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POSITION STATEMENT ON EMS DRIVING
May 6, 2002
Issue:
In the 21st century health care environment in the United States, taxpayers and insurers alike constantly seek ways to reduce health care expenditures. In this context, some have proposed that non-medical stretcher van transportation be reimbursable by Medicare as an alternative to non-emergency ambulance services.
AAA Position:
The American Ambulance Association opposes the use of stretcher vans to transport patients and opposes Medicare reimbursement for stretcher van service.
The AAA is opposed to such a policy because we believe it is not in the best interest of the patients being transported. Actual experience from across the nation makes it clear that patients are put at risk every day in transport vehicles not staffed or equipped to meet their medical needs. The AAA believes that every patient who needs to be in a stretcher during transport must have a medically trained EMT to attend to his or her medical health and safety needs. There is ambulance service and there is wheel chair transportation. Ambulances and wheel chair vans are very different. It is a misguided public policy to blur the distinction between medical care provided by ambulance services and transportation for people in wheel chairs.
The AAA also believes these patients require medical observation and handling by EMTs in a vehicle which is equipped with patient monitoring and management equipment. We also believe that some Medicare carriers have incorrectly interpreted HCFA guidelines when they deny these patients' claims. It is important to note that bed confined is a criterion for medical necessity.
Background:
Policies vary on this issue across the country. Some states such as Massachusetts, Michigan and Ohio have banned the use of stretcher vans because of patient handling and monitoring concerns. Other states allow this form of transportation under very strict regulation (such as California and Arkansas) or even in an unregulated fashion as in New York.
Some ambulance service providers have been forced to provide this type of service due to the reimbursement practices of some of the contracted Medicare carriers. Certain categories of patients get their claims denied due to lack of medical necessity with the carrier maintaining the patient could be transported safely by some other means. Typically these patients cannot tolerate sitting in a wheelchair during transport and are bed confined.
Conclusion:
The AAA believes that stretcher vans are an unsafe mode of transportation for patients, instead of safe regulated ambulance service. To allow use of stretcher vans will create a financial incentive to inappropriately place patients who need proper medical care and handling into a non-medical service at great potential risk to patient health. As a result, the AAA opposes the use of stretcher vans and opposes Medicare reimbursement for stretcher van service.
On a related issue, the AAA supports the condition-based system that the Medical Issues Work Group of the HCFA Negotiated Rule Making Committee developed to prospectively determine medical necessity. When implemented, there will be no confusion as to which patient should have ambulance service. It is important to note that in this condition-based system, bed confined is a criterion for medical necessity.
Board Action: Approved by the AAA Board of Directors on March 6, 2002.
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