Emergency Medical Services: Decreasing Revenue and the Regulated Healthcare Environment Will Ambulance Transport Providers Survive?

Abstract

Healthcare systems and EMS ambulance transport providers are struggling to find alternative funding sources because of the decreasing reimbursement dollars from private and public insurance.[i]  Pre-hospital Emergency Medical Services systems are currently struggling to find a balance between the increased federal government involvement, steadily increasing business costs of providing emergency medical care, and the declining reimbursement funds from Medicare and Medicaid.[ii]  CMS reimbursement has decreased their reimbursement but unlike the hospital systems that have been under the regulatory spotlight for reimbursement standards, EMS has recently found themselves held accountable to the same standards as hospital health systems.[iii]  The hospital health systems had to change and remodel their business practices to embrace the government oversight by developing robust internal compliance departments with personnel who had the necessary background and experience to implement effective programs and policies.[iv]  

EMS needs to accept government oversight in their daily practices, just as their hospital system counterparts did years ago, if EMS transport providers want to remain viable in the ever-changing healthcare climate.[v]  Leadership of EMS providers is failing to adopt the regulatory standards and recommendations.[vi]  This is apparent when management neglects to implement effective compliance programs within their current business practices.[vii]  The leadership is unwilling to place key personnel in positions with the ability to implement necessary compliance standards.[viii]  Fire based EMS systems have a difficult time in hiring essential staff who have the credentials and expertise necessary to operate an effective compliance program due to their traditional business structure.  This traditional structure of the fire service relies on internal promotion resulting in fitting the position to the person and not the qualified person to the position.  This practice places Fire Service EMS providers at a disadvantage and leaves them unprepared for the increased scrutiny being placed on their business practices by the Office of the Inspector General (OIG).[ix]  Until EMS transport providers whether public, private, or fire-based systems embrace recommended compliance practices, they will continue to be subject to fines and fees as a covered entity.[x]