EMS System Review - State of New Jersey

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State of New Jersey, DHSS, OEMSConsulting Services: EMS System ReviewFigure 6: Scores for Legislation and RegulationLegislation & RegulationGroup Score Average 1.78 (Marginal)3.002.502.00Score 1 - 51.501.000.500.001GroupSystem Finance – The topic that generated the most conversation, debate, andfrustration within the focus groups was financing of EMS. Reduced compensation frominsurance carriers, especially Medicare and Medicaid, has precipitated concern and even crisis insome EMS circles. This is particularly true among non-transport ALS programs who haveshouldered a major part of this burden.Another major issue is the funding that is not collected by NJFAC and non-affiliatedvolunteer programs. Several focus groups felt that this unclaimed money could be used tosupport the state EMS system. There was considerable discussion about the complexities offinancing such as the need for separate agreements between hospital-based ALS units and eachsquad they provide services.Their financial issues are neither local nor New Jersey specific. National EMS agendascontinue to address them and recommend the following actions:• Development of proactive relationships between EMS and other healthcare providersand healthcare payors.• Compensate EMS based on preparedness instead of volume-based incentives.TriData, a Division of 34September 2007System Planning Corporation
State of New Jersey, DHSS, OEMSConsulting Services: EMS System Review• Consider other compensation models that do not require transportation forcompensation.• Addressing EMS relevant issues within government healthcare policy. 27Recently, the U.S. General Administration Office (GAO) determined thatMedicare/Medicaid reimbursement rates were insufficient. The average reimbursement ratecaused EMS transportation providers to operate at 6 -17 percent below the break-even point. 28The American Ambulance Association (AAA) supported the GAO finding and said thatMedicare payments were 8 percent below the break-even point for their organizations. 29Air Medical EMS financing was another topic of contention. There is competitionbetween private services and JEMSTAR (New Jersey State Police) programs as to who can run amore efficient and effective service. (This is explored in-depth in the JEMSTAR chapter.)Two related financial concerns are the New Jersey State Police Helicopter Fund and theNew Jersey Training Fund. An amount of $3.00 from every car registration goes into a fund forthe two New Jersey State Police helicopters that provide air medical transportation and pilots.Some of this fund is also used to partially finance the medical portion of the program(JEMSTAR). EMS providers and organizations are concerned that this system may be inefficientand very little funding is used for the EMS portion. The hospitals supplying medical personnelclaim that the fixed rate of $1,337 is far below the break even point.The EMS Training fund is identified in legislation allowing for reimbursement ofvolunteers for EMT training and continuing education. It is funded by traffic citations; 50 centsof each moving violation fine is targeted to this fund. Some focus group members question howthe funding is being spent while others are concerned about its limited use. JEMSTAR and theTraining Fund will be discussed in detail in other sections of the report.The focus groups scored this component at M = 1.48, SD = 0.29. This and EMS Researchwere the only two components that received unsatisfactory evaluations (Figure 7).27 NHTSA, 1996, p. 22.28 GAO. (2007). Ambulance Providers: Costs and Expected Medicare Margins Vary Greatly. Report toCongressional Committees (GAO-07-383)29 AAA (May, 2007). GAO Report Confirms Medicare Ambulance Payments Are Below Average Cost PerTransport. Available: [Online]. www.the-aaa.org.TriData, a Division of 35September 2007System Planning Corporation
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EMS System Review - State of New Jersey

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