EMS system performance-based funding and reimbursement model.

The National Emergency Medical Services (EMS) Advisory Council (NEMSAC), formed in 2007, is a statutorily authorized federal advisory committee that provides advice to the US Department of Transportation and to the Federal Interagency Committee on EMS. The NEMSAC comprises 25 members representing different sectors of EMS, eg, Kenneth Miller, MD, PhD, represents the emergency medicine sector. The members are appointed by the Secretary of Transportation and serve on the council for 2 years. The Finance Committee was one of several standing committees of the NEMSAC from 2010 to 2012, with members from the Advisory Council, supplemented by “at large” subject matter experts, all of whom serve pro bono. “EMS System Performance-Based Funding and Reimbursement Model” is an Advisory article prepared by the Finance Committee and approved by the NEMSAC. Ambulance services, a part of the EMS systems, have historically been funded by user fees and, in some locations, local tax subsidies. Although many EMS systems provide advanced life support to ill and injured patients, the Centers for Medicare & Medicaid Services recognizes ambulance service solely as a transportation benefit and does not provide reimbursement for care provided in the out-ofhospital setting. Generally, an ambulance must transport a patient to a hospital emergency department (ED) for the EMS agency to receive compensation from federal payers and most commercial insurance companies. For example, if an EMS agency responds to a law enforcement request to assess an injured patient at the scene of a motor vehicle crash and the patient is not transported to a hospital ED, the EMS agency receives no reimbursement from government or private insurers. Policies vary among EMS agencies about whether it is appropriate to bill patients for a response without transport. A significant portion of the operating expenses of EMS systems is related to the cost of achieving and maintaining a state of readiness to respond to emergencies in a timely and effective manner. According to the Institute of Medicine, “EMS costs include the direct costs of each emergency response, as well as the readiness costs associated with maintaining the capability to respond quickly, 24 hours a day, 7 days a week.” Those costs W