Ambulance providers strained by lack of reimbursement for treat-at-home cases

Commercial ambulance providers in New York are used to a small number of calls for which they treat patients at home who don’t need or want to be taken to a hospital. Such instances have skyrocketed during the pandemic, however, and the companies aren’t being reimbursed for them.

In the early days of the COVID-19 public health crisis, commercial ambulance providers moved to help ease the burden on local hospitals by treating and releasing patients when it was possible to avoid a transfer. And many individuals opted to stay at home, even after calling for emergency services, for fear of exposure to COVID.

Members of the United New York Ambulance Network note that the cost of business already exceeded the rate of reimbursement for Medicaid and Medicare services. The pandemic and the lack of reimbursement for treating and releasing patients have only compounded the financial strain.

Hanan Cohen, mobile integrated health administrator of Empress Emergency Medical Services, based in Yonkers, says treating and releasing certain patients without reimbursement has historically been an “irritant but tolerable.” But now it's taking a tangible financial toll, as the number of treat-in-place patients is “significantly higher” than at any other time, he said.

Comparing a 30-day period in March and April with the same time frame last year, Empress recorded 1,400—versus 175—treat-and-release patients, Cohen said. The financial hit for the increase was about $700,000.

Since then the number of cases at any given time has been up nearly 300% year over year.

Mordy Lax, community paramedicine program director and training and education manager at SeniorCare Emergency Medical Services in the Bronx, said his company’s experience has been similar to that of Empress in recent months.

The goal in health care consistently has been higher-quality, lower-cost treatment that improves outcomes for people, Lax said. Commercial ambulance providers are helping to achieve that with new ways of attending to patients, but they are being penalized instead of recognized for doing so, he said.

Some of the potential inroads to addressing the lack of reimbursement include the Centers for Medicare and Medicaid Services and Congress, Lax and Cohen said. Congress might need to give CMS the go-ahead to alter reimbursement.

A pilot program through CMS to test reimbursement for emergency medical transportation to alternative destinations, such as a primary-care-doctor’s office or an urgent-care clinic, as well as for treatment in place, was scheduled to begin in May. It was delayed due to the pandemic, however.

Reimbursement help also could come at the state level through Medicaid waivers or discussions with insurers to develop alternate payment models, Cohen said.

In reality, he said, commercial ambulance providers are treating the same group of patients as they always have.

“It’s not a money grab for a larger chunk of the Medicare-Medicaid pie,” he said. “It’s just, quite frankly, the world is changing, and more and more patients are desiring to be treated at home.”