SQUEEZE Me Tighter

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					Cover report by John Erich,
Associate Editor

                             Will healthcare reform happen on the backs of ambulance providers?
                             The early optimism about healthcare reform waned as summer wore on, swallowed amid
                             partisan rancor, growing public skepticism and the vulgar realities of patchworking together
                             such an enormous package of law.
                               But when Congress took off for the       ultimately passes will have impacts on      unveiled in July could change tremen-
                             month in August, preliminary legisla-      EMS and medical transportation, and         dously in September, when Congress
                             tion was on the table that spelled out     the consequences of those impacts           reconvenes and begins its final push
                             what America might expect from a           aren’t fully known,” says Rick Keller,      toward disposition. The most ambitious
                             final bill, if and when one’s passed. And   an expert on EMS finance and resource        aspects may be gutted, mooting some of
                             there are components in there, frankly,    utilization with industry consultants       this discussion (though remember it for
                             that should be of great concern to EMS     Fitch & Associates. “We don’t know how      the future; these questions aren’t going
                             and the ambulance transport industry.      significant they’ll be. The unintended       away). Heck, a bill may never be passed
                             The well-intended efforts of lawmakers     consequences could be huge.”                at all.
                             could lead to unintended consequences        There will be a lot of coulds in this       But if one is, and it retains certain
                             with profound ramifications for the way     discussion, because as it’s written,        elements included at the break, it will
This topic was selected to   we do business.                            nothing it talks about is final. What’s in   likely cause problems for a lot of people
be covered as part of our
 Reader’s Choice Survey.       “Any healthcare reform package that      the preliminary legislation lawmakers       in the emergency medical response and

      34 OCTOBER 2009 EMS www.emsresponder.com

                    ambulance transportation businesses.       Accountability Office, that program,
                    Lots of money and operational ability      Medicare, reimburses many ambulance           Read for Yourself
                    are at stake. Those end-of-life death      providers at less than their actual costs    House      legislation: America’s
                    panels you heard about may have been       of providing service. While noting a         Affordable Health Choices Act (H.R.
                    a crude partisan rhetorical contrivance,   wide national variability in the costs of    3200)
                    but in a worst-case scenario, dispas-      ground ambulance transport, the GAO
                                                                                                            Status at break: Out of committee,
                    sionate councils of non-EMS bureau-        determined that on average, Medicare
                                                                                                            awaiting debate by full House upon
                    crats may indeed hold your future in       repaid urban ambulance providers at 6%
                                                                                                            return in September
                    their hands.                               below their average costs, and so-called
                                                               “super-rural” providers at 17% below. In     Find it at: http://edlabor.house.gov
                    THE COSTS OF                               2010, the GAO estimated, up to 61% of        Senate legislation: Affordable
                    DOING BUSINESS                             providers without shared costs could be      Health Choices Act
                       Concern No. 1 involves perhaps the      reimbursed at less than their expenses.      Status at break: HELP (Health,
                    biggest issue under debate, a possible     Among super-rurals, that figure may be        Education, Labor and Pensions)
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