In a recent column, a writer made reference to the New York State Association of Fire Chiefs’ efforts to amend Section 209-b of the Executive Law to allow fire district and fire department ambulance services to recover costs from Medicaid, Medicare, and private insurers. It seems that the author has bought into the objections of the for-profit and not-for-profit ambulance providers that are trying to prevent fire service ambulance services from being treated the same way they are.
I have several issues with this column. First and foremost, this legislation is supported by the NYS Fire Service Alliance, which includes FASNY, AFDSNY, the NYS Fire Coordinators, NYS Volunteer Fire Police, and NYS Fire Marshals & Inspectors Associations, in addition to the NYSAFC.
Second, the author claims that if the legislation (S.363-B/A.7717-B) were to pass, it would place thousands of people in rural areas in jeopardy, as they would lose Medicare coverage for paramedic intercepts performed by for-profit ambulance services. This is a fallacy. No changes would occur in Medicare benefits. The legislation would simply allow fire service ambulances to recover costs in the same way as not-for-profits. It would also proactively help proprietary ambulances by addressing the issue of Advanced Life Support care in rural areas of the state by requiring the fire department ambulance services to contract for paramedic service if they do not provide it themselves. The only difference from the current situation is that Medicare (or the patient’s insurer) would pay the transporting ambulance for the paramedic intercept service along with payment for the transport. The transporting agency would pay the ALS provider the ALS share of the reimbursement, the same way not-for-profit BLS services do. Under current law, the ALS provider collects the whole fee even if they don’t transport and gives nothing to the fire department ambulance.
The argument put forward by UNYAN/NYSVARA is that New Yorkers will lose Medicare benefits. This is not true. A very small percentage of rural elderly New Yorkers receive paramedic intercept service – so small that the total value of services provided pales in comparison to the millions of dollars that New Yorkers are being forced to pay for EMS via tax dollars. What kind of argument is that? That tiny little faction that will still be able to access paramedic intercept services under the proposed law is being used as a fulcrum to deprive millions of others from using their health insurance benefits, forcing them instead to pay for ambulance service through their tax dollars.
New York is the only state where fire department ambulances cannot be reimbursed by insurers. The result is that the entire cost of fire department ambulance service must be borne by the taxpayers. When it comes to EMS, residents served by fire department ambulances cannot use the health insurance benefits they pay for. Why is it that what works in the rest of the country will not work in New York state? Is EMS different in New York?
There are 1,025 ambulance services in New York state. Of these, 468 are operated by fire departments and 60 are for-profit services; 497 are either not-for-profit ambulance agencies, are operated by city fire departments that are allowed to recover costs, or are operated by other entities, such as Native American nations. The for-profit and not-for-profit ambulance providers can recover costs by billing insurers, yet these providers want to deny that same ability to fire service ambulances. The author cites NYSVARA’s argument that all the fire department ambulances need to do is simply spend money to separate from the fire departments and they can bill. Why should they do that? Why incur additional costs to establish another entity and potentially lose members who chose to stay with the fire department? Perhaps more importantly, in an era when we want to consolidate services, why create potentially 468 new entities with duplicated costs? Simply put, separating ambulances from fire departments will reduce the number of people providing both fire and EMS services and hurt the quality of emergency medical services available while raising the taxpayers’ bills.
Throughout the state, the average cost recovery for ambulance service is $350. There were 297,000 ambulance calls handled by fire department ambulances in 2015. The prohibition for fire department ambulance services to bill insurers cost municipalities $100 million that had to be made up by taxpayers.
In 2015, there were approximately 2,135 paramedic intercepts in rural areas of the state. From these calls, proprietary ambulances generate only $747,000 annually while preventing fire districts, cities, and villages from collecting $100,000,000 that had to be made up by the taxpayers.
This legislation will improve the fiscal health of New York state while paving the way for higher quality emergency medical services for all New Yorkers.