By Patrick Varine
Tribune-Review
Nov. 2鈥擱ecent state legislation will increase the reimbursement local ambulance services receive when treating Medicaid patients, but EMS directors said they still are running in the red most of the time.
鈥淓very little bit helps,鈥� said Darrick Gerano, director for Murrysville Medic One. 鈥淎ny increase we can get from any insurance is a win for us. It鈥檚 a definite improvement, but it鈥檚 still not enough.鈥�
Act 15, part of the omnibus House Bill 1351 that passed both state chambers in mid-October, ties the state鈥檚 Medicaid reimbursement rates to the federal Medicare rates, paying whichever amount is higher for services such as basic and advanced life-support ambulance trips.
It also removes a reimbursement exemption for the first 20 miles an ambulance travels on a Medicaid transport. That is good news for New Kensington Ambulance Services EMS Manager Addie Birch.
鈥淭hat鈥檚 the biggest thing, at least as far as mileage,鈥� Birch said. 鈥淥ur closest hospitals are five and 14.7 miles away, so we鈥檝e never gotten any reimbursement for transporting those patients.鈥�
The Tribune-Review reported in early October about how many EMS companies are stuck with an unsustainable funding model and a shrinking workforce.
Ambulance service officials say the biggest culprit crushing their business model is bottom-barrel insurance reimbursements. Providers get paid 30% to 60% of what they spend to care for patients from insurance companies.
Sometimes, that amount doesn鈥檛 even arrive.
鈥淎t times, you鈥檒l transport a patient who has, say, Highmark and (a high-level) 鈥楥adillac鈥� plan,鈥� Birch said. 鈥淭hey get transported, and then Highmark sends them a check, and it never comes to us for reimbursement. We finally contracted with Highmark, and we鈥檙e now in a situation where we can count on getting at least a third of what our reimbursement is supposed to be.鈥�
For Murrysville Medic One, as well as Mutual Aid Ambulance Service in Greensburg, the new legislation won鈥檛 affect their bottom line much because they don鈥檛 perform a large number of Medicaid transports.
鈥淢edicaid is only about 15% of our service area, so we鈥檙e not going to see a huge increase. But it does help us reduce our deficit,鈥� said Dan Mertz, deputy direction of operations at Mutual Aid. 鈥淚 appreciate our state legislators for realizing that there鈥檚 a crisis and doing everything within their power to help alleviate that. We鈥檇 like to see initiatives like this continue to help ambulance services.鈥�
Birch said, after all the costs are calculated, it is $753 to send a New Kensington EMS vehicle to a Medicaid call.
鈥淚t鈥檚 a huge win and a step in the right direction to try and increase reimbursement because that鈥檚 what we depend on,鈥� he said. 鈥淏ut we lose money every time we go out the door to take any Medicare or Medicaid patients.鈥�
Mertz and Gerano agreed.
鈥淲e鈥檙e still losing money on reimbursements,鈥� Gerano said. 鈥淲e鈥檙e just not losing as much now. It would be nice if they could bring it up to at least cover our costs.鈥�
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