Administration and Leadership

EMS Leaders Discuss Cost Surveying in Medicare Payment Reforms at AAA 2016

The American Ambulance Association (AAA) has led efforts on Capitol Hill to take the initial steps necessary to reform the Medicare ambulance fee schedule. In a session delivered at the association’s annual conference, AAA 2016 in Las Vegas, presenters Kathy Lester of Lester Health Law and Tristan North, senior vice president of government affairs for AAA, reviewed upcoming changes to cost surveying.

The Medicare Ambulance Access, Fraud Prevention and Reform Act guarantees that Medicare increases are permanent and will set the foundation for future reform. The act also:

  1. Changes the status of ambulance service suppliers to that of providers;
  2. Collects data on the cost of providing ambulance services; and
  3. Address fraud and abuse with dialysis transports.

Lester and North stressed the need for EMS to be considered care providers, and the need for cost data in order to drive changes to the fee schedule beyond ambulance transport services.

Currently, there is no standardization in cost collection for EMS, and we must standardize data elements so that we can compare apples-to-apples.

Efforts to standardize costs must include small, rural and what the presenters identified as “super-rural” providers. “If we don’t have this data we will not have a strong voice [on the hill],” Lester said.

At the end of 2017, the temporary Medicare increases will expire. AAA is working to make the temporary Medicare ambulance increases permanent.

The increases need to be permanent to raise the baseline for future payment reform changes. AAA is also working diligently to reduce dialysis transport fraud and abuse. “Creating economic stability is the priority of the AAA,” Lester said.

For the second part of this session, Lester and North were joined by Scott Moore of EMS Resource advisors to discuss key points of AAA’s strategy in lobbying for ambulance payment reform. The AAA Payment Reform Committee is looking at what Medicare reimbursement policy would look like when viewing ambulance agencies as providers of healthcare services, with the data to support changes in ambulance policy. 

AAA understands that it is important to be proactive. As leaders, AAA members need to be looking as far ahead as possible to ensure economic sustainability. The current model of billing only for transportation services is not sustainable. Part of this strategy will include building out community paramedicine services. “We are trying to expand the pie,” Lester said.

To get involved in AAA’s efforts, visit:

Continue the conversation of payment reform at EMS Today 2017 in Salt Lake City, at AAA’s Town Hall Meeting on Payment Reform Feb. 22, 2017 1:00–5:00 p.m.