Funding of EMS

Ambulance providers, like hospital emergency departments, provide care to every person who requests it regardless of whether he has the ability to pay. The system guarantees each individual in the community access to emergency life-saving care. However, requiring ambulances to respond to all calls without ensuring payment for uncompensated care is an unfunded mandate that's bankrupting many providers, thereby hampering access for both insured and uninsured people in the community. Since early 2000, more than 40 Oklahoma ambulance providers have gone out of business.

The EMS reimbursement crisis revolves around two key patient populations: those without health insurance and those who rely on government-provided health coverage.

The Uninsured. Nearly 30 percent of EMSA's patients have no form of insurance. Collecting fees for service from uninsured, usually very impoverished, patients is very challenging; indeed, EMSA receives no form of payment from a full 21 percent of patients transported.

Medicare Cutbacks. On April 1, 2002, the Health Care Financing Administration (now, the Centers for Medicare and Medicaid) implemented a new national fee schedule for reimbursing ambulance providers that care for Medicare members. Upon final implementation in 2010, providers' costs will exceed reimbursement by an average of 27 percent. Providers are required to accept what Medicare is willing to pay, despite the fact that it does not cover costs. In other words, EMSA has a legal obligation to care for all patients but no legal means for collecting adequate compensation for the care it provides. In FY06, 55% of patients EMSA transported relied on Medicare, Medicaid or Medicare HMOs; however, due to reimbursement cutbacks, only 29% of EMSA's operating cash came from these sources.