Medicare has a “no transport” loophole. It doesn’t reimburse for calls that don’t transport a patient to a hospital. Fixing this is one solution to ease emergency responders’ financial pressures.

By Editorial Board

The Minnesota Star Tribune

March 26, 2024 at 10:30PM

An ambulance in Nashwauk, Minn. (Anthony Soufflé/The Minnesota Star Tribune)

Opinion editor’s note: Editorials represent the opinions of the Star Tribune Editorial Board, which operates independently from the newsroom.

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A historic workforce shortage. Shrinking populations in rural areas. Rising costs to equip and fuel ambulances.

There are many reasons why emergency medical services are struggling to provide the swift, sure response that’s expected in Minnesota after dialing 911. As the Star Tribune Editorial Board noted last fall, this service is alarmingly at a “fracturing point,” especially in rural areas.

There’s no panacea for this health care crisis. Instead, it will take multiple solutions at the state and federal levels to target root causes of service providers’ financial pressures. While Minnesota’s two U.S. senators are backing one such smart remedy — a bill that closes a loophole preventing payment for some calls — they are regrettably just two of three co-sponsors on this much-needed legislation.

Broader support is quickly needed so this sensible reform can rapidly pass through Congress and provide financial relief. In particular, Minnesota’s U.S. House delegation should follow the lead of Sens. Amy Klobuchar and Tina Smith and sign on as co-sponsors.

The legislation, S. 3236/HR 6257, has been introduced in both congressional chambers. Its chief Senate author is Peter Welch, a Vermont Democrat. The chief House author, Democratic Rep. Becca Balint, also hails from the Green Mountain State.

The bill takes direct aim at a problem that emergency and city officials in Minnesota have pointed to repeatedly: Medicare doesn’t reimburse for service calls that do not transport a patient to a hospital.

Medicare is the popular federally run health insurance program mainly serving those 65 and older. When a program covering so many people doesn’t pay for calls providing on-scene care without a follow-up hospital visit, there’s an easy-to-understand financial crunch. An emergency response team has fixed costs: staff time and gas, among them. Those expenses don’t magically disappear.

Medicare beneficiaries make up about 40% of patients treated by emergency medical services, according to Welch’s office. That percentage is likely higher in rural areas where there’s often an aging population dependent on Medicare.

In addition, many people do not need to be seen at a hospital, or want that level of care, after emergency crews arrive. “Many people rely on EMS to provide health care services, including after a fall or for minor medical emergencies,” Welch’s office reports.

Emergency responders can’t ignore calls for help, and they ought to get paid for the service they provide. That’s the sensible change that this bill would make. This shouldn’t be controversial, and the fix shouldn’t face delays in Congress.

“I have heard concerns from EMS providers and community leaders across the state about how challenging it is to cover the increased costs faced while providing this essential service,” Klobuchar said on Monday. “I am working in Congress to provide relief and ensure that all areas of our state have access to adequate emergency medical services.”

Klobuchar is also commendably lending her institutional clout to two other proposed federal fixes for EMS services. The first, S. 1673, would extend and increase a temporary Medicare reimbursement boost for three years. The bill laudably has bipartisan support, with three Republican co-sponsors.

The second bill is the VA Emergency Transportation Act, S. 2757, whose chief Senate author is Montana Democrat Jon Tester. The bill would prevent the U.S. Department of Veterans Affairs (VA) from reducing reimbursement “for special mode transportation providers, including ground and air ambulances, unless VA meets certain requirements that ensure rate changes will not reduce veterans’ access to this essential service,” according to Tester’s office. The bill has widespread support from veterans service organizations, and a welcome bipartisan list of cosponsors.

The federal measures do not excuse the Minnesota Legislature from taking action this session to assist emergency services. The $16 million aid package outlined in Gov. Tim Walz’s joint agreement with legislative leaders, announced Friday, is far from adequate.

Again, multiple solutions are urgently needed to resuscitate emergency services. State and federal lawmakers are thankfully listening. Now it’s time to act.