Schumer to push for $2.2M in Medicare funding for ambulances in Westchester, Rockland

[Guest]

WHITE PLAINS - Sen. Charles Schumer announced a bill yesterday that would raise Medicare payments to local ambulance companies grappling with the high costs of fuel and equipment upgrades.

Privately owned, volunteer and municipal ambulance corps in Westchester and Rockland counties would see a combined $2.2 million more in funding in the next two years, a 5 percent increase, if Congress were to pass the Medicare Ambulance Payment Extension Act.

"This is an area not to skimp on because our ambulance services are so vital," Schumer said at a gathering of about 20 ambulance corps personnel at White Plains Fire Station No. 2 on Ferris Avenue. "Medicare's penny-pinching behavior is unacceptable."

The bill comes at a time when those who run ambulance companies, particularly volunteer corps, say they are faced with expenses that exceed their budgets. Higher gas prices, workers' compensation insurance and new drugs are among the most obvious expenses. But pressure to spend thousands of dollars each year for the newest, life-saving technology and global positioning systems, or GPS, are also concerns.

"We don't question where we go or when we go. We don't ask you if you have insurance. We respond no matter what," said Jim O'Connor, senior vice president of operations of TransCare ambulance company.

About 40 percent of patients are covered by Medicare, a federal health insurance for senior citizens and people with disabilities. Ambulance providers must make up the cost when they transport those who are underinsured or uninsured. Private insurance companies often base their payment estimates on Medicare. This makes it difficult to buy new respiratory devices or GPS or give raises to paramedics, O'Connor said.

Some volunteer corps get donations to help with costs, but they often are not enough, said David Raizen, president of the Scarsdale Volunteer Ambulance Corps.

The corps, whose revenue is about half of its $250,000 operating budget, struggles to raise money to upgrade its facilities.

"People don't think about the ambulance until they need one," Raizen said.

Schumer's bill will fit into a broader package being discussed in the Senate that would expand benefits for Medicare recipients. Among them are reducing co-payments for necessary screenings and increasing the availability of intensive, short-term rehabilitation for injuries.

[Guest]

Thank you Mr. Senator!

i hope this Act actually follows through

[Goose 188]

What about the rest of the state, Chuck?

[Danger 160]

What about the rest of the state, Chuck?

The bill is federal, everyone would see a benefit, what are you getting at?

[Goose 188]

Let me break it down:

2.2 million for Westchester and Rockland....

what about Dutchess, Ulster, Colombia, etc. etc. etc. what returns can they see?

[trauma74 111]

A press conference about this was held at the New Windsor EMS HQ on Thursday. I spoke with the Chief from NWEMS who told me that the whole area will be getting the increase.

[tdc202 0]

Is that for the whole region or for each county?

[ex-commish 490]

Would fire district ambulances benefit as well? Does being tax funded knock us out?

[Guest alsfirefighter]

Wow for fuel costs? How about funding for STAFFING!

[tdc202 0]

Because ALS that would make sense to do something like that

[ny10570 745]

Would fire district ambulances benefit as well? Does being tax funded knock us out?

This is suppose to increase medicare payouts, so its not going to affect the fire district based or the agencies that do not bill.

[Medibart 55]

Wow for fuel costs? How about funding for STAFFING!

I personally reminded the good senator of how this bill will benefit the workers, not just allow agencies to buy equipment, fuel etc, at the rally in White Plains. Obviously Chuck and Hillary are in favor of this, I strongly suggest everyone contact their Representative (if you don't know who that is smack yourself in the head then go to http://www.house.gov/ and look it up) and tell them to support this bill.

This change would not only affect Medicare reimbursement but will probably also cue the privates to increase also as they tend to follow the lead of Medicare.

While 5% is not a huge increase, it's at least nice to see legislation that directly benefits EMS.

[Goose 188]

Anyone know if this legislation has a sunset provision?

[helicopper 1,050]

Anyone know if this legislation has a sunset provision?

Try going to the Senate website and search for the actual legislation. Then you'll see exactly what the legislation includes...

ALS - the Senator highlighted fuel costs as one of their incentives for introducing the legislation, it is unlikely that they would prohibit staffing improvements with the added reimbursement.

Medibart - thanks for going and lobbying for us!

HFD - methinks you are out of luck as Fire Districts can not bill for services now.

Let's hope it actually passes and isn't just a pie in the sky, use for self promotion and media attention, bill.

[Guest alsfirefighter]

ALS - the Senator highlighted fuel costs as one of their incentives for introducing the legislation, it is unlikely that they would prohibit staffing improvements with the added reimbursement.

I doubt "they" would prohibit it. But as far as getting others to wake up smell the coffee and do something about their staffing even with the billing returns they have without the incentive is a different story.

Then again, it might be difficult with the amount money some agencies spend on fuel with a bus idling on the pad awaiting a driver or emt to complete a full crew.

Its nice to see the legislation, don't get me wrong. But lets get real also about the other issues and not this little band aid approach for right now. Solid funding, for proper staffing, proper pay, etc. It won't be easy being EMS is so splintered across how its delivered and we all know I am pro fire based EMS, but it can be accomplished.

[Guest]

I am pro fire based EMS, but it can be accomplished.

can you elaborate a bit?

do you mean ems should be run BY the fd or ems should be run LIKE the fd?

[ckroll 101]

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Legislation > 2007-2008 (110th Congress) > H.R. 2164

H.R. 2164: Medicare Ambulance Payment Extension Act

Bill Status

Introduced: May 3, 2007

Sponsor: Rep. Michael McNulty [D-NY]

Status: Introduced

Go to Bill Status Page

You are viewing the following version of this bill:

Introduced in House: This is the original text of the bill as it was written by its sponsor and submitted to the House for consideration.

Text of Legislation

HR 2164 IH

110th CONGRESS

1st Session

H. R. 2164

To amend title XVIII of the Social Security Act to provide for an extension of increased payments for ground ambulance services under the Medicare Program.

IN THE HOUSE OF REPRESENTATIVES

May 3, 2007

Mr. MCNULTY (for himself, Mr. REYNOLDS, Mr. ALLEN, Mr. PICKERING, and Mr. ENGLISH of Pennsylvania) introduced the following bill; which was referred to the Committee on Energy and Commerce, and in addition to the Committee on Ways and Means, for a period to be subsequently determined by the Speaker, in each case for consideration of such provisions as fall within the jurisdiction of the committee concerned

A BILL

To amend title XVIII of the Social Security Act to provide for an extension of increased payments for ground ambulance services under the Medicare Program.

Be it enacted by the Senate and House of Representatives of the United States of America in Congress assembled,

SECTION 1. SHORT TITLE.

This Act may be cited as the `Medicare Ambulance Payment Extension Act'.

SEC. 2. EXTENSION OF INCREASED MEDICARE PAYMENTS FOR GROUND AMBULANCE SERVICES.

Section 1834(l)(13) of the Social Security Act (42 U.S.C. 1395m(l)(13)) is amended--

(1) in subparagraph (A), in the heading, by striking `IN GENERAL' and inserting `FOR THE SECOND HALF OF 2004 AND FOR 2005 AND 2006';

(2) by redesignating subparagraph ( as subparagraph ©;

(3) by inserting the following after subparagraph (A):

`( FOR 2008 AND 2009- After computing the rates with respect to ground ambulance services under the other applicable provisions of this subsection, in the case of such services furnished on or after January 1, 2008, and before January 1, 2010, the fee schedule established under this section shall provide that the rate for the service otherwise established, after application of any increase under paragraphs (11) and (12), shall be increased by 5 percent.'; and

(4) in subparagraph ©, as redesignated by paragraph (2)--

(A) in the heading, by striking `APPLICATION OF INCREASED PAYMENTS AFTER 2006' and inserting `NO EFFECT ON SUBSEQUENT PERIODS'; and

( by adding at the end the following new sentence: `The increased payments under subparagraph ( shall not be taken into account in calculating payments for services furnished after the period specified in such subparagraph.'.

*****

About the Medicare Ambulance Payment Extension Act

The Medicare Ambulance Payment Extension Act (S. 1310, H.R.2164) was introduced on May 3 in the Senate by Senators Charles Schumer (D-NY), Trent Lott (R-MS) and Kent Conrad (D-ND) and in the House by Representatives Mike McNulty (D-NY), Tom Reynolds (R-NY), Chip Pickering (R-MS) and Tom Allen (D-ME). The legislation would implement an across the board Medicare increase of 5% to all ambulance service providers regardless of the state or area in which the transport originated. The two-year relief would apply to just the base rate and not mileage and would commence on January 1, 2008 and expire on December 31, 2009. The legislation is being viewed as an extension of the relief lost from the expiring provisions of the Medicare Modernization Act (MMA)and would not impact the relief currently in place including the 50 plus mileage bump, the regional fee schedule adjustment or the super rural bonus payment. If enacted, S. 1310 and H.R. 2164 would result in an estimated $341 million in additional Medicare relief to ambulance service providers.

[Guest alsfirefighter]

can you elaborate a bit?

do you mean ems should be run BY the fd or ems should be run LIKE the fd?

Neither.

I believe in FD based career staffed EMS systems. Many of the best systems in this country are FD based. It isn't run by the FD, and it isn't run "like the FD." It is ran properly as part of the FD with Firefighters who are EMS providers staffing the system.

Now before anyone wants to chime in with FD's from their area that do EMS for this and that and they don't want to do it.

That is a management issue. I have a simple rule. If you're going to do it. Do it right, if not don't make a bad name for all the FD's in the world who give world class care.

[Guest]

Neither.

I believe in FD based career staffed EMS systems. Many of the best systems in this country are FD based. It isn't run by the FD, and it isn't run "like the FD." It is ran properly as part of the FD with Firefighters who are EMS providers staffing the system.

Now before anyone wants to chime in with FD's from their area that do EMS for this and that and they don't want to do it.

That is a management issue. I have a simple rule. If you're going to do it. Do it right, if not don't make a bad name for all the FD's in the world who give world class care.

gotcha, the idea isn't half bad. whether someone likes or dislikes the idea...either way you'll have better trained personnel.

...and it would eliminate corporate ems...thats a plus

...but i'll keep the neg thoughts to myself...

Edited December 5, 2007 by vacguy

[ckroll 101]

Neither.

I believe in FD based career staffed EMS systems. Many of the best systems in this country are FD based. It isn't run by the FD, and it isn't run "like the FD." It is ran properly as part of the FD with Firefighters who are EMS providers staffing the system.

Now before anyone wants to chime in with FD's from their area that do EMS for this and that and they don't want to do it.

That is a management issue. I have a simple rule. If you're going to do it. Do it right, if not don't make a bad name for all the FD's in the world who give world class care.

Fire based EMS makes almost no sense to me. Requiring medics to be firefighters limits who will want to be a medic and for no obviously good reason. Be it strength or temperament, the fire service is almost exclusively male and I think women can make excellent medics. Fire and EMS are different skill sets. Why arbitrarily limit medics to those who fight fire?

I recall group hysteria at the suggestion that fire service be asked to mow lawns somewhere. Yet paramedics should fight fires? Fire fighter and paramedic are both great jobs. I just think EMS is important enough to be treated as a profession that stands on its own, not as an afterthought.

[Goose 188]

Ckroll, i agree wholeheartedly with above and i appreciate that response.

So, it looks like this bill expires after 2 years sadly...better than nothing i suppose

As a side bar what is corporate EMS? ...did you mean commercial?

Edited December 5, 2007 by Goose

[Guest]

Ckroll, i agree wholeheartedly with above and i appreciate that response.

So, it looks like this bill expires after 2 years sadly...better than nothing i suppose

As a side bar what is corporate EMS? ...did you mean commercial?

yup, i prefer calling it corporate, because that essentially what it is

[Medibart 55]

Try going to the Senate website and search for the actual legislation. Then you'll see exactly what the legislation includes...

ALS - the Senator highlighted fuel costs as one of their incentives for introducing the legislation, it is unlikely that they would prohibit staffing improvements with the added reimbursement.

This is not grant money, this is Medicare reimbursement. All it says is that if you currently recieve $200 for each Medicare bill submitted, you will now recieve $200 + 5% ($210). If you do not bill, you do not get anything. The money will be spent the same way as any of your agency's other insurance billables received: staff, fuel, supplies, capital expenditures etc.

It's not a ton of money though. A very rough estimate - if your agency transports 1000 patients, probably 45% of them are Medicare patients so that's 450 transports. On the average, your agency probably receives about $270 per patient. Five % of that is $13.50 x 450 transports = $6075. So roughly $6000 per 1000 transports or $6 per transported patient. So if you run with a VAC that transported 400 patients so far this year, you would have received an extra $2400. Agencies doing more non-emergency transports probably have a higher percentage of Medicare patients. Agencies with long transport distances will have higher averages due to mileage, but it's a rough estimate.

[x635 4,066]

This is just another EMS band-aid and politco thing. EMS should be it's own entity, just like FD and PD. Goverment funded, civil service. That's what the lobbying should be for-some kind of bill that would help that along.

I would like to see the Senators introduce grants and incentives that help communties form their own civil-service EMS ALS/BLS agency or district. Give the Paramedics and EMT's civil service status, good benefits, job security, and entry into the State Retirment system.

Also, outlaw current pseudo-civil service agencies that staff with per-diem or part time only, make those employers give their employees the benefits they deserve

[ckroll 101]

yup, i prefer calling it corporate, because that essentially what it is

Interesting observation. I think there are two issues here. If by fire based EMS, one means municipal EMS vs corporate/commercial EMS, then I think that municipal service is preferred. Cor/com by its nature, looks to maximize revenue and I question whether the greater good is served by focusing on maximizing revenue stream. EMS management ought to be looking at response times and level of service, training, equipment, and call it, maybe, community contribution. What are times to transport and is ALS available 9/90, are at risk populations being served and are there cost effective bells and whistles that will improve patient outcome?

A municipality can ask the question, "What do we want to provide in terms of service?". Cor/com has to ask,"How can I cut costs and squeeze out a profit?". To some extent, speed, efficiency and value are shared goals. At the end, the question becomes "Did we make money today?" or "Did we meet the needs of our citizens?".

So I would like to rephrase what I said before. I think, in my heart of hearts that well run municipal EMS ought to be the model. If that means the choice has to be fire based or cor/com, I'd enthusiastically support fire based EMS, which without debate provides professional, compassionate care. If the choice can be municipal EMS provided as a stand alone entity whose primary focus is community health or EMS provided as a secondary service by another agency, I prefer EMS as a separate agency. That said, a mixed model might work very well. Dedicated EMS for minimum coverage needs and supplemented by fire based EMS for high volume periods might be good middle ground.

****

It reminds me of a story. Years ago I invited a logger to look at our 'back 40.' Actually, he was at the door begging and on a lark I decided to see what he had to offer. He told me how I really needed a professional to manage my mature woods and how I could get good money for it, no hassles just a fat check in the mail. He promised to take care of things for me. I said it sounded great..... but I wanted him to manage it for sustained harvest. He could only take the largest trees, thin the trash trees, process the waste and stabilize the roads, replant as necessary. Can you do all that for me? He snorted as if I were being foolish. "Yeah, Lady, I can do it right, but then I can't pay you for the lumber."

Maximizing for profit/savings can be entirely different than maximizing for quality. Given current reimbursement rates, even if the Schumer sponsored bill is passed, I don't think there's enough income available without municipal involvement to get us the standard of care most of us would like to see.

[helicopper 1,050]

This is just another EMS band-aid and politco thing. EMS should be it's own entity, just like FD and PD. Goverment funded, civil service. That's what the lobbying should be for-some kind of bill that would help that along.

I would like to see the Senators introduce grants and incentives that help communties form their own civil-service EMS ALS/BLS agency or district. Give the Paramedics and EMT's civil service status, good benefits, job security, and entry into the State Retirment system.

Also, outlaw current pseudo-civil service agencies that staff with per-diem or part time only, make those employers give their employees the benefits they deserve

Admirable goal but that would best be served at the state level. Many states already have some form of this, albeit through the fire service, but there should be a career path for non-FF EMS'ers even in FD's.

New York is the reason we're so backwards. It's because the decisions about EMS are not made with the best interests of the public at heart - they're made by and for whoever lobbies the hardest.