Ambulance Funding Summit

December 6-7, 2004

 

Purpose: Increase ambulance funding through federal legislation

 

Objectives:

 

• Develop successful federal legislation which increases ambulance funding
• Policy objectives determined through an inclusive and representative process
• Stronger, more unified ambulance industry voice in federal legislative arena
• New data used internally to evaluate and validate external studies (i.e., GAO) and to guide legislative decision making
• Creative approaches to policy and political arguments

 

Deliverables as a result of summit:

 

• Stakeholders and priority need of each identified
• Political assessment of 109^th Congress and assessment of current advocacy/ lobbying process and culture with recommendations
• Key issues identified and policy options articulated for development
• Fee schedule structural reform recommendations
• Identification of deal breakers and basis for industry unity
• Data and research questions identified
• Outline of a white paper for each key issue with initial recommendations, roles and responsibilities

 

Meeting Highlights

 

Ambulance Funding Policy Stakeholders & Their Priority Needs

The participants identified 11 primary stakeholders and their primary priority needs for evolving ambulance funding policy. These include:

Taxpayers                         Low taxes

Patient                                       Access to quality, affordable care

Ambulance Providers           Reimbursement reflective of cost

Owner                              Return on Investment

Rural Providers                   Equity

Employees                         Stability/Security, Fair Compensation

Public                               Available

Ambulance (AIR)                Share of funding

Federal & State Gov?t                   Fair Policy

Government                       Economy

Other medical providers       Their share of Limited Funds

3^rd party payers                 No cost shifting

 

Additional Stakeholders include any federally funded program, equipment and supply Vendors, CMS, Congress and lawmakers, hospitals, state EMS organizations, trade groups and volunteers.

 

109^th Congress Political Landscape

The participants describe their view of the 109^th Congress as very conservative with ambivalence toward ambulance services because of a focus on other issues (i.e. medical malpractice, values, war, and homeland security). The budget will be cash strapped because of homeland defense and war with tax cuts having tightened the budget which is now in deficit spending. Many freshmen members need to be educated. Congress may not want to address ambulance funding, choosing instead to wait for a Government Accountability Office study which is underway. The public and congress may think that Medicare ambulance funding was fixed in the Medicare Modernization Act. On a positive note, there is significant respect to badges and uniforms post 9/11.

 

How effective is current advocacy & lobbying process & culture?

AAA has had a great influence even as small as they are; having been able to hold down cuts in 90s. There was some relief for ambulance in the MMA, although there is universal agreement it was neither fair nor equitable.

 

There are competing agendas, and fragmented voices (?what?s in it for me?), with no agreed-upon equitable point of view. Within the industry as a whole, there is a lack of involvement by providers who could be effective. We are not leveraging our strength; a result of which is influential politicians supporting their local services. Individually, some providers or groups have been effective, but there is a need for a unified front, of an equitable policy solution that has been adequately vetted and developed with the right stakeholders, so that advocacy can occur for the whole industry using a unified front.

 

Perceptions of the Medicare Ambulance Payment Reform and Rural Equity Act

We may spend political capital on a marker bill that may not be best bill. While it meets industry criteria, the data used to set the payment level is 5 years old and we haven?t evaluated how or if it meets the needs of stakeholders. A positive is that it refers to the GAO report, but it is asking for funds that don?t exist in deficit spending.

 

While we are savvier now, we need a comprehensive solution that is based on data and a scientific approach that includes a permanent and uniform system of dispersal. The urban/rural definition is good, but the bill doesn?t adequately meet the funding needs of rural providers.

 

Additional structural changes to the fee schedule and/or policy objectives

There are other issues that could be addressed in an ambulance bill. Any bill should be realistic considering the political landscape, yet contain sufficient funds to cover ambulance service costs, using standard and clear definitions.

 

Participants rated these factors as most important: accurate data collection, rural payment methodology, tort reform, Medicaid leveled with Medicare, finding a better method than GPCI to address cost differences and the development of a method to define ?medical readiness? costs.

 

Additional factors identified include: basing the fee schedule on ?current? data, condition codes, population densities vs. volume, mandating Medicaid crossovers, regulatory changes (like PCS), payment for all ALS mandates, alternate destinations, adding an RVU for ?treat and release? using downstream cost savings as an offset, adjustments for extreme uncontrollable changes in costs, validating the accuracy of the current RVUs, shifting SCT and Air Ambulance funds, RVU adjustments due to technology changes, incorporate improvements in clinical care, payment for unused availability, harmonizing traditional Medicare & Medicare + Choice, adding RVU for certain medicines that are not reimbursed and expensive, re-defining ALS-2 and consistent costs.

 

Ambulance funding issues other than Medicare reform

There are other areas that could be addressed in a bill. For example the cost of liability insurance is an issue in many states. Some states do not receive cross-over payment from Medicaid. There could be some provisions that do not cost the government money, like reversing mandatory Medicare assignment, eliminating the geographical cost provision and regulatory relief. A bill could focus on downstream savings. For example, there would be off-setting funds if ambulance services were reimbursed for treat and release, or for transporting patients to non-hospital destinations like clinics, urgent care centers and to other free-standing health care providers. Other ideas include 7K exemption expansion, better distribution of Homeland Security funds (dedicated EMS funding in homeland security), accounting for fuel cost increases, regulations that don?t make it harder and more expensive to get EMTs and paramedics (i.e., 4 yr college degree), eliminate inequities between private & public providers, streamline the Medicare enrollment process, limit unfunded mandates, eliminate inequities in taxes, make EMS eligible for already existing healthcare grant programs, provide mechanisms to disallow double dipping, minimum (floor) for Medicaid base rate, ambulance should be a statutorily covered Medicaid benefit, National Registry should be accepted in all states, prompt payment for insurance claims, eliminate Railroad Medicare (have claims processed by regular Medicare contractors), deal with uncompensated care and reimbursement for undocumented aliens.

 

Committee Formation

The participants chose 6 issue areas around which to form committees (and also established a planning committee). The committees include (chair names listed first):

 

Rural Payment Methodology: Gary Wingrove, Dale Gibbs, Joe Bradshaw, Brenda Staffan, Tony Myers.

 

Data Collection: Brenda J. Staffan, Scott Lesiak, Bryon Andrews, David Nevins, Gary Wingrove.

 

Vetting Recommendations: Mike Williams, John P. Karolzak, Chuck Kearns, David Nevins, Bob Garner, Ann Singer.

 

Geographic Cost Index: Darlene Denison, Kurt M. Krumperman, Ben Hinson, David Nevins, Jeff White, Gary Wingrove.

 

Medicaid: Michael Peironi, Kurt M. Krumperman, Darlene Denison, David Nevins, Jeff White, Kim Stanley, Scot Lesiak.

 

Stand by/Cost of Readiness: David Nevins, Darlene Denison, Mark Bruning, Dale Gibbs.

 

Planning: Julie Rose, Buck McAlpin, David Nevins, Tyrone Picard, Tracey S. Riehm.