BOSTON (State House News Service) - Emergency transportation in a publicly-owned ambulance in Massachusetts costs about twice the national average, according to an upcoming report from the state's Health Policy Commission.
The report, which has not been publicly released yet, shows significant disparities in how much insurance payers are charged for ambulance services in Massachusetts between publicly- and privately-owned ambulance companies, and between commercial insurers and public insurance such as MassHealth.
Nationwide, commercially-insured patients pay an average $761 for an ambulance trip from a municipally-owned emergency medical services company, compared to a $1,578 charge in Massachusetts, researcher Diana Váscones told the HPC's Market Oversight and Transparency Committee at a meeting on Wednesday.
"Ground" ambulance services, as opposed to costly air ambulances, are not included in federal protections under the No Surprises Act, to prevent "surprise bills" from emergency medical care. Since patients don't have the ability to choose which ambulance picks them up in an emergency, they often end up with these surprise bills if the ambulance provider is not in their insurance network.
The HPC reported in 2017 that nearly half of ambulance trips in Massachusetts that year resulted in at least one out-of-network claim.
Of the 1.5 million EMS patient transports in Massachusetts in 2019, commercial insurance payers paid municipal ambulance services roughly double what they paid private ambulances per transport. Most payments for middle-tier services were between $500 and $1,000 for private ambulances and between $750 and $2,500 for municipal transports.
When asked why emergency trips were so much more expensive in publicly-owned vehicles, Váscones said "we don't have the clearest picture of that."
"We do think that it may be related to differences in payer contracting with private versus municipal services. It may be that payers are less likely to contract with municipal services," she said.
She added that it is something the commission plans to look into further. The commission is an independent state agency that monitors health care spending with an eye towards lowering costs and improving health care.
Massachusetts does not regulate health care rates and disparities in payments for similar services has long been a topic that policymakers have wrestled with since rising care costs are shared across the economy.
Publicly-owned ambulance services are commonly tied to fire departments, although there are some cities that have standalone EMS departments, such as Boston and Fall River. It is up to local jurisdiction to designate a primary ambulance service, municipal or private. In 2019, there was about a 1-1 chance of being picked up by a private versus public ambulance.
Even as emergency trips have gotten more expensive for everyone over the last six years, payments over $2,000 for municipal ambulances have doubled from 17 percent in 2017 to 34 percent in 2020 for similar care.
"There's just no rationale at all for calling an ambulance, being in a medical emergency and then not knowing how much it's going to cost or finding out later on that it was an unaffordable thing," committee chair of the Market Oversight and Transparency Committee David Cutler said.
Not only are there vast price disparities between public and private ambulances, but public and private insurance providers were charged at very different rates between 2017 and 2020, the main years the report focuses on.
Commercial insurance providers pay more than double what MassHealth and Medicare spend on ambulance rides, the report shows.
In 2019, private insurers paid a median $1,185 per trip compared to $501 for Medicare and $300 for MassHealth. The following year prices went up even higher for private payers to a median $1,371, while Medicare and MassHealth stayed mostly the same at $510 and $300.
Data for 2022 shows Medicare and MassHealth paid more for ambulatory care, at a median $541 and $397, respectively, and data is not yet available for commercial insurers.
Some of Massachusetts' neighbors have begun addressing ambulance billing reimbursement, Váscones said.
In 2021, Maine passed a law to require payers to reimburse out-of-network ambulance service providers for emergency services under certain guidelines. The Connecticut Office of EMS maintains ambulance providers' rates and annually adjusts the rates based on the federal cost index.
The median rate for basic care on an ambulance in Massachusetts was $1,149 in 2020. The maximum allowable amount in Connecticut in 2021 was $781.
"I think we ought to propose to the Legislature, maybe one if we think there's one way to solve it, or two or three ways to solve it, but encourage the Legislature to act, just because there's just absolutely no way this can happen," Cutler said.
Written By Sam Drysdale/SHNS