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Reimbursement Policies for Out-of-Hospital Care Flawed

Decoupling payment for care with transport to ER would improve patient-centered care, cut costs

WEDNESDAY, Feb. 20 (HealthDay News) -- Current Medicare reimbursement costs for out-of-hospital care, which link payment with transport to an emergency department, should be modified to improve patient-centered care and reduce costs, according to a viewpoint published in the Feb. 20 issue of the Journal of the American Medical Association.

Noting that Medicare and other payers provide no reimbursement for out-of-hospital care unless the patient is transported to an emergency department, Kevin Munjal, M.D., M.P.H., from Mount Sinai Medical Center in New York City, and Brendan Carr, M.D., from the University of Pennsylvania in Philadelphia, examined the impact of transport-based fee-for-service reimbursement on health costs and on the ability of emergency medical services (EMS) to provide patient-centered care.

According to the authors, out-of-hospital care agencies that rely on transportation-based fee-for-service reimbursement disincentivize the EMS from providing patient-centered care. Reimbursement reform should not penalize EMS for offering the most medically appropriate option, which may not include an emergency department visit. Out-of-hospital care reimbursement policies could be modified by decoupling payment for care and transportation; this could be achieved by modifying the existing ambulance fee schedule to separate payment rates for components of a typical response, as well as a transport fee. An additional approach would involve converting out-of-hospital care reimbursement to a population-based model of payment, such as global payment or a shared savings model. This would likely provide incentives necessary to remodel out-of-hospital care into a more patient-centered model that would reduce downstream costs.

"Financial and delivery model reforms that address EMS payment policy may allow out-of-hospital care systems to deliver higher-quality, patient-centered, coordinated health care that could improve the public health and lower costs," the authors write.

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