GloucesterTimes.com, Gloucester, MA

August 6, 2012

Ambulance billing shift in governor's hands

From Wire and Staff Reports
Gloucester Daily Times

---- — BOSTON — As Gov. Deval Patrick weighs a bill that would require insurers to pay private ambulance companies directly for the cost of a transport, supporters and opponents of the legislation are both trying to use the governor’s focus on health care cost containment as leverage.

While insurers and business groups are warning that the bill on Patrick’s desk could add $80 million to ambulatory costs, municipalities and a majority of legislators say the changes in the bill would impose a rate cap for the first time on ambulance services and provide stability for providers.

The issue of payment for ambulance services cropped up in 2011, when Blue Cross Blue Shield of Massachusetts and other insurers began reimbursing subscribers directly for the cost of a ride, shifting the responsibility for paying the ambulance company to the patient.

Insurers hoped this practice would encourage private ambulance providers to join their networks and negotiate contracts for lower rates, but service providers say patients often fail to pay in a timely manner, or at all.

And while the shift has exempted municipally-run emergency squads, critics of the practice have noted that Blue Cross and other insurers have refused to include that exemption in any statute, sparking criticism and concern from emergency departments that bank on keeping current with ambulance squads revenues. That includes in Gloucester, where the city’s Fire Department staffs and runs ambulance squads that bring in more than $1 million per year. “They’re not driving down the cost of health care,” Marshfield Fire Chief and state association president Kevin Robinson said at the time, joining then-Gloucester interim fire Chief Phil Dench and emergency services coordinator Sander Schultz in a visit to the Times. “They’re shifting it, onto us and onto our communities and our taxpayers.”

During the last legislative session, Patrick vetoed a bill that would have banned direct payments to patients, returning the bill to the Legislature with an amendment that would have capped payments at 300 percent of Medicaid, or the usual rate paid by insurers, instead of ambulance providers.

“You presented a reasonable compromise at that time, prohibiting health plans from reimbursing members, while ensuring that private ambulance companies are fully and directly reimbursed at reasonable rates. We urge you to take the same action now,” read a letter from businesses and insurers.

Rep. James Cantwell, D-Marshfield, delivered a letter to Patrick on Wednesday signed by 102 House members calling on the governor to sign the bill.

“We’re trying to work with the health care cost containment idea,” Cantwell said. “We have incorporated what the governor sent back two years ago with the billing provision and triple the rate of Medicaid. The only difference is whether the rate is set by the insurer or the ambulance provider.”

Marshfield Chief Robinson met last week with Lt. Gov. Timothy Murray’s chief of staff to review the bill, and press for the governor to sign it. Kim Haberlin, a spokeswoman for the governor, said Patrick is still reviewing the bill.

“It’s the providers who understand the cost of service readiness and providing service, so it should be providers who set the rate,” Robinson told the State House News Service. “They’re in the business to make money, we’re in the business to provide service.”

The letter urging Patrick to veto the bill was signed by leaders of A.I.M., the Retailers Association of Massachusetts, the Massachusetts Association of Health Underwriters, N.F.I.B., Blue Cross Blue Shield, the Massachusetts Business Roundtable, the Worcester Regional Chamber of Commerce, the Greater Boston Chamber of Commerce, the Massachusetts Association of Health Plans, and Health Services Administrators.

The fight has now been boiled down to whether insurers or ambulance providers get to set the rate for emergency transport services.

The bill (H 3917) on the governor’s desk would prohibit the direct payment of patients for ambulatory care, and would set a cap on rates at 300 percent of the Medicaid reimbursement rate or the usual rate of an ambulance provider, whichever is lower. It would also ban “balance billing” as a consumer protection against ambulance providers billing patients for the balance of a transport not covered by insurers.

“Threats of ‘pay the patient’ and under-funded reimbursements undermine the ability of cities and towns to fund and operate responsive and efficient ambulance services that are the backbone of emergency medical response in Massachusetts,” wrote Geoffrey Beckwith, the executive director of the Massachusetts Municipal Association, in a letter to the governor.