks sometimes reported savings resulting from cost-cutting measures as management
efficiency savings. Although both can achieve savings, cost-cutting measures, unlike
management efficiency initiatives, are not consistent with VA’s objective of providing the same
or higher quality and quantity of service at a lower cost. Finally, VA does not have a reliable
basis for determining whether it has realized the management efficiency savings that were
reflected in the President’s budget requests for fiscal years 2003 and 2004. Specifically, VA’s
use of its savings calculation for its national procurement initiatives is misleading because VA
March 29,2012
Draft Advisory
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