Ambulance Providers Brace for Fee Fight

Ambulance providers were dealt a blow in November 2012 when the Medicare Payment Advisory Commission (MedPAC) voted to recommend to Congress that temporary fees added to service payments be eliminated. With the temporary fees in effect since 2004, the industry has supported efforts to make them permanent, arguing that the cost of supplying service exceed the reimbursements they receive. (See November 2012 Capitol Report.)

In addition to eliminating the “add-ons” of 2 percent and 3 percent for urban and rural transports, respectively, MedPAC recommended eliminating a permanent 50 percent rural mileage add-on for trips of 1 to 17 miles. It suggested using these monies to create payments to improve service by low-volume ambulance providers in extremely rural areas that are reimbursed at significantly below cost.

Ambulance providers argue that some of the decisions were based on flawed data and assumptions about the industry. For instance, the Government Accountability Office (GAO) released a report in October 2012 on Medicare margins for transport providers in 2010, the most recent year for which data are available, and found that with the add-on payments, the median Medicare margin for providers was about 2 percent, slightly above their transport costs. When the GAO removed the add-on, the median margin dropped to minus 1 percent. But the GAO also found, even with the add-ons, a wide variability of margins for providers in its sample, from minus 2 percent to plus 9 percent. Without the add-on payments, the margins ranged from minus 8 percent to plus 5 percent. This variability led the GAO to conclude that it was unable to determine whether the providers represented by the sample had a positive or negative margin.

The study, “Ambulance Providers: Costs and Medicare Margins Varied Widely; Transports of Beneficiaries Have Increased,” is here.

MedPAC announced its recommendations to Congress prior to its June 2013 deadline because the temporary add-ons were scheduled to expire on Dec. 31, 2012, and it wanted to release its data prior to that date.

A transcript of the MedPAC meeting is here.

FirstNet Announces Advisory Board

Chief Harlin McEwen was appointed chairman of the First Responder Network Authority’s (FirstNet) Public Safety Advisory Committee (PSAC) in November 2012, the same month four vice chairs were appointed to the PSAC by FirstNet’s board chairman, Sam Ginn.

McEwen is chairman of the Public Safety Spectrum Trust Corp., the not-for-profit organization selected by the Federal Communications Commission as the public safety broadband licensee for the 10 MHz of 700 MHz public safety broadband spectrum. He was formerly deputy assistant director of the Federal Bureau of Investigation, and communications adviser to the Major Cities Police Chief Association, the National Sheriffs Association and the Major County Sheriffs Association. He is also chairman of the International Association of Chiefs of Police.

The organization also announced that the vice chairs appointed to serve on PSAC are Chief Bill McCammon from Alameda County, Calif., representing the Metropolitan Fire Chiefs Association; Paul Patrick from Salt Lake City, representing the National Association of State EMS Officials; Heather Hogsett from Washington, D.C., representing the National Governors Association; and Tom Sorley from Houston, representing the U.S. Conference of Mayors.

FirstNet was created by the Middle Class Tax Relief and Job Creation Act of 2012 with a mandate to improve communications among first responders following the events of Sept. 11, 2001. The legislation creates FirstNet as an independent authority within the National Telecommunications and Information Administration at the U.S. Department of Commerce and requires the board to establish a standing PSAC to help it carry out its responsibilities.

The FirstNet board held its inaugural meeting Sept. 25, 2012, at the U.S. Department of Commerce in Washington, D.C. Links to the board’s actions and resolutions from that meeting are at A transcript and archived webcast are here.

EMS-C Grant Deadline Announced

A funding opportunity under the EMS for Children Targeted Issues (TI) Grants was announced in October 2012.

The TI Grants are designed to improve EMS for children through innovative approaches in research. The three program goals are to improve pediatric emergency care by utilizing pilot studies to improve the science and evidence base; provide national models for quality improvement; and develop national resources to improve care delivery.

The total estimated funding is $2.1 million, with seven grants expected to be awarded with an estimated award ceiling of $300,000. The TI Grant application is expected to be released in January with a due date likely in March 2013; among the eligible institutions are accredited medical schools and state governments. The anticipated start date of the grants is September 2013.

Contact information and additional details are here.

Seat Belt Use at Record High

With residents of the southern states increasing the rate at which they are buckling up, seat belt use in the United States has reached a record high, according to the National Highway Traffic Safety Administration (NHTSA).

New NHTSA research, the annual National Occupant Protection Use Survey, shows national seat belt use reached 86 percent in 2012. While this number represents a 2 percent increase over the previous year, the most dramatic increase was seen in the southern region, where use rose 5 percent, up from 80 percent in 2011.

The study found that seat belt use is still highest in states where non-use of a seat belt alone is a law-enforcement violation. Thirty-two states and Washington, D.C., have the “primary” seatbelt law; 17 states have secondary laws requiring additional violations before a citation can be issued. New Hampshire is the only state with neither type of seatbelt law on its books for adults over the age of 18.

The agency’s report, published in November 2012, is here.

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