Prior authorization dramatically lowered the use of regular, non-emergency ambulance transportation among Medicare beneficiaries without affecting quality or beneficiaries’ access to care, according to a government report on Monday. Those are the results of a CMS Center for Medicare and Medicaid Innovation experiment to test whether requiring ambulance service providers to get pre-approval for such services would reduce their use among Medicare beneficiaries with End-stage Renal Disease or pressure ulcers. Researchers found that prior authorization reduced unnecessary use and spending by more than 70%, lowering total Medicare spending by 2.4%.
State regulators have approved a deal allowing Hartford HealthCare to buy Hunter’s Ambulance Service Inc., making it the first ambulance service owned by the health care network. The proposed agreement didn’t require a public hearing, according to a letter from the state dated Friday. The approval paves the way for a stock acquisition for Hunter’s licenses, primary service area responsibilities, contracts and more, said David Lowell, chief operating officer and Hunter’s vice president.
EMSAR, a leading independent service organization (“ISO”) that provides maintenance and repair services nationwide for medical, retail and security equipment, is pleased to announce a strategic partnership with MedPro, a leader in repair and maintenance for emergency medical service (“EMS”) equipment in the Eastern US. As the largest, independently owned, US-based ambulance equipment maintenance and service company, MedPro is a perfect complement to EMSAR’s national footprint and expertise in the EMS and healthcare space. EMSAR’s deep OEM relationships and MedPro’s on-the-ground acumen will better serve clients and their customers.
Ambulance companies rely on growth in volume of reimbursable transports to cover expenses and even turn a profit. But since the COVID-19 pandemic struck in March 2020, Michigan companies have been facing more severe staffing shortages, they have seen volume decline by as much as 40% as people choose not to call 911 to avoid potential coronavirus exposure at hospitals and inter-facility transfers have slowed. Last year, 13 ambulance providers went out of business or merged with another company, according to the Michigan Department of Health and Human Services.
Intermountain Healthcare has signed an agreement to acquire Classic Air Medical, a leading air medical transport company that serves patients in eight western states, including much of the same footprint as Intermountain’s telehealth service network. Classic is headquartered in North Salt Lake, Utah, and operates 28 aircraft (16 rotary-wing and 12 fixed-wing units). Classic completed approximately 5,000 flights in 2020. It has 22 bases primarily located in Utah, Idaho, Nevada, Wyoming, Colorado, Arizona, New Mexico, and Alaska.
Beaumont Health has gained approval from the Michigan attorney general’s office to sell its ambulance division to Superior Air-Group Ambulance Service. AG Dana Nessel gave the green light to Southfield-based Beaumont to sell Community Emergency Medical Service Inc., Parastar Inc., and Beaumont Mobile Medicine to Warren-based Superior. The deal has been in review with the AG’s office since April. Beaumont officials said the deal is expected to close in mid-December. About 500 Beaumont employees will move to Superior, which employs 150 and reported $2.24 million in sales, according to Dun & Bradstreet. Superior of Michigan is part of Illinois-based Superior Air-Ground Ambulance Service Inc.
Nonprofit ambulance company Mobile Medical Response Inc.’s already huge service territory will grow even larger when North Flight EMS merges with the company. Munson Healthcare, which runs North Flight EMS as a wholly owned subsidiary, announced the equity partnership agreement Wednesday. Both are working out a transition plan, and Mark Deponio, Munson Healthcare senior vice president and North Flight EMS president, said the deal is effective Dec. 1. Combining the two ambulance services is about bringing in Mobile Medical Response’s vast resources for everything from vehicle maintenance to electronic health records to staff training, Deponio said.
The Trump administration is expanding a Medicare ambulance model nationwide requiring providers to get prior authorization before scheduling a non-emergent ambulance transport for a patient. But the implementation timeline is still up in the air and will depend on the state of the coronavirus pandemic. Repetitive, scheduled non-emergency ambulance transport (RSNAT) is covered under Medicare Part B for beneficiaries who need consistent medical appointments, usually for dialysis. The model, called the Medicare Prior Authorization Model for Repetitive, Scheduled Non-Emergency Ambulance Transport, was launched in 2014 in a bid to cut down on overuse of RSNAT.
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.
Most air ambulance services are out-of-network, making them too pricey for most consumers, a new study by authors at Georgia State and Wake Forest law schools, the Brookings Institution and the University of Southern California found. The report, which analyzed insurance claims data from Aetna, Human and UnitedHealthcare collected by the insurer-backed Health Care Cost Institute, found more than 75% of patients transported by air ambulance with commercial insurance did not have coverage for the transport. Forty percent faced a balance bill nearing $20,000. Even in-network charges are pricey, averaging about 3.6 times Medicare rates. Although some state regulators have taken small steps toward curbing high air ambulance bills, the study’s authors said the federal government needs to intervene to ameliorate the issue.
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