Do We Need a Rural Payment Differential Under the Medicare Ambulance Fee Schedule?

Research center:
Lead researcher:
Penny Mohr, MS, 301.656.7401
Project completed:
August 2003
In April 2002, Medicare began paying for ambulance transports on the basis of a prospectively-determined national fee schedule. Before this fee schedule was implemented, there was considerable variation in the way in which ambulance services were paid under Medicare. Because the national fee schedule is leveling out these differences, there has been on-going concern about whether certain types of ambulance providers would more likely be adversely affected by the fee schedule. In particular, some have suggested that small rural ambulance providers might be more likely to experience reductions in their Medicare revenue under the new fee schedule than their urban counterparts.

The purpose of this project is to use national data sources to further explore the need for a payment differential for certain types of rural providers, and, if a payment differential appears to be warranted, to examine which criteria might be useful for targeting increased Medicare payments to rural ambulance providers. We examine how the costs of services for rural and urban providers compared with Medicare payment and which types of rural providers will be winners or losers under the new fee schedule.

Data from the National Survey of Ambulance Providers are linked to Medicare claims or Medicare cost report data for the same year of the survey, depending on whether the provider was an independent or hospital-based provider in that year. Other secondary data files, such as the Bureau of Health Professions Area Resource File (ARF), will also be merged with the analytic file to enable us to determine the demographic characteristics of the counties of location for each of the EMS providers.

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