In this vital episode of EMS One-Stop, host Rob Lawrence is joined by Matt Zavadsky and attorney Doug Wolfberg of Page, Wolfberg & Wirth for a deep-dive into three financial flashpoints currently impacting EMS.
First, the trio unpack the launch of the new PWW|AG/EMS|MC , a quarterly report leveraging billing and revenue cycle data from over 1,500 agencies nationwide. This unprecedented benchmarking tool allows EMS leaders to measure performance against regional and national trends, uncovering actionable insights into billing strategies, reimbursement rates, payer mixes and the economics of service delivery. It鈥檚 a critical step in helping agencies justify their value and improve their financial sustainability.
Next, the discussion turns to MedPAC 鈥� the Medicare Payment Advisory Commission 鈥� and its controversial response to cost data submitted by ambulance services under the CMS Ground Ambulance Data Collection System. Doug Wolfberg explains how MedPAC discarded over half of the data, labeling higher-cost services 鈥� often rural or government-run 鈥� as outliers. This move could justify lower or stagnant Medicare fee increases, potentially devastating many providers.
Finally, attention shifts to the moving through Congress and now on its way to the Senate that would eliminate or severely restrict enhanced Medicaid funding mechanisms, such as supplemental payments and provider taxes. If passed, this legislation would reduce reimbursement for millions of transports, triggering funding crises across EMS systems 鈥� particularly in states like California and Illinois. The episode delivers a clear message: EMS leaders must prepare, advocate and act now.
Memorable quotes
- 鈥淭he primary struggle is financial, which then dominoes into all of the other issues.鈥� 鈥� Matt Zavadsky
- 鈥淢edPAC actually threw out from its cost analysis more than half of the ambulance service cost data in the United States. They cherry-picked the lower-cost providers ... and then used that to say there鈥檚 no need for a reimbursement increase.鈥� 鈥� Doug Wolfberg
- 鈥淒etermine your cost-of-service delivery. If it costs you $2,200 to put an ambulance in front of an address, then try and increase your revenue to get close to that.鈥� 鈥� Matt Zavadsky
- 鈥淟et me tell you something, everybody 鈥� EMS is a business. Like it or not.鈥� 鈥� Rob Lawrence
- 鈥淐ollection percentage doesn鈥檛 matter. What matters is the actual dollars collected.鈥� 鈥� Matt Zavadsky
- 鈥淲e could have a paramedic on every street corner ... but of course that costs the Earth.鈥� 鈥� Rob Lawrence
- 鈥淲e become the safety net when other parts of the healthcare system break down.鈥� 鈥� Doug Wolfberg
- 鈥淭his is a cycle of insufficiency and unsustainability.鈥� 鈥� Doug Wolfberg
- 鈥淣o matter whether you鈥檙e operational, clinical or financial, we鈥檙e giving you the tools to affect change.鈥� 鈥� Rob Lawrence
- 鈥淵ou can have 100% response time ... but you better have a big fat checkbook.鈥� 鈥� Matt Zavadsky
- 鈥淭hey鈥檙e teeing up the rationale for lower 鈥� or no 鈥� increases to Medicare ambulance fee schedule rates.鈥� 鈥� Doug Wolfberg
- 鈥淣obody likes surprises, especially elected officials ... start those conversations early.鈥� 鈥� Matt Zavadsky
- 鈥淭his is going to be Force 10 in California 鈥� let me tell you.鈥� 鈥� Rob Lawrence
Episode timeline
00:41 鈥� Rob introduces the three main topics: the PWW|AG/EMS|MC EMS Financial Index, MedPAC鈥檚 response to ambulance data and a major federal bill impacting Medicaid
01:59 鈥� Part 1 鈥� PWW|AG/EMS|MC Financial Index
03:37 鈥� Matt explains that the index is built using data from over 1,500 EMS agencies via EMS|MC
05:43 鈥� The importance of regional benchmarking
08:22 鈥� First major finding: dramatic variation in ALS billing rates across regions
09:30 鈥� Key insight: agencies that bill more tend to collect more revenue 鈥� agencies are encouraged to determine their true cost of service and align billing accordingly
12:37 鈥� Collection percentage is debunked as a misleading metric; focus should be on dollars collected
15:36 鈥� ALS vs. BLS billing levels explained, with a look ahead to Q2鈥檚 emergency-only data set
18:48 鈥� How EMS agencies can better engage with insurers to cover non-transport and MIH services
20:46 鈥� Part 2 鈥� MedPAC
22:24 鈥� Doug outlines how MedPAC discarded over half of the reported ambulance cost data
25:00 鈥� Explanation of which data was discarded and why 鈥� primarily high-cost, rural and government-based services
28:22 鈥� Doug asserts MedPAC is using cherry-picked data to suppress reimbursement increases
30:10 鈥� Rob and Doug emphasize that EMS gave MedPAC quality input, but MedPAC is producing garbage output
32:08 鈥� Doug outlines what MedPAC will do next and what EMS leaders must do in response
34:40 鈥� Strong call to action: educate Congress, use real CMS data and don鈥檛 accept MedPAC鈥檚 narrative
36:59 鈥� Doug emphasizes the importance of evidence-based deployment strategies for financial sustainability
37:31 鈥� Part 3 鈥� 鈥淥ne Big Beautiful Bill鈥�
38:19 鈥� Matt outlines how the bill would drastically limit Medicaid supplemental payments
39:43 鈥� Federal/state Medicaid match rates explained with California as an example
42:51 鈥� The looming reckoning: local governments may have to pay to maintain current EMS service levels
46:02 鈥� Matt warns that the bill could trigger PAYGO cuts to Medicare as well
47:16 鈥� Agencies are urged to plan now, talk to their communities and adjust operations
48:06 鈥� Doug adds that pressure on U.S. senators, especially in red states, could still influence the bill
51:26 鈥� Close and call to action
Final takeaway
This episode underscores that EMS cannot remain reactive 鈥� leaders must proactively use data, engage legislators and educate their communities on the true cost of care. The EMS Financial Index, the MedPAC dismissal, and the pending bill all point to a critical need for informed, strategic advocacy.
Additional resources
- Doug Wolfberg: MedPAC stacks the deck against ambulance services
- PWW|AG/EMS|MC:
