Volunteer Labor and the Organizational Structure of Rural Emergency Medical Services (EMS) Providers
Many rural areas are served by low-volume Emergency Medical Services (EMS) providers. By definition, these providers are high cost providers because the costs of capacity cannot be spread over a larger number of EMS transports. Revenue sources of low-volume providers are varied, and the new Medicare Ambulance Fee Schedule may be changing revenue for many providers. The purpose of this study is to examine the cost and revenue structures of low-volume providers and impacts of Medicare payment changes on these providers. Issues addressed include how the cost and revenue structures differ between full-cost and volunteer providers, whether recent changes in Medicare payments have affected providers, and how these changes might affect providers cost and revenue structures. We characterize low-volume EMS providers with data from 1999 National Survey of Ambulance Providers, examining whether the degree of volunteerism varies with provider characteristics, including provider location, service mix, and average cost. Using results from these analyses, we will select several EMS providers with "high" and several with "low" reliance on volunteers for case studies of their uses of volunteers, their cost and revenue structures, and realized and expected impacts of the new Medicare Ambulance Fee Schedule.
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