Breaking News!
CMS Releases First GADCS Report
By Chuck Humphrey, B.A., EMT-B, CADS*
Year 1/Year 2 Cohort Analysis
The Centers for Medicare and Medicaid Services (CMS) in cooperation with the RAND Health Care Corporation has issued the long-awaited first report detailing the results of the Year 1 and Year 2 Cohort Analysis of the initial data collected from the Medicare Ground Ambulance Data Collection System (GADCS).
It has been a relatively long road to arrive at this point. Readers will recall that the GADCS project was commissioned by Congress to begin just as the COVID-19 Public Health Emergency (PHE) caught us all by surprise in early 2020.
Initially, the process was to include a collection of data from all ambulance services in the country, each year, over four years. The data collection was intended to be followed by a report to be submitted to the Medicare Payment Advisory Commission (MedPAC), which is an independent federal body established by Congress to advise on issues affecting the Medicare program.
The MedPAC Role
MedPAC plays a key role in the end-game payments to providers by recommending appropriate payment rates for all healthcare providers. Its role includes analyzes of beneficiaries access to care and identifies potential barriers to such care. The Commission also evaluates the quality of care provided to Medicare patients, including how technology and new medical treatments affect care over time and with an eye to the future.
Two major reports are produced by MedPAC each year and handed up to Congress including their findings and recommendations. The reports serve as important resources for policymakers as they rely on the information when they consider legislation and major decisions regarding the Medicare program.
Historic First-Ever Ambulance Cost Data Collection
The GADCS project is historic. It is the first-ever cost data collection focused solely on the ambulance industry in America.
Heretofore, broad assumptions have been made with regards to the impact of the now two-decade old national Medicare ambulance fee schedule. History has shown that Congress and CMS have been somewhat blindly making reimbursement decisions with no single idea of the costs of providing EMS services to the nation. As such, Congress directed CMS via Section 1834(1)(17) of the Social Security Act to collect cost, revenue, utilization, and other information from representative samples of ground ambulance organizations.
The just-released report details the results of the GADCS collection process which saw both Years 1 and 2 combined into a single-collection phase following the pause caused by the COVID-19 PHE.
The report includes information submitted by more than 5,000 ambulance organizations. It describes the response rates, data cleaning and validation, statistics summarizing Year 1 and Year 2 responses and econometric analyses exploring relationships between costs per service and organization characteristics of these EMS organizations.
A second, planned, future report will expand the analyses to include organizations as part of the Year 3 and Year 4 GADCS cohorts.
The Hope
The hope of the ambulance industry is for Congress to gain a complete understanding of the rising costs of providing modern EMS treatment and transport in the United States.
In the moment, as of the writing of this blog, Congress has yet to consider the extension of the Medicare add-on payments with a looming funding crisis should those necessary additional dollars be allowed to lapse. It is this kind of end-of-year brinksmanship that must be eradicated. Our federal legislators can no longer hide behind what they have labeled as a lack of information when kicking the reimbursement can down the road, failing to “fix” a broken fee schedule system that literally has been broken since its inception.
As EMS sits at a critical crossroads, citing service closures, a shrinking labor pool and funding crises across the entire demographic. It is this blogger’s sincere hope that MedPAC, CMS and ultimately Congress digests the information in this and a subsequent report to follow when deciding to repair the funding gaps created by an aging America coupled with a flawed Medicare ambulance fee schedule.
The Next Step
Over the coming days, the next step will be to digest the information in this critical GADCS report. Collectively, we will all be looking closely at the findings as will many industry stakeholders and watchdogs.
Watch this blog space for more information as we peel back the layers of the EMS landscape for the first time ever!
*Chuck Humphrey is an independent contractor who spent 25 years in the EMS revenue cycle management industry, prior to his retirement from Quick Med Claims. In addition to holding EMT credentials in Pennsylvania, he is also a Certified Ambulance Documentation Specialist via the National Academy of Ambulance Compliance. Humphrey is a periodic guest contributor to the QMC blog and podcast space.
