Ems System Performance-Based Funding And Reimbursement Model - Finance Committee Draft Advisory Page 8
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34Finance Committee DRAFT Advisory
EMS System Performance-based Funding and Reimbursement Model
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 GAO verified the Medicare ambulance fee schedule rates are an average of six percent (6%)
below cost per ambulance transport. Unfortunately, the report was not designed to calculate true
EMS System costs and reported only the shortage of funding to transport providers.
National Highway Traffic Safety Administration. Emergency Medical Services Agenda for
the Future. DOT HS 808 441. National Highway Traffic Safety Administration, Washington,
DC, 1996.
The purpose of the EMS Agenda for the Future is to determine the most important directions for
future EMS development, incorporating input from a broad, multidisciplinary spectrum of EMS
stakeholders. The agenda provides guiding principles for the continued evolution of EMS,
focusing on out-of-facility aspects of the system. The agenda proposes the continued
development of 14 EMS attributes.
D:
Analysis
The NEMSAC Finance Committee had two objectives:
1) Evaluate and develop recommendations for reimbursement or funding models based on
readiness and performance standards
2) Evaluate and develop recommendations for reimbursement or funding models for treat
and release services provided by EMS
Review of Previously-defined EMS System Components. The Committee first conducted an
extensive review of previous EMS finance projects, primarily the EMS Makes a Difference
paper, the IOM report, the Project Hope survey, the GAO report, and Lerner’s Cost of EMS
System project. The Committee reviewed the methodologies used in those projects and
compared them against previously defined EMS System components. They included:
1. 15 EMS Components (EMS Systems Act, 1973)
2. 14 EMS Attributes (NHTSA EMS Agenda fo rthe Future, 1996)
3. 10 Components of the EMS Cost Framework (Lerner, et al, 2007)
The Committee determined these projects were narrowly designed and did not comprehensively
articulate all the factors that make up EMS Systems, especially costs and revenues. For the
purposes of this analysis, the Committee used the Insitute of Medicine’s definition of EMS – pre-
hospital and out of hospital EMS, including 911 and dispatch, emergency medical response, field
triage and stabilization, and transport by ambulance or helicopter to a hospital and between
facilities. This definition pertains to the subject at hand and does not include the other elements
of the EMS System once the patient enters the hospital emergency department.
Review of the Public Health Model. The Committee then reviewed the potential linkages
between the respective missions of EMS and public health disciplines. EMS has consistently
held a public health function as a part of its mission. The public health system was researched to
determine whether EMS could adopt the public health model. Public health has Three Core
March 29,2012
Draft Advisory
8
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