Private ambulance services and fire departments in two New England states are widely criticizing insurance carriers’ recent practice of cutting checks to patients instead of reimbursing EMS providers directly. In a move that it says will “encourage” EMS providers to join its network, Blue Cross Blue Shield (BCBS) of Massachusetts started sending checks for ambulance transport/EMS to patients last year.
EMS organizations say the tactic delays reimbursement, forces them to incur costs in an effort to collect from patients and invites fraud—all in an attempt by insurers to coerce providers into accepting lower rates.
“[Blue Cross Blue Shield’s] sole motivation is to force ambulance providers into contracting with them, and forcing them into giving drastic discounts,” says Brian Connor, chief executive officer of LifeLine Ambulance Service in Woburn, Mass., and past president of the Massachusetts Ambulance Association. “Unfortunately, the rates they want to pay aren’t sufficient.”
While BCBS’ practice doesn’t apply to municipal ambulance services, private ambulance services throughout the state are struggling to collect from patients and have taken a significant financial hit as a result, Connor says.
Sending payment directly to patients instead of health care providers isn’t new, says Tara Murray, director of corporate communications for BCBS of Massachusetts. “We have been doing this for years with out-of-network emergency, radiology, anesthesiology and pathology providers and have now expanded this to include private, out-of-network ambulance providers,” she says. “Private, out-of-network ambulance companies have been charging our customers rates that are, on average, 300 to 500 percent above what Medicare pays them for the exact same service. This pay-subscriber initiative encourages private ambulance companies to join our network at more reasonable rates.”
The Massachusetts Fire Chiefs Association and the Massachusetts Ambulance Association have supported a bill that would compel BCBS to send checks to the EMS service rather than the patient. “About 50 percent of the time, the patient is going to keep the check vs. passing it on to the ambulance provider,” Connor says. “Ambulance services are having to add full-time staff to chase people, and literally we’ve had patients that have kept checks and said, ‘I’m not going to pay you. Take me to court.’ Some people are getting thousands of dollars of income.”
In a recent widely publicized case, a patient admitted to defrauding an ambulance service in Lowell, Mass., of thousands of dollars. The patient, a drug addict, told police he had repeatedly been transported by ambulance to receive checks from BCBS, which he simply cashed without paying his ambulance bill.
The ambulance association’s members have reported drops in revenue ranging from 10 to 45 percent, Connor adds.
In September, the New Hampshire Ambulance Association successfully lobbied to pass legislation prohibiting insurers from sending checks to patients instead of providers. In New Hampshire during the 1990s, most ambulance providers had preferred provider agreements with Anthem Blue Cross, says Scott Hodgkins, owner of BestCare Ambulance in Laconia, N.H., and president of the New Hampshire Ambulance Association. But after 2000, Hodgkins says, the insurer began offering reimbursement that was below what Medicare paid, and many providers left the network. Anthem Blue Cross responded by sending checks to patients instead of ambulance providers.
“A lot of people spend this money like it’s found income,” Hodgkins says. “Some people were using it to fill up their gas tank and feed their kids. We ended up chasing these people, and it was a nightmare. We were collecting about two-thirds of what we were billing.”
New Hampshire’s new law, which goes into effect Jan. 1, will take financial pressure off the ambulance providers, but it’s also better for patients, Hodgkins says. “They were being taken to collections, their credit was being ruined, and chasing them was adding to the cost of doing business.”
City of Los Angeles Mulling 911, EMS Fee
The chief legislative analyst for the city of Los Angeles has proposed a voluntary EMS fee to make up for budget shortfalls that have led to a series of cuts over the past two years.
Though nothing has been decided and the idea needs more study, the proposed fee could be $5 to $10 on a bi-monthly water and power bill. Assuming 10 to 15 percent of residents participate, that would raise $5 to $10 million annually for the city, according to an Aug. 10 report. The chief legislative analyst is an independent adviser to the 15-member city council.
Paying the fee would entitle insured residents to emergency medical services with no out-of-pocket costs and a reduced bill for those without insurance.
The report cited other municipalities that use voluntary fees, including Anaheim (Calif.) Fire Department’s Paramedic Membership Program, which gives residents and businesses the option to pay $3/month (or $36/year) instead of receiving a charge of $350 for medical aid given at the scene (transport is billed separately). Exemptions are available for those with incomes of less than $25,000.
Nearby Loma Linda has a similar program in which for $48 a year, subscribers receive EMS response at no out-of-pocket cost. Non-subscribers who are residents are charged $300 per EMS call, while non-residents are charged $400.
Other options floated in Los Angeles include a $342 “treatment/non-transport” fee for medical attention provided at the scene of the injury that doesn’t result in a transport. That would raise $3.5 million annually.
For more information on the L.A. proposal, visit huffingtonpost.com/2011/08/19/los-angeles-emergency-fees_n_931684.html. To read more about Anaheim’s program, visit anaheim.net/article.asp?id=372.
Survival for Witnessed Cardiac Arrest Continues to Improve in Seattle-King County
Just under half (49 percent) of patients who experience witnessed sudden cardiac arrest and who have a shockable rhythm (ventricular fibrillation) survive to hospital discharge in Seattle-King County, Wash. That’s up from 46 percent in 2009 and the highest survival rate in the region to date, according to the King County Emergency Medical Services 2011 Annual Report, released in September. In 2010, the EMS system responded to 210,719 calls to 911, 47,012 of which were for advanced life support. The average response time remained steady at 7.6 minutes.
“Patient survival from cardiac arrest is one of the most critical measures of success for any EMS system, and survival rates in King County make our system the gold standard,” says David Fleming, M.D., Seattle-King County’s director and health officer for public health.
Among the initiatives that further boosted the system’s already high CPR survival rates was a pilot program to provide police in Bellevue and Kent with 100 AEDs and training all police officers on hands-only CPR and AED operation. As of Feb. 1, dispatchers also began sending police in those cities to cardiac arrest calls. Police arrived before EMS in 18 of 64 cases, or 28 percent of the time. Police applied an AED 15 of 18 times when they arrived first. Of those, four patients had a shockable rhythm, and three of the four survived to discharge.
Since the pilot started in February, five more police departments in King County have equipped patrol cars with AEDs and police there are responding to cardiac arrests. “We hope to see the Police Defibrillation Program continue to help bolster the effort to increase survival from cardiac arrest in King County,” the reports states. The full EMS 2011 Annual Report is available at kingcounty.gov/health/ems.
