Philadelphia among first to try ambulance Medicare program that diverts patients to non-hospitals

Philadelphia will be among the first cities to try a new program designed to reduce ambulance costs for Medicare, and, as a result, some patients might find themselves driven to urgent care centers rather than hospitals.

In the past, Medicare paid for emergency ambulance rides only to hospitals, skilled nursing facilities, and dialysis centers. Under the new program, ambulances could get paid for taking Medicare patients to lower-intensity — and lower-cost — facilities, such as urgent care centers, when appropriate for the patient’s needs, according to the U.S. Centers for Medicare and Medicaid Services.

“Most beneficiaries who call 911 with a medical emergency are transported to a hospital emergency department, even when a lower-acuity destination may be more appropriate,” CMS administrator Seema Verma said in a statement. Participating ambulance organizations “will be able to deliver care to patients at the right time and place.”

The program applies only to people covered by original Medicare following a 911 call — not Medicare Advantage plans managed by private insurers.

Philadelphia Fire Department, which operates emergency ambulances in the city, is one of 205 ambulance operators in 36 states selected to participate in the five-year pilot program.

The fire department handles more than 750 EMS incidents a day but has limited options for where to take Medicare patients and get paid for the service, said Crystal Yates, assistant deputy commissioner for EMS with the city’s fire department.

“If we don’t take a patient to a hospital, we’re unable to bill insurance for reimbursement,” Yates said in a statement. “This gives us the chance to expand the reimbursement model while doing the right thing for patients.”

The Second Alarmer’s Association & Rescue Squad of Montgomery County was also selected to participate. The private nonprofit ambulance service operates in the southeastern part of the county, including in Abington, Jenkintown, Upper Dublin, Upper Moreland, and Hatboro.

Four additional ambulance companies serving other parts of Pennsylvania were selected for the program.

Ambulance operators in northern New Jersey, Baltimore, Washington, D.C., and New York City will also be testing the new payment model.