A recent article in the Washington Post discusses how the mayor of Washington D.C. wants insurance companies to pay for ambulance service whether the patient is transported or not. From the article:
The bill — the Affordable Emergency Transportation and Pre-Hospital Medical Services Amendment Act — could be introduced in the coming weeks. The goal is to help the department keep up with the fast-growing number of medical calls that have strained the city’s system.
Mayor Muriel E. Bowser (D) said requiring insurance companies to pay would help ensure the fire department is reimbursed for care not only given during transport but also while at the scene of an emergency. Under current rules, the city only gets reimbursed or paid for care that ends with a transport, anywhere from $428 for basic treatment to $735 for advanced life support.
This is not a new concept. The fact that EMS is a fee-for-service reimbursement model, the service being actual transportation, has been a point of contention for reimbursement over recent years as call volume increases. The costs incurred for readiness, uninsured patients, and patients who are not transported is what drives up the fees for transportation. Interestingly enough, looking at those rates, they seem kind of low to me personally.
After a number of high profile response time issues and the resignation of their medical director, DC FEMS brought in private ambulance provider American Medical Response to supplement the department’s resources. All indications are that AMR is paid directly by the city and does not bill the patient, but by being transported in an AMR ambulance instead of a city ambulance the patient (or their insurance company) is essentially getting a free ride.
While local legislation may help highlight the need for adjustments to the reimbursement model, it is unlikely to change anything unless it is done on a State or Federal level. What really makes this interesting is the fact that Washington D.C. belongs to no one state, so the legislation may actually have an impact that you would not see in other cities.