FOR IMMEDIATE RELEASE: December 20, 2001
SCHUMER: LOW MEDICARE PAYMENTS THREATEN SCHOHARIE AMBULANCE
SERVICE
Senator unveils plan to boost Medicare reimbursements to ambulance
providers in an effort to keep response times down and patient care
intact
With nation on high alert for new threats since September 11,
Schumer points to urgent need to increase support for first responder
emergency personnel
With falling Medicare reimbursements threatening ambulance service
throughout the Capital Region and New York State, US Senator Charles
E. Schumer today unveiled a plan that would boost payments to ambulance
providers in Schoharie County.
Currently, Medicare pays about $2.1 billion each year to reimburse
ambulance providers for two types of service basic life support
(BLS) and advanced life support (ALS). In some parts of New York,
payments for BLS transports can be as low as $162.92, while in others
they can be as high as $189.10 per trip. ALS transport reimbursements
in New York State range from $277.19 to $361.36 per trip. In an
effort to correct these disparities, Congress directed the Center
for Medicare and Medicaid Services to put together a simpler, more
equitable reimbursement formula. This new formula, however, is expected
to cut Medicare payments to ambulance providers throughout New York
State.
"With the need for top-flight emergency services never greater
in the wake of September 11, it is vital that we provide reimbursements
that reflect the actual cost of providing these services. Denying
our state ambulance providers the dollars they need denies New York
residents the quality of care they deserve," said Schumer.
"Boosting reimbursement rates for these ambulance providers
will help ensure that the public is served by qualified emergency
personnel."
The new reimbursement formula scheduled to go into effect
in April of next year would reduce reimbursement rates for
ambulance service in New York by about $15 million annually to about
$145 million, well below the actual cost of providing these services.
According to one major ambulance provider, which handles approximately
a third of Medicare ambulance transports in New York, the cost to
the company of a basic ambulance trip is $222. Under the new fee
schedule, however, it would receive only $163.51 per trip.
The Medicare Ambulance Payment Reform Act, introduced by Senator
Mark Dayton and co-sponsored by Schumer, would require Medicare
to peg ambulance reimbursement rates to the "national average
cost" of providing the service. Industry experts say this legislation
would mean New York ambulance providers would get $203 million in
Medicare reimbursements annually $58 million more per year
than they would receive under the formula scheduled to go into effect
in April.
Rural/Metro Medical Services the primary provider of private
ambulance service in Schoharie County responds to 6,100 calls
annually with 12 emergency vehicles and employs some 60 people throughout
Herkimer, Montgomery and Schoharie counties.
"September 11 was a vivid reminder of the full extent on which
we rely on our First Responders, those whose job it is to run toward
danger not from it," said Schumer. "If we want to continue
to rely on them as we did in the aftermath of those senseless terrorist
attacks, we must make a financial
commitment to keeping them afloat."
In Schoharie County, ambulance providers currently receive $187.65
per BLS trip and $349.68 per ALS trip $4.28 per BLS mile and $4.89
per ALS mile in reimbursements. Schoharie providers face cuts as
high as 44 percent to those rates under the proposed fee schedule.
For example, non-emergency ALS transport reimbursements will fall
from $349.68 to $196.21. The legislation Schumer is backing would
soften the blow of those cuts by reimbursing Schoharie providers
$299.65 per non-emergency ALS trip. In the Capital Region overall,
providers estimate that they would receive an additional $1.55 million
annually to cover the full cost of their services. On average, it
costs $100,000 to buy, supply and equip a new ambulance.
The Capital Region is not alone in feeling the crunch of the new
fee schedule. According to industry sources, ambulance providers
in Central New York one of the hardest hit New York regions
by the proposed fee schedule stand to lose $800,000 annually
but would gain an additional $2.8 million in Medicare reimbursements
under Schumer's plan. Providers in Buffalo would lose $600,000 annually
but would gain an additional $1.6 million in Medicare reimbursements
under Schumer's plan. In Rochester, providers would lose $300,000
under the proposed fee schedule but would receive $2 million in
additional reimbursements under the legislation.
Specifically, the Medicare Ambulance Payment Reform Act would:
Require Medicare to set ambulance payment rates at the "national
average cost" of providing service when it implements a new
fee schedule currently under consideration.
Require the findings of 1997 Congressionally-mandated study
due to be finished in June be used to ensure adequate reimbursement
for rural ambulance providers, who not only serve a higher percentage
of Medicare patients, but also incur higher per-trip costs due to
fewer transports and longer travel distances.
Establish a "prudent layperson" standard for the
payment of emergency ambulance claims, such that if a reasonable
person believed an emergency medical problem existed when the ambulance
was requested, then Medicare would pay the claim. Currently, ambulance
payments are sometimes denied if the patient's condition is not
as serious as the layperson who called the ambulance believed at
the time. If the payment is denied, the patient and the ambulance
service are then stuck with the bill.
Make it easier for providers to file claims with Medicare
by eliminating a processing system that often leads to legitimate
reimbursement claims being rejected as "medically unnecessary."
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