EDITORIAL: Medicare test to help ambulance services is sound

Walla Walla Union-Bulletin (WA)

Feb. 19--The city of Walla Walla has a top-tier ambulance service with excellent equipment and it's staffed by highly trained paramedics.

Unfortunately, keeping a high-caliber ambulance service in this community, as well as every city in America, is at risk because Medicare and private insurance doesn't always fully reimburse for providing this lifesaving service.

Walla Walla and other local governments, including fire districts in this Valley, have been focused on filling in the gaps in insurance payments with taxes and fees.

Last week, Medicare officials launched a pilot project aimed at reducing financial losses to ambulance services. This could spawn further changes to steady the looming financial crisis of local ambulance services.

Medicare's experiment aims to change how the federal insurance program for older Americans pays for emergency ambulance services. It is doing this by giving seniors who call an ambulance for aid more options for a covered transfer than going straight to a hospital emergency room. The financial rub in this is that some patients wanted to go somewhere besides an ER and Medicare would not fully reimburse fire departments for their service.

Of course, as anything to dealing with insurance (as many of us have personally experienced) it can very complicated. This could be a tiny step toward making thing simpler -- and more fair.

"We definitely think this is intriguing and exciting, but it really does need to be monitored very closely," Julie Carter, a federal policy expert with the Medicare Rights Center, which advocates on behalf of beneficiaries, told The Associated Press. "We see this as a potential opportunity to keep people out of the ER when they don't need to be there."

This pilot project was spawned from the Center for Medicare and Medicaid Innovation, created under the Affordable Care Act as a way to improve quality and reduce wasteful spending in the Medicare and Medicaid. Innovation Center Director Adam Boehler said he was astounded to learn that under current rules Medicare will only pay for emergency ambulance services if the patient is going to a hospital. Transportation to rehab centers or nursing homes, as well as dialysis facilities, were not allowed in most cases.

Boehler called Medicare's current policy a "ridiculous incentive" to funnel patients to the most high-cost setting. Most private insurance plans discourage emergency room use by imposing higher copays, and some state Medicaid plans are trying similar tactics.

Trying to infuse reason into insurance rules is a mammoth task, but even some progress could save million of dollars -- and, perhaps, some local ambulance services.

Editorials are the opinion of the Union-Bulletin's Editorial Board. The board is composed of Brian Hunt, Rick Eskil, James Blethen and Alasdair Stewart

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