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ABSTRACT
Emergency Medical Service (EMS) agencies in the United States have an outdated billing model which treats them more like taxis with base rates and a per mileage fee than healthcare providers. EMS is also not reimbursed in any way for its cost of readiness, the expenses have having EMS units prepared and available for 911 calls 24 hours a day. EMS services do have some unique revenue opportunities, some of which are not well known or considered throughout the industry. Further, the EMS reimbursement system is in need of major reforms. Revenue sources such as community paramedic programs, point of care labs and ultrasound, and specialty care transport should be considered by every EMS agency to see if they fit within their system. As an industry, EMS must come together to advocate for reforms that are vital to recognizing EMS as a member of the healthcare system, not simply a transportation method for patients.
Key words: Emergency Medical Services, EMS, ambulance, paramedic, revenue, community paramedic, point of care
INTRODUCTION
EMS agencies in the United States have a billing process that is often misunderstood by our healthcare leadership peers as it is very different from, and in many ways far behind, typical facility billing practices and revenue streams. There are a number of unique and alternative revenue streams, as well as potential reimbursement reforms, that may help offset high the cost of readiness of EMS, and better encourage quality of care in the industry. EMS is expected to be ready at any time to handle 911 calls quickly, which requires units be ready for calls, invariably creating a utilization ratio that is below 1, often below 0.5. This cost of readiness has never been addressed in EMS reimbursement, rather EMS is effectively reimbursed in a similar fashion as a taxi. There is a "base rate" and then a charge for each loaded mile thereafter, but unlike taxis EMS is expected to be ready at all times, not just during the busy hours. The base rate for EMS depends on the level of care provided, as well as the level of care reasonably expected to be needed by that patient based on the dispatch information. This extenuates an underlying challenge of EMS to be seen...