Fixes Medicare ‘No Transport’ Loop Hole

The White River Valley Ambulance headquarters was host Friday to U.S. Sen. Peter Welch, who, along with representatives from the rest of Vermont’s congressional delegation, was in Bethel to announce the introduction of a bill called EMS ROCS, which could help ambulances remain solvent in the face of rising costs.

EMS crews, Welch said, “show up no matter how inconvenient it is” to help out when they get a call and in many cases aren’t able to recoup the costs associated with providing emergency medical care.

According to national data, between 20%-30% of ambulance calls don’t require transportation of a patient. What many don’t realize is that ambulance services can’t bill insurance for those “no-transport” calls.

Matt Parrish, the executive director at WRVA, said that his outfit is seeing about 30%.

During the brief ceremony at WRVA, Welch noted that the “reimbursal rate that Medicare provides is insufficient already. It puts enormous stress financially on the communities and folks who are providing these absolutely critical services.”

The lack of reimbursement for no-transport calls puts an even bigger strain on ambulance services, he added.

“There’s expense for EMS— they’ve got to be ready, they’ve got to be on call, they’ve got to deliver the services—but they don’t get reimbursed,” Welch said. “It’s not just unfair, it’s essential that we maintain the financial stability of EMS so it can be there for Vermonters when they need it.”

The EMS ROCS bill, which Welch introduced in the Senate with support from Sen. Bernie Sanders, proposes to amend the Social Security Act so as to enable Medicare to cover the costs of ambulance visits “regardless of whether the provider or supplier provides the transport for the individual at a reimbursement comparable to the transport reimbursement.”

In the Senate, that’s bill number S.3236. Rep. Becca Ballint has introduced a similar bill in the U.S. House (H.R.6257).

On hand for Sen. Welch’s announcement, James Finger, who heads the Vermont Ambulance Association and works on the Rutland Regional Ambulance Service, gave a common example of such calls. Elderly people, he said, often call for help after they’ve suffered falls. In many cases, they need a hand to get upright and to treat whatever injuries they may have sustained, but many times, first aid is all that’s necessary.

In those cases, Finger said, ambulance services foot the bill for the crew, supplies, and operation of the ambulance itself.

Drew Hazelton of Brattleboro’s Rescue, Inc. highlighted the importance of getting patients the best possible treatment, “which quite often is in their homes.”

Financials

Parrish noted that WRVA, which gets part of its funding from the 10 towns it serves, has been cautious in keeping budgets as low as possible, which has meant holding off on buying new equipment in recent years.

Being able to bill for that missing 30% of its calls, Parrish said, would help greatly.

With Town Meeting Day around the corner, WRVA has compiled its annual budget, along with requests for funding from its 10-town coverage area. In most towns, that will appear among other individual requests for funding.

This year’s budget will increase the per-capita request by $7.

No-transport calls are not the sole issue challenging ambulances. Parrish noted that only about 57% of WRVA’s billing is actually recouped. According to WRVA’s balance sheet, the ambulance corps’ $1,542,113 of expenses in 2023 are anticipated to include a cash deficit of $947,514, once figures are finalized. It’s that portion that payments from the member towns largely cover. In 2024, WRVA anticipates an 8.5% increase in that deficit.

The proposed bill to area towns is set at $991,845 for 2024, which will leave the ambulance service to eat an anticipated $36,247 not made up elsewhere.

According to numbers from the 2020 census, the WRVA service area includes 12,555 people and, Parrish said, for the past few years, the service has responded to about 1,600 calls each year.

Finding Unity

Even though it’s the Vermont delegation standing behind the EMS ROCS bill, Welch said he hopes it will have universal appeal.

“It’s exactly the kind of thing where we can find unity,” he said.

Welch added that Vermont’s congressional delegation has a real interest in healthcare delivery and have met each year with Vermont EMS crews and Finger in particular to hear about challenges in the industry.

“These folks here,” he said, gesturing to Finger, Hazelton, and Parrish, “brought to our attention this incredible situation where they provide a service and don’t get paid.”

Welch said he’d brought the issue to the attention of several colleagues at the Capitol and they were unaware that there was such a problem in their own districts.

“The reason I have some optimism about [the bill] is that you’re in a red state or a blue state, it really doesn’t matter. You care about having emergency services be available to the people you represent,” Welch said. The problem, he added, “just wasn’t known.”

In Vermont, ambulances answer about 118,000 calls each year, according to Hazelton.

“It’s really reassuring that someone answers the phone,” Welch said.

Story Written by Tim Calabro, The Herald

Story Link: https://www.ourherald.com/articles/welch-unveils-bill-to-help-ems/