Friday, December 16, 2016

EMS Facing Uncertainty in 2017

Happy New Year!

We’re just two weeks from shouting Happy New Year! The year 2017 is just around the corner and the ambulance industry faces unusual uncertainties surrounding funding and reimbursements in the upcoming year.

EMS Facing Uncertainty in 2017

Just before we begin the two-week celebration of Christmas and New Years Day, we thought it fitting that we take a few minutes to look at what 2017 brings.

Obamacare

Other than his becoming the first African-American President in our nation’s history, Barack Obama’s legacy will forever be entwined in the successful passage of the Affordable Care Act (ACA), most commonly referred to after his namesake, “Obamacare.”

While touted to be the ultimate “fix” for America’s healthcare insurance woes, the reality of the ACA is that it has not had the desired effect Americans had hoped for. Now, our President-Elect and a majority Republican Congress, has vowed to repeal the ACA.

But what comes next?

We find, especially in the ambulance industry, that bad debt is growing, charity care is increasing, patient collections are down and providers consistently struggle to collect bills where patients have no insurance. Billing complexities increase with regulatory changes and most importantly higher deductibles have equated into painful decreases in reimbursement to providers.

While the hope was for millions of people to acquire healthcare coverage cutting patient responsibility dollar amounts, the reality of the ACA has been coverage that carries high deductibles, resulting in many cases increased patient balances owed to EMS agencies. Payer shift to Medicaid and Medicaid managed care for those economically challenged individuals means significant underfunding well below our costs to provide vital EMS services to the communities we serve.

Insured but not…

According to the Association of Credit and Collection Professionals (Pulse, October 16, Vol. 32, No. 10, “Succeeding in the Changing Healthcare Industry”, Sornberger); “Statistics show the uninsured or “true” self-pay percentage has decreased from 16 percent in 2009 to 9 percent today. However, the mix of those who are newly insured tend to have high-deductible plans. According to the Centers for Disease Control and Prevention, 25 percent of plans issued in 2010 were high-deductible, compared to 36 percent today.”

The article goes on to explain that the healthcare industry, including the ambulance industry in our opinion, is experiencing a reality check thinking self-pay responsibility would go away but instead finding that patient pay is now the number three payer across all healthcare disciplines behind Medicare and Medicaid.

People are insured, but basically in name only as one-time use allowances are being applied to deductibles shifting payment burden for ambulance bills back to the patient. As proof of this shift, The Kaiser Family Foundation reported last year the average deductible is now $2,099, which is a whopping 70 percent increase from 2010!

Will the new Administration be able to turn this trend around? Will Congress finally recognize the tenuous position of reimbursements and enact reform for our industry to stem rising premiums and deductible amounts?

Medicare Bonus Payments

Credit the American Ambulance Association for ratcheting up the dialogue surrounding reimbursement reform. Of course, the big ticket item on the horizon this year looks ahead to next year this time when the Medicare Ambulance Bonus Payments are set to expire on December 31, 2017.

Even with the bonus payments, Medicare payments still underfund us. Imagine if the bonus payments are allowed to expire without a permanent fix? The ambulance industry will lose millions of dollars further critically straining a system which is struggling to hang on by a shoestring.

Congress must pass a permanent funding initiative to plug the hole in Medicare reimbursements once and for all and spearhead an initiative to force States to increase Medicaid spending for EMS.

Opiate Crisis Strains EMS

According to the Centers for Disease Control and prevention (CDC), drug overdoses are now the leading cause of injury-related mortality in the United States. Drug overdose deaths have increase by 137 percent over the last 15 years. Opiods- prescription painkillers and illicit drugs like heroin- caused the majority of that increase, says the CDC. The National EMS Information System reports that EMS providers encountered more than 430,000 drug ingestion patients in 2014.

Imagine what that number has grown to in 2016 with no end in sight for the New Year.

American EMS is on the front-lines in this epidemic battle and it is costing us big bucks. EMS agencies are struggling to keep up with the increased volume of drug-related incidents and the costs of caring for overdosed individuals are rarely reimbursed. The majority of overdose patients fail to carry even base healthcare insurance coverage. These people wind up incarcerated or die from their drug abuse and the result is expense without compensation for EMS.

Local, State and Federal officials must address this crisis in 2017 to relieve the financial and operational strain on EMS systems across the Country.

The Ambulance Billing Services blog is brought to you as an educational tool by Enhanced Management Services, Inc. Enhanced Management Services, Inc. is an all-EMS third-party billing contractor serving Fire/EMS agencies across the United States. To learn more about who we are and what we do, please visit our website at www.enhancedms.com and click on the “Get Started” button on any landing page.

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