This action, while not unique as many providers have left certain communities, this is an interesting decision in a high-profile community to cease a certain service within the community.
The wage pressures due to regulatory issues in California (fast food worker wages up to $22/hr.), the overall worker shortage, and the desire to seek generally higher reimbursement for emergency services, may all be factors that led to this action.
This might be a bellwether for other providers dropping select services in some communities. For example, like many physicians have, ambulance providers could elect to not provide non-emergency transfer services to Medicaid patients, while continuing to provide services for other commercially insured patients.
Imaging what would happen to a region’s healthcare system if all ambulance providers simply took the stand on low Medicaid reimbursement and said ‘no’ to any Medicaid, non-emergency transfer? Or told the hospitals if they want the Medicaid patient transported, the hospital will have to pay, perhaps in advance, for the transfer?
If no provider was willing to provide non-emergency services for say Medicaid patients, does then the 911 safety net provider become the ONLY option? Meaning, publicly funded agencies may then HAVE to provide the service if there is no one else? What would that do to the availability of the 911 safety net system?
That might align incentives in states with ridiculously low ambulance Medicaid rates that have not changed in decades, to increase the ambulance rates. Imaging the hospital association joining the state’s ambulance association to advocate for higher ambulance reimbursement rates.
Perhaps this same action could be taken for patients insured by commercial insurers who have a pattern on choosing to make surprise payments (payment less than perhaps a state required % of UCR, or % of Medicare), placing their members at risk for a high balance due to the surprise payment? “I’m sorry, but ‘XXXX’ insurer is on our blacklist for surprise underpayments, and we do not want to put the patient at risk for a large out of pocket expense, so we are NOT going to provide the scheduled transfer”. That, too, might send a very strong message to ‘XXXX’ insurance?
To some, it may seem harsh to deny non-emergency medical services to patients based on their who their payer is but hasn’t the U.S. healthcare system been doing that forever!?
AMR Letter Exiting NEM LA.jpg