A new report released by Attorney General Andrea Joy Campbell examines ground ambulance services in Massachusetts and the financial burdens many consumers face after an ambulance ride. This is the latest Health Care Cost Trends report from the AG’s Office in its ongoing work to promote health care affordability in Massachusetts.
The report looks at the landscape of ground ambulance services across the state and factors that have contributed to costly and unaffordable bills for many residents. The findings and observations made in this report incorporate information provided to the AGO by cities and towns, private ambulance companies and commercial health plans.
“When emergencies occur, Massachusetts residents must have access to high quality, prompt emergency medical services without fear that the bill will be unaffordable,” said AG Campbell. “We recognize that many ambulance providers are struggling with labor shortages and increased costs, among other challenges. Our report proposes policy fixes aimed at balancing provider costs and system sustainability while ensuring that consumers who need ambulance services do not face unexpected bills.”
The report includes the following key findings:
- The majority of Massachusetts municipalities provide their own ambulance response; approximately one-third of municipalities outsource ambulance services, typically to a private provider.
- Massachusetts municipalities rarely contract with commercial health plans. In general, private providers are more likely to do so. Of the claims data the AGO reviewed, 67% of emergency transports in 2022 were out-of-network (OON) for commercial health plan members.
- The majority of transports in Massachusetts involve MassHealth or Medicare members. Municipal ambulance providers assert that they need to stay OON with commercial plans to maximize reimbursement for services provided to commercial plan members. They also stated that public payers do not pay enough to meet their costs.
- On the commercial health plan side, there is significant variation in reimbursement of OON ambulance transports. Often, commercial health plans in Massachusetts allow an ambulance provider’s full charge for OON emergency transports. When health plans do so, and their members must pay a deductible, the average deductible amount was $971 in 2022.
- When commercial health plans pay only a portion of an ambulance provider’s charge, their members are at risk of receiving high “balance bills,” a bill an OON provider may send for the difference between the provider’s total charge and the amount the health plan determines the provider is “allowed” to be paid by the plan and/or the patient through cost sharing (such as a co-payment or deductible). For example, one private (non-municipal) ambulance provider sent 904 balance bills to patients totaling approximately $1,425,000 for ambulance transports provided September 2021 through December 2022.
- Many Massachusetts residents struggle with paying ambulance bills. In 2021, four private ambulance providers sent approximately 29,000 accounts – totaling nearly $23.4 million in charges to consumers – to collections. Those amounts increased in 2022, when the same four providers sent approximately 31,000 accounts – totaling nearly $27.5 million – to collections.
First, Massachusetts should prohibit balance billing and establish a fair and reasonable default reimbursement rate for OON transports to protect consumers who have commercial health coverage from facing unaffordable or unexpected ambulance bills.
Second, the report recommends a working group be established to study ground ambulance costs in Massachusetts and the adequacy of current EMS funding models in meeting these costs. The working group should consider appropriate funding mechanisms beyond health plan reimbursement that can support and sustain EMS services.
Third, the Commonwealth should continue to study and facilitate health care models, including community paramedicine and mobile crisis response, that may provide more cost-effective alternatives to an ambulance response in appropriate circumstances.
Prior cost trends report from the AG’s Office have focused on inefficiencies in the distribution of health care dollars, including provider price variation unexplained by differences in quality, complexity of services, and other common measures of consumer value.
Today’s report was prepared by Assistant Attorney General Lisa Gaulin, Chief Sandra Wolitzky, Assistant Attorney General Nina Cohen, Paralegals Gaëlle Bouaziz and Maya Al-Ahmad, Mediator Mila Mignosa, Health Care Analyst Maeva Veillard, and Administrative Assistant Sandra Charalel of the AG’s Health Care Division.
Original source can be found here.