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

Posted on RAND.org on December 01, 2013

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

Read More

Access further information on this document at Health Affairs

This article was published outside of RAND. The full text of the article can be found at the link above.

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.

This report is part of the RAND Corporation External publication series. Many RAND studies are published in peer-reviewed scholarly journals, as chapters in commercial books, or as documents published by other organizations.

Our mission to help improve policy and decisionmaking through research and analysis is enabled through our core values of quality and objectivity and our unwavering commitment to the highest level of integrity and ethical behavior. To help ensure our research and analysis are rigorous, objective, and nonpartisan, we subject our research publications to a robust and exacting quality-assurance process; avoid both the appearance and reality of financial and other conflicts of interest through staff training, project screening, and a policy of mandatory disclosure; and pursue transparency in our research engagements through our commitment to the open publication of our research findings and recommendations, disclosure of the source of funding of published research, and policies to ensure intellectual independence. For more information, visit www.rand.org/about/principles.

The RAND Corporation is a nonprofit institution that helps improve policy and decisionmaking through research and analysis. RAND's publications do not necessarily reflect the opinions of its research clients and sponsors.