Bi-Partisan Senate Bill Critical to Ambulance Industry
SB 1405
Once again, the American Ambulance Association deserves major props for issuing its latest “Call to Action.” In an e-mail blast forwarded to all members on August 1st, AAA President Jimmy Johnson is urging the American ambulance industry to urge Senators to co-sponsor SB 1405, commonly known as the Medicare Ambulance Access Act of 2013.
Johnson called on ambulance industry representatives across the nation to lobby Senators during the August congressional recess in an effort to get widespread backing for the bi-partisan bill authored by Senators Schumer (D-NY), Roberts (R-Kan.), Leahy (D-VT), and Landrieu (D-LA).
5-Year Extension
SB 1405 calls for a 5-year extension for what we call the “add-ons.” These add-ons include the 2% urban and 3% rural payment increases in addition to super rural bonus payments.
As we all are aware, these relief measures are set to expire at the end of the year. If these payments are not extended, the result will be a further negative impact on reimbursements to ambulance providers and suppliers, many of which are already struggling to survive due to reimbursements falling well short of rising costs.
More Difficult Every Year
Credit the AAA for leading the fight, but by their own admittance each year it proves to be increasingly difficult to convince Congress to extend these relief efforts which were initially intended to be temporary until the Medicare National Ambulance Fee Schedule can be permanently adjusted to adequately cover the costs to provide EMS services nationwide.
In our opinion and the opinions of others who monitor the present Congressional climate, there is a very real risk of these bonus payments not being extended into 2014 than at any point since their introduction.
On the heels of the introduction of the negative productivity factor, adjustments to the GPCI calculations that lowered payment amounts and this year’s 2% payment reduction that resulted from government sequestration, the industry has already taken a hit that has resulted in the loss of millions of dollars for the ambulance industry as a whole.
If the bonus payments are allowed to expire, we may well see EMS access across the nation become even more dire, not to mention the potential for job losses as ambulance companies begin to scale back or curtail services altogether, especially in the most remote areas of the country.
Key Points
Consider the facts…
- Medicare reimbursement represents a large portion of total payments for ambulance service providers and suppliers with Medicare patients being on average 50% of ambulance transports.
- The majority of ambulance service providers are small business operations and are often the only providers of emergency and non-emergency medical services for their community. Negative cash flow could result in many communities losing this vital emergency resource.
- In October 2013 and May 2007 the Government Accountability Office (GAO) issued reports that found that Medicare consistently reimburses ambulance service providers on average below their costs and that’s WITH the bonus payments. Take away the bonus payments and the hole gets deeper.
- Congress recognized and addressed the EMS financial crisis when they added this temporary relief most recently as part of the American Taxpayer Relief Act. One must ask; What has changed? To strip this relief without a permanent fix compounds a crisis that has lifesaving implications including but not limited to reductions in service, layoffs and decreased investments in life-saving technology.
Curbing MedPAC
As a result of passage of this legislation (and a companion bill in the House of Representatives currently being considered for draft), the recent, potentially damaging recommendations issued by the Medicare Payment Advisory Commission or MedPAC would, in effect, be delayed.
While focusing on attempting to curb acknowledged problems with one type of transport (BLS Non-Emergency) that is ripe for fraud, MedPAC’s recommendations targeted the entire non-emergency ambulance sector instead of putting together a plan to attack only the fraudulent actors.
Eliminating the rural mileage bonus payment, as recommended by MedPAC would result in a whopping 9.7% additional cut to a majority of rural providers and suppliers where already there is a struggle to keep the ambulance bay doors open. Most of these ambulance providers are law-abiding, compliance-conscious emergency service providers who want to follow the rules and care for the needs of their community.
Following SB 1405’S recommendations to extend the bonus payments for another 5-years would curb these actions, protect the “good guys” and allow time for the legislature to work together with CMS to come up with a permanent and logical adjustment to the Ambulance Fee Schedule that is based on sound research and data compiled from a proper analysis of the industry as a whole, while taking into account the complex nature of the issues surrounding the ambulance industry nationwide.
Act Today
We join together with the AAA and call each of our clients and friends who are frequent readers in the blogosphere to act today!
While your Senator is home visiting while on Congressional break this month, schedule to meet with him/her. Better yet, invite a member of Congress to visit your station or even ask if he/she would like to ride along with you on a few transports to see first-hand what you do and how you do it.
Demonstrate to your senator, first-hand, those expensive pieces of equipment and how they dramatically save lives. Share your balance sheet with him/her. Educate your senator about your concerns for the future of EMS in America and enlighten him/her about the impact any cuts will have on your community.
In addition, become a member of the AAA. Your dollars and support will help further the critical national lobbying efforts of this important industry watchdog. Encourage your State or regional ambulance associations to support the AAA and ask them to join the call for passage of this legislation and any future measures to correct the shortfalls in funding we are all experiencing at the hands of government as a whole.
There’s strength in numbers and we must act fast. It’s already August. December 31st is now less than five months away.
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