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This change would be consistent with the EMS Agenda for the Future document (see the October 1998 EMS column, "Mapping Our Future"). In essence, fire departments could save money for federal programs by triaging and assessing patients at the scene, providing on-scene care, treating and releasing, or transporting to an alternative medical facility instead of a costly emergency department.
The Balanced Budget Act has made the private ambulance industry quite nervous. After all, a great percentage of its income over the years has been derived from Medicare - especially in the area of inter-facility transports. In preparation for the negotiated rule-making process, the AAA, which mostly represents the interests of the private ambulance industry, has paid $300,000 to contract with an independent agency to examine the cost of ambulance transports on a nationwide basis.
Under the contract, the Project HOPE Center for Health Affairs will gather data on the cost of providing ambulance service. After completion of the data gathering, Project HOPE will develop proposed fee-schedule models based on a relative-cost approach. The AAA then plans to use this fee schedule in meetings with HCFA to validate what ambulances should be reimbursed. One position the AAA will take is that the new fee schedule should recognize the "cost of readiness" for EMS providers.
There will also be differing opinions on reimbursement for treatment versus transport. The AAA has no disagreement with the IAFC and the IAFF positions, but contends the money budgeted for first responder fees should not come from the existing "pot of money." This is highly unlikely, since HCFA is going through this process to reduce cost to the Medicare program, not increase it.
Ambulance reimbursement for fire agencies doing EMS transport is certainly an important component. Fire agencies need to be fully aware of all reimbursement issues that may affect their operations.
Gary Ludwig, MS, EMT-P, a Firehouse® contributing editor, is the chief paramedic for the St. Louis Fire Department and is currently serving his fourth term as an elected member of the EMS executive board for the International Association of Fire Chiefs. He was awarded Missouri's EMS Administrator of the Year for 1998.