7/22/2020
Finger Lakes Times

To the Editor:

U.S. House Representatives Cindy Axne (D-IA), French Hill (R-AR), and John Larson (D-CT) are requesting for the Centers for Medicare and Medicaid (CMS) to provide emergency medical services (EMS) with reimbursement for treatment in place (TIP) and telehealth facilitations. The request letter being circulated around Capitol Hill has been endorsed by the International Fire Chief's Association (IAFC), National Association of Emergency Medical Technicians (NAEMT), and the Arkansas Ambulance Association (ArAA).

EMS agencies transport tens of millions of patients to hospitals each year and treat countless others on-scene. However, CMS does not provide any reimbursements to "ambulance service suppliers" when a patient is not transported to a hospital. EMS is prohibited from seeking CMS reimbursement for TIP, which can provide the most appropriate patient care of low acuity Medicare and Medicaid beneficiaries and reduce the strain on the overall healthcare system.

CMS should also provide EMS direct reimbursement for facilitating emergency telehealth consultations. In Section II(E) of CMS' recent interim final rule with comment (IFC), CMS recognized the value of EMS in telehealth by recommending physicians consider collaborating with EMS to facilitate telehealth consultations.

However, the IFC leaves it up to the individual physicians to reimburse EMS for these facilitation services. CMS should develop a payment methodology to reimburse EMS agencies for facilitating the telehealth consultations utilizing established CPT codes.

The COVID-19 pandemic is driving people to refuse ambulance transport to hospitals due to the fear of exposure to the virus. The large reduction in CMS-mandated transports is placing an enormous financial burden on EMS, an already under-resourced and financially strained system. Anticipated state and local budget deficits are going to force EMS agencies to conduct layoffs or stop providing their essential service to their community. Reimbursement of TIP and facilitating telehealth consultations can help to mitigate some of the financial burden EMS agencies are experiencing now and into the future due to the COVID-19 pandemic.