Pa. EMS directors say reimbursement legislation is not enough
Bill ties state’s Medicaid reimbursement rates to federal Medicare rates, paying whichever is higher, and removes 20-mile travel exemption
By Patrick Varine
Nov. 2—Recent state legislation will increase the reimbursement local ambulance services receive when treating Medicaid patients, but EMS directors said they still are running in the red most of the time.
“Every little bit helps,” said Darrick Gerano, director for Murrysville Medic One. “Any increase we can get from any insurance is a win for us. It’s a definite improvement, but it’s still not enough.”
Act 15, part of the omnibus House Bill 1351 that passed both state chambers in mid-October, ties the state’s Medicaid reimbursement rates to the federal Medicare rates, paying whichever amount is higher for services such as basic and advanced life-support ambulance trips.
It also removes a reimbursement exemption for the first 20 miles an ambulance travels on a Medicaid transport. That is good news for New Kensington Ambulance Services EMS Manager Addie Birch.
“That’s the biggest thing, at least as far as mileage,” Birch said. “Our closest hospitals are five and 14.7 miles away, so we’ve never gotten any reimbursement for transporting those patients.”
The Tribune-Review reported in early October about how many EMS companies are stuck with an unsustainable funding model and a shrinking workforce.
Ambulance service officials say the biggest culprit crushing their business model is bottom-barrel insurance reimbursements. Providers get paid 30% to 60% of what they spend to care for patients from insurance companies.
Sometimes, that amount doesn’t even arrive.
“At times, you’ll transport a patient who has, say, Highmark and (a high-level) ‘Cadillac’ plan,” Birch said. “They get transported, and then Highmark sends them a check, and it never comes to us for reimbursement. We finally contracted with Highmark, and we’re now in a situation where we can count on getting at least a third of what our reimbursement is supposed to be.”
For Murrysville Medic One, as well as Mutual Aid Ambulance Service in Greensburg, the new legislation won’t affect their bottom line much because they don’t perform a large number of Medicaid transports.
“Medicaid is only about 15% of our service area, so we’re not going to see a huge increase. But it does help us reduce our deficit,” said Dan Mertz, deputy direction of operations at Mutual Aid. “I appreciate our state legislators for realizing that there’s a crisis and doing everything within their power to help alleviate that. We’d like to see initiatives like this continue to help ambulance services.”
Birch said, after all the costs are calculated, it is $753 to send a New Kensington EMS vehicle to a Medicaid call.
“It’s a huge win and a step in the right direction to try and increase reimbursement because that’s what we depend on,” he said. “But we lose money every time we go out the door to take any Medicare or Medicaid patients.”
Mertz and Gerano agreed.
“We’re still losing money on reimbursements,” Gerano said. “We’re just not losing as much now. It would be nice if they could bring it up to at least cover our costs.”