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Ambulance Providers Across Capital Region are Shortchanged by the Current Medicare Payment System - Schumer Legislation Passed in 2007 Provided Temporary Relief, But Provision Set To Expire in 2009

With Aging Population and Baby-Boomers Becoming Eligible for Medicare, A Well Funded Ambulance Service More Important Than Ever; Increased Funding Will Allow For Cutting Edge Equipment, Better Patient Outcomes, and Increased Survival Rates

Senator Unveils Bill to Permanently Bo

U.S. Senator Charles E. Schumer today revealed that ambulance providers across the Capital Region are on the verge of cuts in critical Medicare payments, hampering their ability to invest in lifesaving medical equipment and procedures. The cut, which is the result of an expiring provision, is the latest in a series of Medicare payment transitions.  Medicare ambulance payments have undergone major changes in the past 10 years, but a 2007 Government Accountability Office (GAO) report showed that ambulance providers are being underpaid by Medicare, hampering their ability to outfit their vehicles with cutting edge medical equipment and training their emergency personnel and medics in the latest prehospital care procedures and treatments.  In response to the GAO report and the growing needs of Upstate ambulance providers and patients, in 2008, Schumer secured a temporary increase in payments in the Medicare bill, but that increase is set to expire at the end of 2009.  Schumer said that the increased payments provided over the last two years have allowed ambulance providers in the Capital Region to make significant updates to their medical equipment, but they are in danger of losing those important advances if Medicare payments to ambulances are not permanently adjusted upwards. Currently, Medicare payments to private, nonprofit, and volunteer ambulance providers barely keep up with the cost of equipment upgrades, and the funds are set to be reduced at the end of the year. Schumer noted that well equipped, well funded ambulance services and medics who provide lifesaving care to patients are more important now than ever, as the population ages and the number of Medicare beneficiaries increase.


Standing at St. Peter's Hospital, Schumer today unveiled his bipartisan bill, the Medicare Ambulance Access Preservation Act, which will increase funding for counties in the Capital Region by $10.3 million over the next 10 years.  The bill provides payment updates of 6 and 17%, as recommended by the GAO.


"Across the Capital Region, residents deserve topnotch emergency services, which is why it's vital that we continue to give ambulance providers fair reimbursements so they can invest in acquiring the latest medical equipment," said Senator Schumer. "In 2008, I was able to provide much needed shortterm relief through a Medicare ambulance payment extension provision, but now we need a longerterm solution. My new bill provides a permanent increase for ambulance reimbursement so that ambulance providers can continue to upgrade with the latest technology and equipment to provide Capital Region residents with the finest medical care."


"We are very grateful to Senator Schumer for taking the lead on this critically important health care issue," said James McPartlon, Immediate Past President of the American Ambulance Association and Vice President of Mohawk Ambulance Service, Inc.  "It is very expensive to train our employees and equip our Ambulances with cutting edge medical technologies.  If Medicare underpays Ambulance providers, there will be a drastic negative long term effect on emergency care."


In the Capital Region, ambulance providers have continually been shortchanged by Medicare. A May 2007 GAO report found that ambulance service providers are reimbursed on average 6% below their costs of providing services to Medicare patients.  Since approximately 40% of patients transported by ambulances are covered by the Medicare program, inadequate Medicare payment is a critical problem for ambulance service providers. In 2007, Schumer introduced legislation to partially and temporarily close this gap while a more permanent solution could be enacted.  Schumer's legislation was included in the 2007 Medicare bill, and increased Medicare reimbursements by 3% on average for two years.  This stopgap increase allowed ambulance companies across the region to keep up with technical advances, but the funding is set to expire at the end of this year.  Schumer's new Medicare Ambulance Access Preservation Act will permanently increase reimbursements by 6% and ensure that patients have access to the cutting edge medical care. 


Low Medicare payments mean ambulance providers lack the necessary funds to acquire train with cuttingedge medical equipment and technology that can make a lifesaving difference to patients, but are often too expensive for cashstrapped ambulance companies to afford.


According to the Ambulance Association of America, increased funding over the last two years has enabled ambulance providers in the Capital Region to purchase equipment such as Automated External Defibrillators, which reduces the time a victim of cardiac arrest suffers from the most common lethal cardiac arrhythmias, and Intraosseous (IO) Infusion devices, which allows paramedics to deliver life saving fluids and medications to victims of cardiac arrest, heart attack, and serious trauma. As blood pressure falls it is increasingly difficult for even the most highly skilled technician to obtain intravenous access to deliver life saving care. In those cases, adult intraosseous (IO) infusion, a procedure where a needle is placed into the bone marrow of one of the long bones in the leg, provides critical access to the circulatory system for patients that need it most. Like most new medical technologies, IO infusion is expensive. Reducing Medicare reimbursement for ambulance services could threaten access to this important medical procedure.


Increased reimbursements permanently will enable ambulance providers to keep up with technological advances, and purchase life saving devices like the Waveform End Tidal CO2 (Capnography), used in endotracheal intubation, one of the most important and dangerous procedures performed by paramedics in the field. The procedure is so dangerous for patients because an undetected, misplaced endotracheal tube is potentially lethal.  Waveform capnography is a powerful tool that reduces or eliminates the incidence of undetected misplaced endotracheal tubes. It allows paramedics to more closely monitor their patients during transport to ensure that their airway is secure.


Increased reimbursement will also allow for ambulances to purchase Automatic Compression CPR Devices that expand the capability of the paramedic as they care for a victim of cardiac arrest. These devices through either a piston system, or a band that fits around the patient's chest automatically compresses the chest at the correct rate and to the correct depth ensuring that the patient receives textbook quality CPR. In addition, because the paramedic does not have to pause to perform cardiac compressions, the medic is free to administer medications, perform airway procedures, or provide other life saving care. These devices are new, and very expensive. With the threat of reductions in Medicare payments, ambulance services may not be able to afford these potentially life saving devices.


Based on the success of the original reimbursement plan, continuing the relief on a more permanent basis would be beneficial to medical care providers and their patients. Schumer noted that as the baby boomer generation continues to age, more and more residents in the Capital Region will become eligible for Medicare, further stressing the need for increased reimbursements. Without a permanent solution, funding levels for ambulance providers will drop back to 2007 base levels, a 3% drop overall.


To ensure that Capital Region ambulance providers have access to the life saving equipment they need, Senator Schumer today announced the introduction of his new bill, the Medicare Ambulance Access Preservation Act of 2009. Schumer's bill will increase funding for counties in the Capital Region by 6% over 2007 levels through 2019, a total increase of $10.3 million.


The increased funding will enable Capital Region ambulance providers to supply their vehicles with cutting edge medical equipment and training emergency personnel and medics in the most uptodate prehospital care procedures and treatments available.


The chart below shows the increase that ambulance providers in each county would experience between 2010 and 2019.




Additional Payments, 20102019

Payments in 2010 without Schumer's Legislation

Payments in 2010 with Schumer's Legislation

Albany County




Rensselaer County




Saratoga County




Schenectady County