In this week’s episode of EMS One-Stop, we examine two major financial threats facing EMS reimbursement.
Host Rob Lawrence is joined by Matt Zavadsky to analyze the recent Elevance (Anthem) Health Public Policy Institute paper, which argues that commercial insurers should reimburse ambulance services at approximately 160% of the Medicare fee schedule.
| NEW RESOURCE: What Paramedics Want in 2026
Zavadsky, EMS/mobile healthcare consultant with PWW | Advisory Group, explains why this paper is significant, noting that Medicare already reimburses below the actual cost of providing ambulance services. If policymakers adopt or even believe Elevance’s recommendations, commercial reimbursement could fall dramatically, removing one of the few revenue sources that currently offsets chronic underpayments from Medicare and Medicaid. The discussion highlights the growing influence of commercial insurers in state legislatures and stresses the need for EMS leaders to counter policy proposals with credible cost and operational data rather than anecdotal arguments.
The conversation then shifts to CMS’s proposed Medicaid supplemental payment rule (GEMT), where Matt predicts that most of the proposed changes are likely to survive into the final rule despite industry opposition. Both hosts discuss their review of the public comments, noting differing impressions of stakeholder sentiment but agreeing that agencies should begin financial planning now for a potential reduction in supplemental Medicaid revenue beginning in 2029.
Throughout the episode, the recurring theme is that EMS must become far more effective at explaining both the cost of readiness and the consequences of underfunding. The episode concludes on a more positive note by highlighting the newly released What Paramedics Want in 2026 report as a practical roadmap for improving workforce satisfaction while the industry continues addressing long-term reimbursement challenges.
Additional resources
Key quotes
“The commercial insurance industry is creating a story that elected officials may perceive as reasonable. We need to combat that story with facts.” — Matt Zavadsky
“Medicare reimbursement is already below cost, so using it as the benchmark automatically discounts ambulance services.” — Matt Zavadsky
“We do a great job telling stories about the lives we save. We do a poor job telling the story of what it costs to provide that service.” — Matt Zavadsky
“The balance billing issue is going to be the No. 1 issue in the next 12 months.” — Matt Zavadsky
“The first time local elected officials hear there’s a problem is usually when the sky is already falling. We need to tell the story before the sky falls.” — Matt Zavadsky
“Know your costs; know your costs at different service levels, and begin educating your local community.” — Matt Zavadsky
“This isn’t necessarily good news, but it’s something we need to understand and all work together to deal with.” — Rob Lawrence
Episode timeline
00:00 – Introduction and the Elevance Health Public Policy Institute report
02:00 – Matt explains who Elevance Health is and why the report should be viewed as a commercial insurer’s policy position
03:30 – Discussion of state balance billing legislation and how commercial insurers are successfully pushing lower reimbursement benchmarks
06:15 – Breakdown of what percentages of Medicare actually mean using national EMS financial data
08:30 – Why using Medicare as the reimbursement benchmark is fundamentally flawed because Medicare itself pays below cost
10:30 – Discussion on the political influence of insurers and why EMS must counter with data-driven messaging
12:30 – Why EMS has historically struggled to tell its financial story despite being effective at telling patient care stories
14:20 – Matt predicts balance billing legislation will become the industry’s No. 1 policy issue over the next year
16:10 – Potential consequences if commercial reimbursement falls to 160% of Medicare
17:30 – Discussion on community funding, essential service models and matching service expectations with available revenue
22:20 – Transition to CMS’s proposed Medicaid supplemental payment (GEMT) rule
22:45 – Review of public comments submitted on the CMS proposal and differing observations about stakeholder support
25:00 – Matt predicts the CMS rule will largely move forward and agencies should prepare accordingly
27:45 – California and other states discussed as examples of systems likely to experience significant reductions in supplemental Medicaid funding
30:45 – Closing on a positive note with discussion of the What Paramedics Want workforce survey
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