Giving EMS flexibility in transporting low-acuity patients could generate substantial Medicare savings

Some Medicare beneficiaries who place 911 calls to request an ambulance might safely be cared for in settings other than the emergency department (ED) at lower cost. Using 2005-09 Medicare claims data and a validated algorithm, we estimated that 12.9-16.2 percent of Medicare-covered 911 emergency me...

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Bibliographic Details
Published inHealth Affairs Vol. 32; no. 12; pp. 2142 - 2148
Main Authors Alpert, Abby, Morganti, Kristy G, Margolis, Gregg S, Wasserman, Jeffrey, Kellermann, Arthur L
Format Journal Article
LanguageEnglish
Published United States The People to People Health Foundation, Inc., Project HOPE 01.12.2013
Subjects
Algorithms
Beneficiaries
Cost
Cost control
Cost Savings
Efficiency, Organizational
Emergency medical care
Emergency Medical Services
Emergency services
Federal government
Flexibility
Government programs
Health care access
Hospitals
Humans
Insurance
Medical service
Medicare
Patient Acuity
Patients
Payment
Primary care
Reimbursement
Reimbursement Mechanisms
Saving
Savings
Studies
Transportation
Transportation of Patients - economics
Transportation of Patients - organization & administration
United States
United States
United States > US
Medicare
Cost Of Health Care
Organization And Delivery Of Care
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Summary:Some Medicare beneficiaries who place 911 calls to request an ambulance might safely be cared for in settings other than the emergency department (ED) at lower cost. Using 2005-09 Medicare claims data and a validated algorithm, we estimated that 12.9-16.2 percent of Medicare-covered 911 emergency medical services (EMS) transports involved conditions that were probably nonemergent or primary care treatable. Among beneficiaries not admitted to the hospital, about 34.5 percent had a low-acuity diagnosis that might have been managed outside the ED. Annual Medicare EMS and ED payments for these patients were approximately $1 billion per year. If Medicare had the flexibility to reimburse EMS for managing selected 911 calls in ways other than transport to an ED, we estimate that the federal government could save $283-$560 million or more per year, while improving the continuity of patient care. If private insurance companies followed suit, overall societal savings could be twice as large.
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ISSN:0278-2715
1544-5208
DOI:10.1377/hlthaff.2013.0741