News & Updates

In cooperation with the American Ambulance Association, we and others have created a running compilation of local and national news stories relating to EMS delivery. To date, over 1,000 news stories have been chronicled, with 59% highlighting the EMS staffing crisis, and 33% highlighting the funding crisis.

Click below for an up to date list of these news stories, with links to the source documents.

EMS Media Log Through 9-18-23 Read Only.xlsx

  • 12 Apr 2023 9:25 AM | Matt Zavadsky (Administrator)

    We’ve often said, if someone is going to get paid to improve your community’s health and reduce your EMS response volume, it should be YOU.

    MedArrive is using EMS personnel for their VC funded MIH program.

    BCBS investing in this model speaks volumes about their interest in the MIH model.

    The one thing MedArrive cannot do, that local EMS-based MIH programs can do, and bring more value, is ID enrolled patients when they call 9-1-1 and potentially avoid a preventable ED visit.

    BCBS’ $8 million investment in this model should get the attention of those of you who are on the fence about whether these models are perceived as valuable by payers.  We just need to figure out how to a) get to the right people at they payers, and b) figure out how to expand EMS-based MIH service areas beyond mono-jurisdictional boundaries, which often to not align with the payer’s medical trade area.


    Irving Mobile Healthcare Firm MedArrive Gets $8M in Funding To Help Reduce ER Visits, Hospitalizations

    The investment from Cobalt Ventures follows MedArrive's $25 million series A round in November 2021 and brings its total funding to $40.5 million to date.


    APR 11, 2023

    MedArrive, an Irving-based mobile-integrated care management platform company, has received $8 million in new funding led by Cobalt Ventures, a wholly owned subsidiary of Blue Cross and Blue Shield of Kansas City (Blue KC).

    The investment follows MedArrive’s $25 million series A round in November 2021 and brings its total funding to $40.5 million to date, the company said.

    “Everyone in America has a right to inclusive, high-quality care, yet too many are left out and have no one on their side who can connect them to the system,” MedArrive Co-Founder and CEO Dan Trigub said in a statement. “That’s what the MedArrive platform and our field providers offer—a trusted and compassionate bridge into the homes of the people who need care the most and at the right time.”

    “The work we’re doing with dedicated healthcare organizations, who are committed to health equity, is what drives our team every day,” Trigub added.

    MedArrive said it supports both adult and pediatric populations by providing a white-labeled care management solution that offers care in the home—often for the hardest-to-reach, disengaged, and most-vulnerable populations.

    Serving patients at home with paramedics, EMTs, and other healthcare professionals

    The platform connects providers and payers with MedArrive’s field provider network of highly trained and skilled paramedics, EMTs, and other healthcare professionals, the company said.

    Field providers visit the homes of patients or members on behalf of their provider or health plan, providing a mix of in-home healthcare services, diagnostics, health assessments, post-acute care, and other preventive health measures while addressing social care needs such as transportation, mobility, or nutrition assistance.

    When higher-acuity care is needed, the company says its field providers will connect people with physician-led telehealth services.

    The MedArrive platform includes integrations with a growing ecosystem of specialized partners that allow field providers to bring more care services into the home, such as virtual behavioral health, retinal screening, and maternity care.

    ‘A unique platform and agile workforce’

    “MedArrive has quickly become a leader in delivering healthcare at home solutions with a unique platform and agile workforce that helps lower cost of care for health plans while building trust, improving access to care, and driving better outcomes for their members,” David Eichler, managing partner of Cobalt Ventures, said in a statement.

    MedArrive has built a substantial list of customers—especially with managed Medicaid health plans—demonstrating a significant ability to improve the health of very at-risk populations while also lowering costs.

    Reducing ER visits and hospitalizations

    In a collaboration with Molina Healthcare of Texas, MedArrive helped Molina’s members navigate the healthcare system, connected them with resources that improved their health and quality of life, and facilitated more care in an appropriate setting, MedArrive said.

    In the program’s first phase, MedArrive said it drove 74% member engagement and a 20% reduction in emergency room usage; created a 5% improvement in member retention; surfaced undocumented social determinants of health needs in 32% of visits; reduced hospitalizations by 50%; and garnered a 90+ NPS.

    MedArrive said it also led successful home-health programs with Bright Health, and several Centene plans including Superior HealthPlan (Texas), and HealthNet (California), among others.

    Its capital-efficient model has become attractive for payers, providers and investors alike who are all looking to leverage a growing home-health market, the company said.

    Focusing on at-risk populations

    McKinsey has predicted that roughly $265 billion worth of healthcare services could shift into the home by 2025, MedArrive noted. At the same time, payers and risk-based providers are looking for proven ways to reduce costs associated with at-risk populations, such as individuals on Medicaid.

    Research has shown that nearly 50% of Medicaid patients will visit emergency rooms at least once a year, which is about four times more than commercial patients.

    MedArrive has a national network of thousands of skilled EMS providers in its national network. Services span dozens of clinical use cases, including chronic condition management, transitional care, readmission prevention, urgent care, vaccinations, palliative care, and more.

    Cobalt Ventures is the strategic venture capital arm of Blue Cross and Blue Shield of Kansas City, the largest not-for-profit health insurer in Missouri and the only not-for-profit commercial health insurer in Kansas City. It invests in high-growth companies that align with Blue KC’s mission and can scale nationally across the payer industry.

    MedArrive recently launched a partnership with Ouma Health to offer in-home maternity care to women on Medicaid.

  • 4 Apr 2023 6:36 AM | Matt Zavadsky (Administrator)

    Perhaps something EMS agencies should keep in mind as telehealth partnerships.


    States Step In as Telehealth and Clinic Patients Get Blindsided by Hospital Fees

    By Markian Hawryluk

    APRIL 3, 2023


    When Brittany Tesso’s then-3-year-old son, Roman, needed an evaluation for speech therapy in 2021, his pediatrician referred him to Children’s Hospital Colorado in Aurora. With in-person visits on hold due to the covid-19 pandemic, the Tessos met with a panel of specialists via video chat.

    The specialists, some of whom appeared to be calling from their homes, observed Roman speaking, playing with toys, and eating chicken nuggets. They asked about his diet.

    Tesso thought the $676.86 bill she received for the one-hour session was pretty steep. When she got a second bill for $847.35, she assumed it was a mistake. Then she learned the second bill was for the costs of being seen in a hospital — the equipment, the medical records, and the support staff.

    “I didn’t come to your facility,” she argued when disputing the charges with a hospital billing representative. “They didn’t use any equipment.”

    This is the facility fee, the hospital employee told her, and every patient gets charged this.

    “Even for a telehealth consultation?” Tesso laughed in disbelief, which soon turned into anger.

    Millions of Americans are similarly blindsided by hospital bills for doctor appointments that didn’t require setting foot inside a hospital. Hospitals argue that facility fees are needed to pay for staff and overhead expenses, particularly when hospitals don’t employ their own physicians. But consumer advocates say there’s no reason hospitals should charge more than independent clinics for the same services.

    “If there is no change in patient care, then the fees seem artificial at best,” said Aditi Sen, a Johns Hopkins University health economist.

    At least eight states agree such charges are questionable. They have implemented limits on facility fees or are moving to clamp down on the charges. Among them are Connecticut, which already limits facility fees, and Colorado, where lawmakers are considering a similar measure. Together, the initiatives could signal a wave of restrictions similar to the movement that led to a federal law to ban surprise bills, which took effect last year.

    “Facility fees are simply another way that hospital CEOs are lining their pockets at the expense of patients,” said Rep. Emily Sirota, the Denver Democrat who sponsored the Colorado bill.

    Generally, patients at independent physician clinics receive a single bill that covers the physician’s fee as well as overhead costs. But when the clinic is owned by a hospital, the patient generally receives separate bills for the physician’s fee and the facility fee. In some cases, the hospital sends a single bill covering both fees. Medicare reduces the physician’s payment when a facility fee is charged. But private health plans and hospitals don’t disclose how physician and facility fees are set.

    Children’s Hospital Colorado officials declined to comment on the specifics of Tesso’s experience but said that facility fees cover other costs of running the hospital.

    “Those payments for outpatient care are how we pay our nurses, our child life specialists, or social workers,” Zach Zaslow, senior director of government affairs for Children’s Hospital said in a February call with reporters. “It’s how we buy and maintain our imaging equipment, our labs, our diagnostic tests, really all of the care that you expect when you come to a hospital for kids.”

    Research suggests that when hospitals acquire physician practices and hire those doctors, the physicians’ professional fees go up and, with the addition of facility fees, the total cost of care to the patient increases, as well. Other factors are in play, too. For instance, health plans pay the rates negotiated with the hospital, and hospitals have more market power than independent clinics to demand higher rates.

    Those economic forces have driven consolidation, as hospital systems gobble up physician clinics. According to the Physicians Advocacy Institute, 3 in 4 physicians are now employed by hospitals, health systems, or other corporate entities. And less competition usually leads to higher prices.

    One study found that prices for the services provided by physicians increase by an average of 14% after a hospital acquisition. Another found that billing for laboratory tests and imaging, such as MRIs or CT scans, rise sharply after a practice is acquired.

    Patients who get their labs drawn in a hospital outpatient department are charged up to three times what they would pay in an office, Sen said. “It’s very hard to argue that the hospital outpatient department is doing that differently with better outcomes,” she said.

    Hospital officials say they acquire physician practices to maintain care options for patients. “Many of those physician practices are not viable and they were having trouble making ends meet, which is why they wanted to be bought,” said Julie Lonborg, a senior vice president for the Colorado Hospital Association.

    Along with Colorado and Connecticut, other states that have implemented or are considering limits on facility fees are Indiana, Minnesota, New Hampshire, Ohio, Texas, and Washington. Those measures include collecting data on what facility fees hospitals charge, prohibiting add-on fees for telehealth, and requiring site-neutral payments for certain Medicaid services. A federal bill introduced in 2022 would require off-campus hospital outpatient departments to bill as physician providers, eliminating the possibility of charging facility fees.

    Connecticut has gone the furthest, banning facility fees for basic doctor visits off-campus, and for telehealth appointments through June 2024. But the law’s application still has limitations, and with rising health care costs, the amount of facility fees in Connecticut continues to increase.

    “It hasn’t changed much, partly because there’s so much money involved,” said Ted Doolittle, who heads the state’s Office of the Healthcare Advocate. “They can’t just painlessly take that needle out of their arm. They’re addicted to it.”

    The Colorado bill would prohibit facility fees for primary care visits, preventive care services that are exempted from cost sharing, and telehealth appointments. Hospitals would also be required to notify patients if a facility fee would apply. The ban would not apply to rural hospitals. The bill was scaled back from a much broader proposal after criticism from hospitals about its potential consequences.

    Rural hospital executives, like Kevin Stansbury, CEO of Lincoln Health, a small community hospital in the eastern Colorado town of Hugo, had been particularly worried about the impact of a fee ban. The state hospital association estimated his hospital would lose as much as $13 million a year if facility fees were banned. The 37-bed hospital’s netted $22 million in patient revenue last year, resulting in a loss. It stays open only through local taxes, Stansbury said.

    “This will still harm access to care — and especially essential primary and preventive care that is helping Coloradans stay healthier and out of the hospital,” Lonborg said of the revised approach. “It will also have a detrimental impact on access to specialty care through telehealth, which many Coloradans, especially in rural parts of the state, have come to depend on.”

    The Colorado bill presents particular challenges for health systems such as UC Health and Children’s Hospital, which rely on the University of Colorado School of Medicine for staffing. For outpatient appointments, the medical school bills for the doctor’s fee, while the hospital bills a facility fee.

    “The professional fee goes solely to the provider, and, very frequently, they’re not employed by us,” said Dan Weaver, vice president of communications for UC Health. “None of that supports the clinic or the staff members.”

    Without a facility fee, the hospital would not receive any payment for outpatient services covered by the ban. Weaver said the combination of the clinicians’ and facility fees is often higher than fees charged in independent clinics because hospitals provide extra services that independent physician clinics cannot afford.

    “Prohibiting facility fees for primary care services and for telehealth would still cause significant problems for patients throughout our state, forcing some clinics to close, and causing patients to lose access to the care they need,” he said.

    Backers of the Colorado bill disagree.

    “The data on their costs and their revenue paints a little different picture of their financial health,” said Isabel Cruz, policy manager for the Colorado Consumer Health Initiative, which backs the bill.

    From 2019 through 2022, UC Health had a net income of $2.8 billion, including investment gains and losses.

    The Colorado market is dominated by large health systems that can dictate higher rates to health plans. Plans pass on those costs through higher premiums or out-of-pocket costs.

    “Unless the employers and patients that are incurring the prices are raising the alarm, there really isn’t a strong incentive for health plans to push against this,” said Christopher Whaley, a health care economist with the nonprofit think tank Rand Corp.

    Consumer complaints helped pave the way for the federal No Surprises Act, which protects against unanticipated out-of-network bills. But far more people get hit with facility fees — about half of patients compared with 1 in 4 hospital patients who receive surprise bills, Whaley said.

    Dr. Mark Fendrick, a University of Michigan health policy professor, said facility fees are also generally surprises but don’t fall under the definition of the No Surprises Act. And with the rise of high-deductible plans, patients are more likely to have to pay those fees out-of-pocket.

    “It falls on the patient,” Fendrick said. “It’s a tax on the sick.”

    Tesso held off paying the facility fee for her son’s visit as long as possible. And when her pediatrician again referred them to Children’s Hospital, she called to inquire what the facility fee would be. The hospital quoted a price of $994, on top of the doctor’s fee. She took her son to an independent doctor instead and paid a $50 copay.

  • 27 Mar 2023 7:40 AM | Matt Zavadsky (Administrator)

    Kudos to Chief Royal, Dr. Bronsky and the rest of the Colorado Spring Fire Department team!

    Some of you may recognize this CSFD model, as it’s been presented as a best practice at several state and national presentations & webinars about the EMS Transformation.


    Colo. FD wins CFSI award for EMS innovations

    Other departments have shown an interest in the Colorado Springs Fire Department's multi-tiered response program.

    Mar 25, 2023

    By Leila Merrill


    COLORADO SPRINGS, Colo. — The Congressional Fire Services Institute and Masimo will honor the Colorado Springs Fire Department with the 2023 Excellence in Fire Service-Based EMS Award for its innovations in the delivery of emergency medical services.

    The award will be presented at the 33rd Annual National Fire and Emergency Services Dinner on May 23 in Washington, D.C.

    The Colorado Springs Fire Department has a multi-tiered response program for its EMS calls.

    According to a news release from the CFSI:

    The Colorado Springs Fire Department was selected for this award because of its tiered response program. Like many fire departments across the nation, CSFD faced significant challenges dispatching ALS engines and trucks on 911 calls and treating patients for non-emergencies. In response, the fire department developed a multi-tiered response program that dispatches appropriate resources and personnel based on the actual needs of the patient. The program covers various potential users of the 911 system, including super utilizers, the elderly, the mentally ill, homeless and incarcerated. Over 50 departments across the nation have met with CSFD personnel to learn about their program.”

    "With fire departments across the nation developing innovative programs to enhance their EMS capabilities, CFSI is proud to co-sponsor the Excellence in Fire Service-Based with Masimo to recognize fire departments for their innovations,” said Jim Estepp, CFSI president. “We look forward to honoring the Colorado Springs Fire Department with this award, and by doing so, sharing this innovative program with other fire departments seeking to enhance their own EMS systems.”

    Vice President of U.S. Alternate Care Andy Jones expressed Masimo Americas’ pride in sponsoring the award.

    "We want to recognize the departments that submitted a variety of strong applications to the CFSI Board for consideration. At Masimo, we share in the excitement of innovation. We look forward to our continued partnership with the Congressional Fire Services Institute,” Jones said. “Again, congratulations to Colorado Springs Fire Department for the CFSI Award for Excellence in Fire-Based EMS."

    For additional information about the 2023 National Fire and Emergency Services Symposium and Dinner, click here. The event benefits the mission of the Congressional Fire Services Institute, a nonprofit, nonpartisan policy organization designed to educate members of Congress about fire and life safety issues.

  • 24 Mar 2023 7:47 AM | Matt Zavadsky (Administrator)

    Tip of the hat to our friends at Pittsburgh EMS for kicking off this program AND creating Office of Community Health and Safety!


    Pittsburgh launches new EMS program to provide follow-up care for people with chronic conditions

    By Kiley Koscinski

    March 15, 2023

    Pittsburgh was the birthplace of paramedicine with the Freedom House ambulance service half a century ago. Today, the city is aiming to remain at the forefront of the field by expanding a follow-up care program within its Emergency Medical Services department.

    On Tuesday the city announced that its Office of Community Health and Safety and Pittsburgh EMS will lead a city-wide “community paramedicine” program, which will connect patients to preventative health care resources and make referrals to providers.

    “It's the first time in the city's history … that we have embarked on a committed community paramedic program,” said Laura Drogowski, manager of the city’s Office of Community Health and Safety. She will direct the program alongside EMS Community Paramedic Chief John Mooney.

    Drogowski noted community paramedics have a rich history in Pittsburgh through the Center for Emergency Medicine of Western Pennsylvania. The city program marks the first time Pittsburgh's own EMS department will have such a division.

    The four-person unit will work with EMS services to determine when a patient could benefit from a follow-up call to address chronic issues. Officials report that patients who frequently call 911 are often suffering from chronic conditions that are difficult to manage, such as seizure disorders, obstructive lung diseases, diabetes and heart disease.

    According to the city, patients who use EMS services often also tend to call for minor falls, mobility challenges and mental health issues — problems that first responders aren’t always equipped to deal with.

    “The way that our first responders interact with patients is that they come during a 911 call,” Drogowski said. “And by the nature of their work, they are not afforded time to spend hours or days with that patient to rectify the situation.”

    But Mooney said paramedics want to help, especially because if those needs go unaddressed, patients’ health outcomes can worsen.

    “It's devastating for first responders to regularly witness patients decline in health over multiple visits,” Mooney said.

    Prior to this week's official launch, Mooney and three EMS personnel have been working overtime shifts since late 2021, testing a pilot program to provide follow-up care to patients after 911 calls. The team found that many patients who frequently call EMS are living with health conditions like seizure disorders, obstructive lung diseases, heart disease and diabetes.

    According to Drogowski, the small team has worked with patients struggling with breathing devices or with managing blood sugar. But she noted that community paramedics could also follow up with patients who simply need to be connected to a primary care provider, or to find equipment to manage their symptoms.

    She said while these seem like “situations that may seem not too difficult to solve,” paramedics often don’t have the capacity to make sure someone followed up with a primary care provider or bought a refrigerator to keep their medicine.

    The unit will also collaborate with other co-response units in the city, Drogowski said.

    The community paramedics will coordinate with social workers in the police bureau to determine how best to follow up with patients. Drogowski argued that some health issues stem from situations like a financial crisis.

    “If someone's utilities are being shut off, they may not be prioritizing going to their primary care physician," she said. “Sometimes it's helping to address the issues that are precluding them from taking care of themselves.”

    Other joint programs involving public safety workers include collaborations with the bureaus of fire and police. Drogowski said she hopes to expand these efforts to ensure the city can mend holes in the social safety net.

    “Falling through the cracks means that people die, alone, from treatable conditions. Our first responders see them every day,” Drogowski said. “We are committed to changing these outcomes, providing advocacy, connecting patients with resources, and fighting for what is needed."

  • 9 Feb 2023 6:46 AM | Matt Zavadsky (Administrator)

    Fantastic report by a very diverse group of Technical Expert Panel members!

    Congratulations to Ryan Greenberg and the team for putting this together!

    This report is a must read for not only EMS Leaders, but more importantly, elected officials and other policy makers.

    Although this is for the State of New York, you can insert pretty much any state not these findings (and recommendations), as virtually all have similar issues with EMS delivery in their state.  This report could be a blueprint for other states to engage in to address their challenges.

    The preamble pretty much sums up the ‘current state’, and a few of the more compelling recommendations from the report are shown below.

    The New York State [Insert your state here] EMS system has markedly deteriorated over the past several years due to declining volunteerism, lack of public funding to cover costs of readiness, inadequate staffing, rising costs, insufficient insurance reimbursement, rising call volumes, a lack of performance standards, poor understanding of the EMS system by elected officials and the public, NYS home rule, and lack of transparency and accountability for EMS agencies.

    New York State's emergency medical services (EMS) are in trouble.

    Multiple ambulance services have closed their doors over the past several years, and many who remain open are unable to respond to emergency calls in any consistent fashion.

    Originally established as a transportation provider, EMS has developed over time to encompass healthcare, public safety, disaster response mitigation, and public health.

    Today, EMS is an unanticipated (and often unfunded) safety net provider of pre-hospital healthcare, to all patients regardless of their ability to pay for services.

    Link to view and download the report:

    The report’s key recommendations start on page 10 – some notable that are worth highlighting:

    • Increase the number of certified EMS providers in New York State by 10,000 by 2025.
    • Engage stakeholders to address the decreasing pool of EMS providers to include pay disparities between EMS and other emergency services (Fire and Law Enforcement), benefits, longevity, mental health, work hours, access to EMS education and migrating from certification to licensure.
    • Incentivize implementation of tiered EMS response systems, using Certified First Responders (CFRs), Basic Life Support (BLS) ambulances, Advanced Emergency Medical Technician (AEMT) staffing, and Paramedic staffed response units.
    • Establish, implement, and enforce agency performance standards. Develop standardized, reasonable, measurable, and reportable response reliability, clinical quality/outcome, customer service and provider engagement/satisfaction expectations and standards with performance-based incentives, such as subsidies, contract incentives, and other impactful inducements to perform. Measures should be transparent to the public and standardized across the state for comparative purposes.
    • Create statutory changes that establish and define EMS as an essential service in New York State and mandate that the service's beneficial stakeholders pay their fair share of the costs of funding it, including the cost of maintaining continuous readiness and reimbursement for any pre-hospital care that is rendered, including the actual cost of transportation.
    • Amend New York State law to recognize EMS certifications as professional licenses regulated by the Department of Health and issued by the Commissioner.

  • 18 Jan 2023 3:51 PM | Matt Zavadsky (Administrator)

    Thanks to EMS1 for publishing this overview of the NAEMT Workforce Survey.

    Click here to view the full NAEMT 2022 National Report on Engagement and Satisfaction in EMS survey report.


    The EMS workforce: Critical condition!

    Why right-sizing EMS response is crucial to increasing pay and improving work-life balance

    "As the respondents to the [NAEMT survey] clearly state, this is not purely a pay issue – it’s a combination of hard work-life balance, economics, leadership and culture," write the authors.

    By Matt Zavadsky and Robert Luckritz

    Jan 4, 2023

    The National Association of Emergency Medical Technicians’ 2022 EMS Worker Engagement Survey should be a Klaxon for EMS and community leaders across the country. This report is a treasure trove of insights that, on the one hand, may not be terribly surprising to most EMS leaders; but on the other hand, may dispel some myths and urban legends about what EMS leaders think their practitioners want.

    Here are the top 5 things we feel are most revealing about the report.

    "As the respondents to the [NAEMT survey] clearly state, this is not purely a pay issue – it’s a combination of hard work-life balance, economics, leadership and culture," write the authors.


    Only 32% of the survey respondents agreed with the statement “Management provides clear and consistent information to personnel.” We get it, EMS systems often scatter personnel across geography and the clock, but we have to find a way to communicate, really communicate with our workforce.

    Email is easy, but ineffective and impersonal. Perhaps the first step to improving effective communication is to ask what methods of communication your employees would prefer, and then do that.

    At MedStar, we have an employee-only social media platform that helps foster interesting communication processes. We also conduct monthly virtual Town Hall meetings that are video recorded and distributed to all employees.

    At Austin-Travis County, we conduct biweekly Chat with the Chief podcasts to relay the latest department information. Employees are encouraged to submit topics and questions that the Chief answers, regardless of how delicate or controversial. It’s critical to be willing to discuss difficult topics.

    Implementing structured rounding tools to track leadership interactions with front-line employees eliminates unconscious bias and ensures all employees are getting a chance to interact with leadership. The most time-consuming, but most effective thing EMS leaders should do is go visit the employees, in their offices. That may be a station, it may be the cab of an ambulance at a post location, whatever! Go to them, sit in the dayroom, stand in the parking lot of the post location, and listen to what they share with you. What do they enjoy about their job? What drives them crazy?

    What can you and the agency do better? They will rarely come to you with that information, but when you’re in their environment, you’d be surprised how open they tend to be.


    When asked to rank “Management provides regular constructive feedback on my overall performance as an employee” and “My agency provides easily accessible patient outcome information to its EMS practitioners,” 48% of the survey respondents disagreed, while only 28% agreed.

    Today’s workforce needs lots of feedback. A recent study cited in an article by Inc. found that 66% of Gen Z say they need feedback from their supervisor at least every few weeks to stay at their job. Similarly, EMS practitioners want to know how their patients did after they cared for them. This is due to the deeply rooted desire to make a difference with their actions. EMS leaders need to find a way to deliver feedback at least monthly to their employees – this could be through specific metrics that the employee can access or a push notification about some aspect of their performance (patient experience scores, clinical bundle compliance, anything!).

    One high-performance EMS agency positions a supervisor in their deployment center to literally touch base with every crew member before they go out for their 12-hour shift, just to say “hi,” address them by name, smile and ask if they need anything for their truck, did they get water, etc.

    Medical oversight departments should automate processes that link EMS patient charts to hospital data so crews can log in to a prior EMS chart and review the outcome fields (e.g., admitted, discharged, deceased, etc.). This will not only improve employee satisfaction, but also allow crewmembers to do some self-analysis, and help them feel more like they are a part of the patient care team for that patient.


    Not surprisingly, the lowest score from the respondents to the engagement survey related to pay and compensation. Sixty-three percent of respondents indicated they disagreed with the statement, “My pay and benefits are adequate and appropriate for the work I perform.” The economic model for EMS is challenging. Revenue is derived from two sources, user fees and public funding. For EMS agencies to be able to increase pay rates, those two funding sources must support the expense. Fee for service reimbursement has been static, if not decreasing, at a time when expenses for personnel, equipment and supplies are skyrocketing.

    Thankfully, some states and local communities have recognized the need to increase compensation for EMS providers and have provided supplemental funding to support increased pay rates. EMS leaders need to get serious (and creative) about finding ways to increase compensation for EMS practitioners. You can seek additional funding by either increasing reimbursement (Medicaid rate increases), or convincing local elected officials that additional tax support is needed.

    You can also consider EMS delivery re-design, such as tiered (BLS & ALS) deployment, changing response time goals, or alternate response models (e.g., medic only, RN/NP only, medical first response only) for low-acuity calls. This would reduce staffing needs while having minimal impact on revenue. The financial savings can be used to increase wages for EMS practitioners.


    When asked why they were leaving EMS, 50% of the respondents said, “Better work-life balance.” Yes, EMS is a 24/7 operation, and someone will always have to work nights and weekends, but the problem is more deeply rooted. Due to staffing shortages, many agencies are mandating overtime to achieve optimal coverage, while many EMS practitioners are working two or three jobs to make ends meet due to the low pay. Those extra jobs tip work-life balance to the point people become dissatisfied and leave EMS. It’s almost a self-fulfilling prophecy. Practitioners leave, which means others in the agency must work extra shifts to fill the void. That, in turn, leads to dissatisfaction with work-life balance, causing EMS practitioners to leave, which causes ... well, you know!

    EMS leaders should work with practitioners to create schedules that A) meet the agency’s needs and B) allow the employees some work autonomy and balance. MedStar allows select EMTs and paramedics to self-schedule. As long as the employee meets certain eligibility and schedule requirements, they pick their shifts. This helps with retention of folks that may have left for work-life balance.

    System redesign isn’t just about economics; it affects work-life balance as well. Shifting to a tiered system changes staff workload and work experience by different levels of providers and can also extend careers by providing a better career ladder for providers. Shifting staff to alternative resources to address high utilizers and provide alternatives to EMS transport relieves the workload on transport providers. We can’t be afraid to reimagine our systems. Systems need to look at staff resources, and if they aren’t necessary at a certain time, be willing to shut them down. Employees don’t want to be mandated in, even on overtime.

    At Austin-Travis County EMS, we began electing not to staff some ambulances instead of mandating overtime, and have seen a minimal impact on system performance when done with a strategy in mind. Employees that are working would rather spend time during their shift moving and ensuring coverage than being mandated in.


    The EMS staffing crisis was looming for years; the pandemic merely accelerated the inevitable. A perfect storm of changing workforce expectations, with employment needs across healthcare and many other sectors is exacerbating the crisis. As the respondents to the survey clearly state, this is not purely a pay issue – it’s a combination of hard work-life balance, economics, leadership and culture.

    It’s up to us to dig ourselves out of the hole we’ve dug. Employees need to be put first, not last or even second. No EMS system can survive, no matter how advanced, without an engaged workforce. EMS delivery needs to be totally transformed away from a “you call, we haul” model to a “you call, we navigate” model. We need to take a hard look at long-held preconceptions about things like ALS staffing, response times and throwing everything, including the kitchen sink, to every EMS call. We need to seriously reduce workloads, and the resulting costs of readiness, based on processes that are not supported by evidence-based research.

    Community partnerships with clear, transparent and frank conversations about community expectations and costs of service delivery need to be held with local stakeholders. If we are successful at right-sizing responses, we just might be able to increase the value of EMS delivery with a reduced workload – allowing us to increase funding and reduce costs. Then, we may be able to help EMS practitioners achieve a better work-life balance, and increase pay rates.



    Robert Luckritz is the chief of Austin-Travis County (Texas) EMS. He has more than 25 years of experience in EMS and healthcare, serving as an EMS provider, EMS leader, attorney and healthcare executive. Rob is also the treasurer for the National Association of Emergency Medical Technicians (NAEMT) and chairs its Workforce Committee.

    Matt Zavadsky is the chief transformation officer for MedStar Mobile Healthcare, the Public Utility Model EMS system serving Fort Worth, and 14 other cities in Texas. He has 43 years of experience in EMS. He is an at-large director for NAEMT and chairs its EMS Economics Committee.

  • 9 Jan 2023 6:25 PM | Matt Zavadsky (Administrator)

    Aspirational for the U.S.?

    The Scottish Ambulance Service is part of the National Health Service (NHS).

    You might also be interested in their 2021-22 OOHCA stats:

    • 66% Bystander CPR Rate
    • 8% AED use prior to EMS arrival
    • 10% survival to discharge rate


    Nearly 50% of 999 calls being managed out with Emergency Departments

    December 22, 2022

    The Scottish Ambulance Service is managing nearly 50% of the 999 calls it receives without the need to take patients to Emergency Departments across Scotland.

    Latest figures for the Scottish Ambulance Service (SAS) in October 2022 show that the proportion of patients being cared for out with Emergency Departments was 49.1%.

    This was made up of 24.9% of patients who were managed at the point of call and a further 24.2% whose care was managed by SAS clinicians on scene.

    These results have been achieved through a range of initiatives, including working closely with partners to increase the range of alternative clinical pathways in communities which support the Service to deliver care closer to home, accessing  Health Board Flow Navigation Centres, expanding our Mental Health pathway access, and utilising highly-trained staff in remote clinical consultation and assessment. The Service’s central Pathway Navigation Hub also continues to increase the volume of calls it manages, connecting patients with services and communicating pathway information to SAS clinicians.

    The figures are released as the Service launches its Integrated Clinical Hub, coordinated through the SAS Ambulance Control Centres in the west, north and east of Scotland. Health secretary Humza Yousaf visited the Service’s East ACC base today in South Queensferry to meet SAS Chief Executive Pauline Howie and Chair Tom Steele, along with key staff involved in the Integrated Clinical Hub. The Health Secretary also thanked staff for their dedication over the past year.

    Using a multi-disciplinary network of skilled clinical staff across Scotland, the Hub gives SAS the ability to provide a detailed consultation for patients whose initial 999 triage has ruled out time-critical illness. The hub will operate 24 hours a day, to ensure patients receive the best possible response to their need when they dial 999.

    SAS Chief Executive Pauline Howie said: “The number of patients being cared for out with hospital Emergency Departments remains substantial and as we head into a challenging winter period, it’s vital we work together with our health board and community colleagues to find ways of delivering the right care for individuals and easing pressure on Emergency Departments. We are focused on continuing to develop our clinical care model to support more patients in communities where it is safe to do so and to ensure patients get the right care, at the right time.

    “The clinical decision-making roles within our Integrated Clinical Hub all have a role to play in understanding patients’ need at point of call, and that they receive the most appropriate care and support to ensure there is a positive impact across the whole system.

    “If the patient’s symptoms are not immediately life-threatening, they can then benefit from a clinical assessment with a senior experienced clinician to agree how help can be best provided. Frontline emergency clinicians can also be supported by more senior clinical staff via telephone and video, aiming to enable the patient to access the most appropriate pathway or care provision to address their need. This can help reduce pressure within Scotland’s Emergency Departments.

    “To help our staff, we also would like to remind people that if you need urgent care, but it’s not life-threatening, you can call NHS 24 on 111, day or night, or your GP during opening hours.”

    Health Secretary Humza Yousaf said: ““We are facing a challenging winter ahead for the NHS and its initiatives such as the integrated clinical hub that can help ensure patients receive appropriate care at home or in the community and alleviate pressures on our already busy A&E departments.

    "There are a range of pathways of care and not every call to 999 needs an ambulance or a trip to A&E as demonstrated by stats out today.  Experienced clinical staff are on hand to triage calls and get patients the right care at the right place. Once again, I would like to thank Scottish Ambulance Service staff for their tremendous work and dedication.”

  • 4 Jan 2023 1:02 PM | Matt Zavadsky (Administrator)

    We did a fact check with John Peterson, the Executive Director for MEDIC on this statement in the article –

    Peterson said less than 1% of Medic’s 13,000 calls in the past year required patients to be transported as high-priority.”

    John stated that less than 1% of their SIERRA protocol 911 calls receive a high-priority transport. 

    MEDIC’s SIERRA protocol is their 9-1-1 ALPHA and OMEGA emergency medical dispatch response determinants that have a response time goal of 90% in under 60 minutes.


    Calling 911 in Charlotte? Your ambulance might show up without lights and sirens.


    DECEMBER 14, 2022

    Medic told county commissioners Tuesday about a plan to use lights and sirens less often.

    Mecklenburg’s EMS agency is proposing a quieter, dimmer and slower way to get some patients treatment in the new year. Medic on Tuesday proposed to county commissioners decreasing lights and siren use from 76% to 19% of 911 responses. That means limiting use to life-threatening situations such as anaphylactic shock or a gunshot wound. The change is expected to occur in the first quarter of 2023.

    Medic Executive Director John Peterson said many responses originally labeled life-threatening, with ambulances using lights and sirens, end up not requiring transportation to a hospital.

    Lights and sirens can get first responders to a patient between 42 seconds and 3.8 minutes faster than without them — enough time to save a life in a potentially deadly emergency.

    But Peterson said the saved time isn’t worth the crash risk if the patient’s life isn’t in danger.

    Using lights and sirens can increase the risk of traffic accidents by 50% according to a study by the U.S. Department of Transportation.

    Peterson said this often happens when a driver doesn’t see other drivers moving over for an ambulance or fire truck and tries to pass through an intersection on a green light like normal, resulting in a collision with the emergency vehicle.

    This year, Medic dispatched 76% of its total calls as life-threatening. Just 5% were determined to actually be life-threatening. Thirty-five percent of patients who called weren’t transported to the hospital at all.

    Mecklenburg County documents Commissioners asked how Medic determines whether an incident is life-threatening. Commissioner Susan Rodriguez-McDowell asked if pain is accounted for when determining dispatch speed.

    Medic representatives said first responders know the difference between injuries and are trained to respond based on notes from the initial call for service. “Fire units have the ability to upgrade calls and request lights and sirens if they feel that there is a medically necessary reason to do so,” Peterson said.


    Mecklenburg County will be the first in North Carolina to reduce its lights and siren usage in this way, Peterson said. Commissioners said they feared it will take time for the public to get adjusted.

    “When you’re in an emergency room, you can see other emergencies and you can physically see what’s more important and what’s more of an emergency than what’s happening to yourself,” commissioner Laura Meier said. “But when you’re calling 911, it’s an emergency to you.”

    Not understanding why a 911 response is taking a long time may result in unhappy customers, Meier said. Peterson said less than 1% of Medic’s 13,000 calls in the past year required patients to be transported as high-priority.


    One part of responses is how quickly dispatchers answer the phone — and Charlotte is responding below industry standard. Industry standard for 911 call centers is to pick up 90% of calls within 10 seconds.

    Right now, Charlotte-Mecklenburg Police dispatchers answer only 60% of calls within the time frame. In Charlotte, 10% of calls take longer than a minute to answer.

    CMPD’s call center shortages fit into a national trend, Deputy Chief David Robinson told the Charlotte City Council Monday. CMPD currently has 124 telecommunicators and needs 20 more to fully staff its call center, Robinson said.

    Robinson said CMPD is implementing the following measures to retain staff:

    • Increased hiring bonus from $2,000 to $4,000
    • Created additional promotion opportunities
    • 1% retention bonus for employees in July and September
    • 5% pay increase across the board week of Dec. 5
    • 2.5% shift differential for afternoon/midnight shifts Jan. 2023
    • 2.5% increase for secondary language
    • 4% salary increase Jan. 2023

  • 22 Dec 2022 9:42 AM | Matt Zavadsky (Administrator)

    Lots to unpack here – but some consistent themes have been emerging as hospitals and EMS systems are stressed during this triple-demic season –

    • The healthcare staffing crisis is impacting all providers, hospitals, EMS agencies and fire departments
    • Too many patients, especially low-acuity patients, are clogging EDs
    • The fundamental financial model for healthcare, including EMS, needs to change

    Notable quotes:

    • “The city has a goal for ambulances to respond to life-threatening emergencies within 10 minutes more than 90% of the time; it has only met that goal for one month since May 2021.”
    • “Pandemic-era staffing shortages in the fire department, which sends paramedics to the majority of medical emergencies, persisted. Making matters worse, the triple threat of winter flu, RSV and Covid packed some SF intensive care units near capacity this month.”
    • “An increase in the number of non-emergency cases coming to emergency departments and a lack of hospital space to take care of patients once they’re stabilized have also impacted ambulance wait times at ERs, according to Coleman.”
    • “We have to have a conversation about how we change health care financing to make the acute care system more resilient to these kinds of changes,” Janke said.

    We are blessed in MedStar’s service area, as our hospitals very rarely hold our units more than 20-30 minutes.  Potential reason? Recent data from our 2 largest hospitals, receiving hundreds of MedStar patients daily, 27% of the patients we bring in, go to the WAITING ROOM.

    We all need to be implementing changes that incentivize EMS to NAVIGATE 911 patients to the most appropriate medical resource.  Models like CMS’ ET3 work very well (we’ve navigated over 1,100 911 patients to resources other than an ED, but more agencies and communities should re-evaluate how they deliver services – it’s going to be a long winter!


    Why San Franciscans Wait So Long for Ambulances

    Written by Noah Baustin

    Published Dec. 20, 2022

    An ambulance crew picked up a young man on Dec. 6 who had probably overdosed on fentanyl. He wasn’t in immediate life-threatening danger, but he needed to see a doctor. The first responders drove the man to St. Mary’s Hospital and brought him inside.

    That’s when the waiting began.

    One hour passed. Then two hours were gone. Three hours came and went.

    The ambulance crew sat in the hallway with the patient on their gurney. Emergency calls continued to come into San Francisco’s 911 system but the ambulance couldn’t leave: the first responders needed to formally pass off care to hospital personnel.

    After four hours of watching a steady stream of walk-in patients get assistance, the hospital staff got to the man on their gurney. Four hours until they could respond to the next call for help in the city.

    It’s an all-too-common experience for ambulance staff working the streets of San Francisco.

    “[The hospital] shouldn’t have a higher priority than getting a patient off of our gurney so we can go back out and get patients who aren’t even at the hospital yet,” said Josh Nultemeier, King-American’s Chief Paramedic, who was not at St. Mary’s that day but oversees the crew and recounted their story to The Standard.

    Both the San Francisco Fire Department and private ambulance companies, such as King-American, respond to 911 calls in San Francisco.

    “We’re supposed to go out and pick up patients that are super sick with real emergencies that aren’t at a hospital yet. We’re being delayed from being able to do that,” Nultemeier said.

    Patients Left Waiting Too Long

    For the past year and a half, while paramedics have often been stuck sitting idle in ERs, San Franciscans having heart attacks, strokes and other medical emergencies have waited too long for an ambulance to show up.

    The city has a goal for ambulances to respond to life-threatening emergencies within 10 minutes more than 90% of the time; it has only met that goal for one month since May 2021.

    “It’s making people wait an unreasonably long time when they need help the most,” said Adam Wood, vice president of the San Francisco Firefighters Local 798 union.

    A perfect storm of problems has kept the city’s ambulances responding slowly. As Covid’s grip on the city loosened over the past year, crosstown traffic increased and the number of emergency medical transports to hospitals went up.

    Pandemic-era staffing shortages in the fire department, which sends paramedics to the majority of medical emergencies, persisted. Making matters worse, the triple threat of winter flu, RSV and Covid packed some SF intensive care units near capacity this month.

    But the most striking driver of ambulance delays is the jaw-dropping amount of time that crews spend in limbo at hospital emergency rooms, even as calls pile up in other parts of the city. Fire department ambulance crews sometimes wait three to five hours to pass off their patients, said SFFD spokesperson Capt. Jonathan Baxter.

    The amount of time between ambulance arrival at the hospital and ER staff taking over care of the patient, a metric called APOT, steadily climbed throughout the past year at all major hospitals in the city.

    Though city regulations state that hospitals should take ambulance patients within 20 minutes more than 90% of the time, none of the city’s largest hospitals hit that goal in a single month in the past year, according to records obtained from the SF Department of Emergency Management (DEM).

    In November, CPMC Van Ness’s APOT time was 61 minutes, triple the regulatory cap.

    “That’s too long, it should be faster,” said Dr. Alexander Janke, an emergency medicine physician and research scientist at the Yale School of Medicine with national expertise on how emergency rooms operate. “But it’s not surprising to me to hear these numbers, because I know how bad the bottlenecks are all over the country.”

    Short Staffing and Too Many Patients

    Local hospitals have struggled with the staffing problems that struck the industry nationwide in recent years. Limited staff and lack of bed availability can cause ambulances to have to wait to offload patients, DEM spokesperson Victor Wai Ho Lim said.

    The city’s eight largest hospitals all declined interview requests. St. Mary’s referred The Standard to the Hospital Council industry group, which represents SF’s public and private hospitals.

    “As evidenced during the Covid surges over the past three years, when patient utilization of emergency departments increases significantly, APOT events also increase,” Michon Coleman, regional vice president of the Hospital Council of Northern and Central California, said in a statement. “Hospitals are seeing an unprecedented volume of patients of all types and including Covid, flu and RSV, making achieving these targets more challenging.”

    An increase in the number of non-emergency cases coming to emergency departments and a lack of hospital space to take care of patients once they’re stabilized have also impacted ambulance wait times at ERs, according to Coleman.

    Hospitals across the country have run short on space this fall, a situation made worse by a nationwide whittling down of unprofitable pediatric beds over the past two decades and now apparent given RSV’s impact on young patients.

    But King-American’s Nultemeier believes that, to a degree, the ambulance backup has come out of a shift in how the hospitals prioritize patients.

    In the past, if a patient came to the hospital in an ambulance, they often got seen faster than if they arrived on their own, he said. Of course, patients experiencing potentially life-threatening emergencies have always taken first priority. But in recent years, the hospitals changed how they prioritize patients, placing more emphasis on clearing their busy waiting rooms than sending waiting paramedics back out to their ambulances, Nultemeier said.

    “It’s not an ambulance problem. It’s not a staffing problem,” Nultemeier said. “The hospitals don’t prioritize us dropping patients off and getting them off our gurney so we can get to the next call.”

    Kaiser-Permanente, however, didn’t point to any policy change as the reason for the hospital’s high offload times.

    “We have sufficient staff to care for our patients, but sometimes lack the physical space at the moment to offload the patient safely, and we will not offload a patient until it is absolutely safe to do so,” a Kaiser Permanente spokesperson said in a statement.

    Yale’s Janke said that the nation's emergency room backup crisis has been brewing for decades. Hospitals have a huge financial incentive to operate as lean as possible, having the minimum number of staff and beds possible at any given time. Inevitably, when the number of people getting sick spikes, the system isn’t flexible enough to handle the influx, like we’re having right now.

    “We have to have a conversation about how we change health care financing to make the acute care system more resilient to these kinds of changes,” Janke said.

  • 20 Dec 2022 9:53 AM | Matt Zavadsky (Administrator)

    With the announcement of the members of Advisory Committee on Ground Ambulance and Patient Billing (GAPB), PIRG released a report on ground ambulance balance billing.

    Download the PIRG Report here:

    The report acknowledges Arnold Ventures for its support.

    The author of the PIRG report is on the GAPB.

    The report has spurred media stories in the Washington Post and USA Today, included below. 

    No highlights in these, as all the content is important.


    Surprise bills from ground ambulances is next up in the move toward reform

    Ground ambulances were left out of surprise billing legislation. Experts will meet next month to consider how to wrangle them.

    Analysis by Rachel Roubein with research by McKenzie Beard

    December 13, 2022

    The Biden administration is set to kick off the work of a key advisory committee designed to help stop patients from getting hit with pricey surprise medical bills from ground ambulances, The Health 202 has learned.

    It took roughly two years for the new committee to get its start. But the panel’s meetings are now set to begin in the new year, with the first scheduled for Jan. 17-18. A critical report will be due 180 days later on how to prevent patients from owing hundreds of dollars for receiving out-of-network ambulance rides through no fault of their own.

    That’s according to a Centers for Medicare and Medicaid Services webpage detailing information about the advisory committee’s membership and its initial meeting, neither of which have been officially announced. CMS cites a Dec. 16, 2022, notice in the federal register, which suggests the information may have been inadvertently published early on the agency’s website.

    The upcoming launch of the advisory committee’s work is a step forward in fulfilling part of a law Congress passed in December 2020The legislation shielded patients from getting slapped with large bills when they unknowingly get care from an out-of-network provider, including for air ambulance flights. Yet, it didn’t apply to ground ambulances, instead mandating key federal departments appoint an advisory committee to recommend options for preventing such bills. 

    • “The ground ambulance loophole is a big gap that harms consumers,” said Madeline O’Brien, a research fellow at Georgetown University’s Center on Health Insurance Reforms. “We’ve been waiting almost two years for the committee to get off the ground and [are] very excited for the actions that they could be taking to protect consumers in this really critical space.”

    About the commission

    The details: The charter for the advisory committee was officially signed in November 2021, and the Biden administration began soliciting nominees to serve on the panel. 

    Roughly a year later, the committee’s membership is coming into focus. According to the CMS webpage, Asbel Montes will serve as the committee chair. He’s a managing partner at Solutions Group, which does health consulting and tech work, and leads the American Ambulance Association’s payment reform task force, according to his work bio. He referred The Health 202 to CMS for comment.

    • Committee members from the federal government include Rogelyn McLean, of the Department of Health and Human Services; Ali Khawar, of the Labor Department; and Tom West, of the Department of Treasury. 
    • Other members consist of a cross-section of the health industry, state and local government representatives, advocates and others. This includes Loren Adler, of the USC-Brookings Schaeffer Initiative for Health Policy; Adam Beck, of the major insurer lobby; and Patricia Kelmar, of PIRG, a public interest group.

    The view from CMS: In a statement, a spokesperson said the agency is looking forward to hearing the committee’s recommendations, which will help inform new policies aimed at “preventing balance billing, improving communication as it relates to insurance options for service, and by providing upfront and easy to understand disclosures of charges and fees for ground ambulance service.”

    State of play

    Ground ambulance billing is particularly complex. For instance, many emergency medical transport services are operated by municipal and county governments, and so they must adhere to state and local regulations. Meanwhile, some municipal services may not contract with private insurance companies, according to the Kaiser Family Foundation. 

    “The reality is there’s so much unknown that there’s wisdom to convening a panel of experts,” said Adam Buckalew, the founder of alb solutions who helped negotiate the surprise billing law as a GOP aide on the Senate health committee.

    The ground ambulance panel has been of particular interest to the House Education and Labor Committee.

    Chairman Robert C. “Bobby” Scott (D-Va.) and ranking Republican Virginia Foxx (N.C.) sent a letter, first shared with The Health 202, Friday afternoon urging HHS to “prioritize and complete its establishment expeditiously.” (The CMS webpage appears to be updated with information about the ground ambulance committee before the lawmakers sent their letter, though an Education and Labor aide said HHS had been alerted last month that the letter was coming.)

    Jamie Pafford-Gresham, the secretary of the American Ambulance Association, said patients should be protected from surprise bills, but a “balanced approach” to addressing the payment is needed. She contends getting it wrong could jeopardize access to emergency care, particularly in underserved areas.

    Onward: The report is just another step toward potentially banning patients from receiving surprise bills from ground ambulances. Congress will likely need to legislate in this space to make good on upcoming policy recommendations. 


    Half of ambulance rides yield surprise medical bills. What's being done to protect people?

    Ken Alltucker


    December 13, 2022

    When people dial 911, perhaps the last thing they think about is how much the ambulance ride will cost. 

    But a report released Tuesday by U.S. PIRG Education Trust shows ambulance companies routinely bill out-of-network charges. This happens when an insurance plan's network doesn't include the public or private ambulance company.

    Even after an insurer pays a portion of charges, about half of consumers are billed more. These extra charges add up to about $129 million each year, according to U.S. PIRG.

    Congress passed a law creating an arbitration process as of January 2022 to protect consumers from surprise bills during emergencies or when an out-of-network doctor provides care at an in-network hospital.

    The federal law, called the No Surprises Act, also protects consumers from costly air ambulance bills — but it doesn't address more common ground ambulance transports. 

    "This was the big gap in the No Surprises Act and it should be closed," said Patricia Kelmar, senior director of health care campaigns at U.S. PIRG Education Fund. "Three million insured people every year are going in an ambulance for an emergency, and half of those folks are exposed to a surprise bill."

    What to know about surprise ambulance billing 

    • Ground ambulances were excluded from the No Surprises Act in part because of the complex regulatory nature and large number of stakeholders. Ambulance companies are usually regulated by states and local municipalities.
    • About 51% of emergency ambulance rides included out-of-network charges that potentially exposed patients to surprise bills, according to Kaiser Family Foundation.
    • The median cost for a surprise ambulance bill was $450, a 2020 study found, but rates vary by state and region. The median surprise bill in Massachusetts and Minnesota exceeded $1,000 while California had the most expensive average bills at more than $1,200. 
    • Fire departments or other local government entities provided nearly two-thirds of ambulance rides in 2020 while private ambulance companies handled 30% of rides, according to Kaiser Family Foundation

    Do states protect consumers from ambulance bills?

    Ten states have laws to limit ambulances from billing patients beyond what their insurance companies pay, but those restrictions apply only to state-regulated health insurance plans and protections vary. For example: Maryland's protections apply only to publicly-owned ambulances and Colorado's prohibits private ambulances from such balance billing, according to the report.

    The states with protections:

    • Colorado
    • Delaware
    • Florida
    • Illinois
    • Maine
    • Maryland
    • New York
    • Ohio
    • Vermont
    • West Virginia

    A major loophole: State bans don't apply to most employer-provided health insurance plans, which are regulated under a Department of Labor law called the Employee Retirement Income Security Act.

    "That's why we really do need a federal law to make sure that all insured patients have protection from surprise bills," Kelmar said. 

    How is the federal government addressing ambulance billing?

    A federal advisory committee created by the No Surprises Act is set to meet in January for the first time. It then has 180 days to make detailed recommendations on fee disclosures and strategies to protect consumers from surprise buildings.

    U.S. PIRG recommends Congress amend the No Surprises Act to protect consumers from surprise ambulance bills. The federal law has prevented as many 9 million surprise medical bills through September, according to an analysis by Blue Cross Blue Shield Association and America’s Health Insurance Plans, a health insurance industry group. 

    Why consumers need protection

    Because people have no chance to compare prices or seek a better deal during an emergency, consumer advocates say it's unfair to stick patients with surprise bills. 

    "When you call 911, you don't know what ambulance is going to come," said Eileen Appelbaum, Co-Director of the Center for Economic and Policy Research, a progressive think tank. 

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