When I started in the business in the mid-1980s, I worked for a private ambulance service in the suburbs north of Boston. We handled 911 and interfacility transports; it was fairly normal to run emergency calls through the night, and end the shift by transporting a scheduled transfer at 6 a.m.
One of these runs was a quiet, older woman who would walk slowly out of her home, cane in one hand and lunch bag in another. We would help her into the passenger seat of the ambulance, and the EMT would ride in the back on the way to her dialysis appointment.
As a young gun, I was frustrated by these runs. It seemed pretty straightforward that she should use a taxi and not one of the town’s 911 ambulances for her “convenience.” Why was it that I had to be the cab driver?
The answer came in the form of a tongue lashing from the general manager ─ it got reimbursed quite well by insurance. If I didn’t like that fact, he pointed out, I could go work somewhere else.
Eventually, I did ─ although the lesson wasn’t lost on me. The financial tail that wags the EMS dog is a pretty long one. The news about Medicare requiring seniors in Pennsylvania, New Jersey and South Carolina to get prior approval from Medicare before they can get an ambulance to take them to cancer or dialysis treatments is surprising, and it’s sad that the patient has to take on this responsiblity.While there is no excuse for intentional fraudulent billing, it doesn’t take a rocket scientist to figure out that certain practices may not make sense medically, but they do financially. I can see how easy it would be to go with the financial flow and direct precious resources there.
Yet these practices are unnecessary and contribute to the ballooning costs of healthcare. As a taxpayer I want our governments to be fiscally responsible in all aspects of their operations, and to pay for services that benefit patients and reduce waste.
Why is it that Medicare/Medicaid doesn’t pay for a taxi for a routine, scheduled medical appointment? It would seem such a small price to pay for a service that contributes to the long-term health of a chronically ill patient.
Might such changes reduce the need for ambulances? Possibly. But that’s no reason to inappropriately utilize resources simply for financial gain. We can do better than that.
