Giving EMS Flexibility in Transporting Low-Acuity Patients Could Generate Substantial Medicare Savings

Published in: Health Affairs, v. 32, no. 12, Dec. 2013, p. 2142-2148

by Abby Alpert, Kristy Gonzalez Morganti, Gregg S. Margolis, Jeffrey Wasserman, Arthur L. Kellermann

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Research Questions

  1. Could some Medicare patients who call 911 be safely treated in settings other than an emergency department?
  2. How much could the federal government save if Medicare could reimburse emergency transport services for taking some beneficiaries to other care settings?

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.

Key Findings

  • More than one-third of Medicare beneficiaries not admitted to the hospital after a 911 call could be treated in settings other than an emergency department.
  • If Medicare had the flexibility to reimburse for transporting beneficiaries to alternative settings, the federal government could save $283-$560 million per year and improve continuity of care.

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