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June 21, 2019

Realignment of EMS Reimbursement Policy: New Hope for Patient-Centered Out-of-Hospital Care

Author Affiliations
  • 1Departments of Emergency Medicine, Population Health Science & Policy, and Prehospital Care, Icahn School of Medicine at Mount Sinai, New York, New York
  • 2Health Policy Fellowships and Leadership Programs, National Academy of Medicine, Washington, DC
  • 3F. Edward Hebert School of Medicine, Uniformed Services University of the Health Sciences, Bethesda, Maryland
JAMA. 2019;322(4):303-304. doi:10.1001/jama.2019.7488

Substantial efforts have been made over the past decade to move the US health care system away from fee-for-service reimbursement toward alternative payment models, with the goals of expanding access, improving quality, and reducing medical costs. However, financing for emergency medical services (EMS) continues to incentivize transport to the emergency department (ED), regardless of the needs or desires of patients. In 2016, EMS agencies in the United States responded to an estimated 22.0 million 911 calls and transported an estimated 14.6 million patients to a hospital. Of those transports with complete billing information, 33% were billed to Medicare, 31% to private insurers, 20% to Medicaid, and 15% were self-pay.1

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