Administration and Leadership, EMS Insider, Legislative Update

Join AAA in Fighting for the Future of Ambulance Organizations

American Ambulance Association

To this day, ambulance organizations in the United States are still the only healthcare provider that delivers care regardless of a patient’s ability to pay. When you call 9-1-1, the medics show up and immediately begin providing care. No one asks for an insurance card, or a credit card. They ask questions regarding the patient’s medical history and whether there’s anything they need to know to provide better patient care.

Ambulance organizations provide more uncompensated care than any other healthcare professional in the U.S. Even under the Emergency Medical Treatment and Labor Act (EMTALA), hospitals are not required to care for all patients, only those who are in an emergency situation and required care to be stabilized. Ambulance organizations, on the other hand, must be ready to provide any service at any moment at any hour of any day. There are no “office hours” or closed signs.

For many patients and their families, receiving services from an ambulance organization is the best thing to happen on the worst day of their lives. Americans count on ambulance organizations take care of us.

But for whatever reason, some legislators, regulators and insurers look at ambulance organizations primarily as providers of transportation services. Ambulance services are viewed as a commodity to be bid, and ambulance organizations—as suppliers of this commodity—are not entitled to be compensated based on the level of healthcare provided. These policymakers and payers assume that ambulance costs are related to each trip, and rarely consider that ambulance organizations always have to be ready to respond and provide care at the scene, even if a patient does not require transport. These policymakers and payers will pay for the transport with a slight acknowledgment of the skill level involved, but refuse to compensate ambulance organizations for the care provided if no transport is warranted.

That is, until someone they love needs us.

The American Ambulance Association (AAA) and its leadership are committed to changing all that. We refuse to let our industry be defined by stakeholders who may not understand the complexities of our world, our expertise, our protocols and our services. We are looking to change the course of our future by asking the Congress to mandate that ambulance organizations be viewed as providers and not suppliers. We are not widgets. We are caring, thoughtful providers like others in the healthcare arena.

We fervently and wholeheartedly believe that ambulance organizations make an even greater difference to the health and well-being of the communities we serve because of the distinct nature of our services: we are mobile, we are everywhere, we are underutilized because of a reimbursement structure that only allows for compensation when transporting. While the federal government struggles to protect access in rural areas, ambulance organizations have stepped in when rural communities lose hospitals as the primary providers of emergency services. In some areas, they are expected to assist with non-emergency care as well.

The only way for ambulance organizations not just to survive but to thrive in any future healthcare system is to be recognized as providers of healthcare. It is the game changer. It puts us in the driver’s seat regarding the type of service we should provide (treat and refer, alternative destinations, collaborative models of care). It also makes our organizations more nimble, efficient and better able to serve our communities.

Being recognized as healthcare providers is important, as is stabilizing the current Medicare payment system. As Congress considers extending the ambulance add-ons once again, it has also become clear that they will mandate some type of cost collection as part of this process. Some would argue that full cost reporting—the kind that hospitals do today—is the only way to collect such information. AAA is fighting hard to ensure that any cost collection system recognizes the unique nature of ambulance organizations and that our cost data are collected in an accurate and effective manner, allowing everyone in this industry of primarily small, rural providers (who at times are the only ones within hundreds of miles providing healthcare) to report costs in the least burdensome way practical. Make no mistake, we need data to prove what every ambulance service provider in the U.S. already knows: We are significantly underpaid by Medicare and Medicaid.

It is critical that the entire industry speak with one voice and support these efforts. Join us in our fight for our future. Help ambulance organizations be identified as healthcare providers by those who have influence on our regulations and reimbursement rates. Make sure that cost collection is designed in a way that recognizes the unique nature of this industry. Getting these policies right is essential for ambulance organizations to finally be recognized and compensated for the lifesaving work ambulance organizations do.

We cannot do it without you. Learn more at


Maria Bianchi is Executive Vice President of the American Ambulance Association.