Free EMS Care: We Can Blame Ourselves

The recent news coverage of Chicago Fire Department losing big bucks to unreimbursed refusal of transport calls is not a problem unique to Chicago.  Sure, asthmatics will call for an albuterol treatment when caught without their own medications and some hypoglycemic patients will invariably need an emergency sugar boost.  The sophistication of modern day EMS delivers definitive solutions to many medical problems like these right on the street (in many systems at the BLS level).  Very often, no further care is needed.  Patients know they don't need to go to a hospital.  Many have experience of having been talked into transport only to waste hours sitting in a busy Emergency Department with no benefit whatsoever.  Firefighters know this too.  So why do we persist?

The answer lies in dollars: no transport, no money.  Not only for the fire department, but also no payment to the hospital or the physician(s) who see the patients we needlessly convince to accept transport.  It's time we smarten up.  Our patients aren't stupid; many know precisely what they need to get well and stay that way.  That's why they call us.  EMS needs to stand up and demand reimbursement for the care we provide - with transport or without.  There have been several common sense demonstration projects where insurers have agreed to reimburse EMS for responses without transport.  Every one of these have died.  Why?  In my opinion, it comes down to politics and money.  Physicians (yes, the people who write our treatment and transport protocols) and hospitals (yes, the places that provide medical control) want money.  And money requires patients.  So we keep bringing them in.

You'd think insurers would find appeal in the lower costs of paying EMS to solve problems on the street without transporting patients to another, more expensive level of care.  It sounds like a good idea and indeed, probably serves as impetus for demonstration projects every so often.  But ultimately, insurers need to stay on the good side of hospitals, and EMS represents a very small pimple on the face of total health insurance dollars.  So, while demonstration projects produce cost savings, they ultimately shift money from hospitals and physicians to EMS.  That's where they end.  It's time for EMS to get a spine.  If cities like Chicago are running $50 million dollar a year deficits, partly attributed to EMS no-transports, then why are not our advocacy organizations putting their collective feet down on getting paid for what EMS does?  Partly because EMS lives in a vacuum.

The place where decisions about healthcare dollars are made is the Department of Health and Human Services (HHS). But EMS is not sitting at the HHS table and it often seems like they don't even know they should be.  The Department of Transportation is not a healthcare entity.  Neither is the Department of Homeland Security. If EMS ever wants to improve their reimbursement position, they will need to take a seat at the table where the game is played.

Mike McEvoy

EMS Editor

Fire Engineering magazine