Where Medicare payments for ambulance service currently exceed the national average (about 1/2 of the U.S.) payments will fall to the current national average. Where payments are currently below the national average, payments may but will not necessarily increase. In both cases, what is now the national average payment will effectively become the maximum payment.

According to Dr. John Sacra, President of the American Trauma Society, "If the current average payment becomes the new maximum payment, the effect will be to literally lop off the entire top half of the national payment distribution curve. This policy will force about half of American communities to accept service degradation, or fund Medicare's obligations from local tax dollars or increased charges to private 3rd party payers. I just don't believe that's what Congress intends."

According to a recent analysis by the U.S. General Accounting Office (GAO), "Current variations in payment rates do not necessarily reflect expected differences in provider costs." Thus, payment increases will not necessarily go where they're most needed. Similarly, payment reductions will not necessarily affect those that can best afford them. The GAO report (GAO/HEHS-00-115) is aptly titled, "Medicare Fee Schedule Payments Could Be Better Targeted."

In areas where the Medicare fee is less than the cost of efficiently-delivered service, and where local governments can't or won't fund the difference, providers can no longer rely on the safety valve of billing the patient, and refusing to accept the Medicare fee as payment in full. The new rules will close that safety value. According to Stephen Williamson, President of the EMS trust responsible for serving 68% of Oklahoma's population, "In our market we already accept assignment, but given the payment reductions ahead, we'll have no choice but to shift a larger portion of Medicare's obligation to other payers, or reduce response time reliability."

The emergency meeting is sponsored by Rural EMS Advocate, a non-for-profit think-tank mobilized to conduct the economic and policy analyses needed to combat defective policy, and to support economically sound policy development. The meeting agenda includes results of several economic studies, an analysis of internally conflicting language within the Balance Budget Act of 1997, presentation of a fee schedule based on the "reasonable charge", and budget projections reflecting the lowest known cost at which quality patient care can be delivered in urban and rural markets.

"By conducting the economic studies required for informed policymaking, and by hosting this national meeting, we hope to provide a forum and focus for informed corrective action," said Anthony J. Myers, Chair of Rural EMS Advocate and Vice President in charge of America's second largest rural EMS system, East Texas EMS. "When fully implemented, Medicare's ambulance fee schedule will make it impossible for us to continue unsubsidized 911 service to most of the 17 rural counties we now serve."

For more information on the Emergency Meeting, and on the work of Rural EMS Advocate, go to www.ruralems.org or contact: