by Julius A. Karash, former longtime business writer for the Kansas City Star
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Once again, Northwest Missouri’s emergency medical service providers and their patients face a crisis due to pending cuts in Medicare payments.
Medicare reimbursement rates to ambulance services are scheduled to be cut Dec. 31. The cuts would reduce payments to all critical ambulance services, both urban and rural, but emergency service providers in remote rural areas would be hit especially hard, with funding reductions of up to 27%.
As proposed, the cuts would lop a combined total of $6.64 million out of the operating budgets of 217 Missouri ambulance services. The majority of ambulance providers are small operations with fewer than 10 ambulances, and they often are the only provider of emergency medical services in their community.
Reductions in reimbursements were first implemented on Jan. 1 of 2010, only to be reversed last spring, when Congress extended payment increases of 2% for urban transports and 3% for many rural transports, via the Patient Protection and Affordable Care Act. Congress also extended a payment boost of 22.6% for ambulance transports in remote "super rural" areas. Those provisions expire on Dec. 31.
"It has been a challenge for Missouri ambulance services to wait every year for Congress to extend ambulance relief payments needed to continue services," said Bob Patterson, president of the Missouri Ambulance Association. "This past year it was March before Congress renewed the ambulance service rates paid by Medicare. EMS directors and administrators struggle to prepare budgets and make improvements such as vehicle and equipment replacements.
"We are hopeful that Congress can establish a permanent fix for this problem, instead of perpetuating an annual crisis that threatens the ability of Missouri ambulance services to maintain critical emergency medical services for the citizens of Missouri," Patterson said.
Medicare reimbursement represents a large portion of total payments for ambulance service providers, with Medicare patients comprising about half of all ambulance transports. With senior citizens comprising a larger segment of the rural population, ambulance services in remote areas could lose more than 10% of their annual operating revenue if the Medicare cuts are enacted.
The Government Accountability Office reported in May 2007 that ambulance providers on average are paid 6% below actual costs – 17% below costs in remote rural areas – to transport Medicare patients. Portions of rural Missouri already have seen some of the lowest Medicare ambulance reimbursement rates in the country.
Officials note that Missouri ambulance services already are facing financial duress from the recession’s downward pressure on sales tax and property tax revenues. They say if not stopped in time, these latest Medicare cuts will cause critical staff reductions, delayed purchases of new equipment and reduced services – all of which could jeopardize the safety and outcomes of elderly ambulance patients.
"The upcoming cuts in Medicare will have a serious impact on our service," said Barb Shupe, administrator of the Grand River Regional Ambulance District, which covers all of Gentry County and parts of Andrew, Harrison and DeKalb counties. "We had a $28,000 deficit budget for our fiscal year that ended Oct. 31. This is the first deficit budget in the history of our service. Where do you make cuts when you are already squeezing every dollar you can? The major cuts are going to be in staff. We are a predominately volunteer service, which is slowly fading away."Shupe added that Grand River also was forced to cut its training budget, "which will limit staff attending training outside of our district, and there is no money in the budget for any new equipment this year."
The Missouri Ambulance Association says that for the health of Missouri’s ambulance providers and their Medicare patients, Congress must extend the emergency Medicare Relief provisions of the health reform act and stop the pending cuts to emergency providers.
If a reprieve is to be forthcoming, Congress must take action before the scheduled Dec. 31 expiration of the current rates.