WASHINGTON -- Medicare wants to change how it pays for emergency ambulance services to give seniors more options besides going to a hospital emergency department, officials said Thursday.
Other options could include going to an urgent care center, a doctor's office, or even treatment at home under supervision of a doctor via telehealth links.
It's just a pilot project for now, but if adopted nationwide the idea could save Medicare more than $500 million a year and allow local fire departments and ambulance services to focus the time and energy of first responders on the most serious emergencies.
Some advocates for patients welcomed the plan, but said it needs careful review and supervision.
"We definitely think this is intriguing and exciting, but it really does need to be monitored very closely," said Julie Carter, a federal policy expert with the Medicare Rights Center, which advocates on behalf of beneficiaries. "We see this as a potential opportunity to keep people out of the ER when they don't need to be there."
Medicare officials said nothing's going to change overnight, and they pledged the pilot program would be closely evaluated. Patients will retain the option of going to a hospital emergency room if that's their wish.
Later this year, Medicare will announce up to 40 grants available to local governments or agencies that operate 911 dispatch centers. The pilot program would start early next year and run for two years. If successful, it could be adopted nationwide. Medicare says it also wants to get state Medicaid programs and private insurance companies interested in the approach.
The idea came out of the Center for Medicare and Medicaid Innovation, created under the Obama health care law to improve quality and reduce wasteful spending in the two giant health care programs. Although President Donald Trump tried to repeal the Affordable Care Act, his administration has now tapped the center in its own efforts to cut costs and help patients become more knowledgeable consumers of services.
Unveiling the ambulance proposal at a Washington, D.C., fire station, Adam Boehler, the innovation center director, said he was astounded to learn that under current rules Medicare will only pay for emergency ambulance services if the patient is going to a hospital, in most cases. Transportation to rehab centers or nursing homes, as well as dialysis facilities, is also allowed.
"I thought that was a joke," said Boehler, a former health care entrepreneur who ran a company providing in-home medical care to seriously ill patients. He called Medicare's current policy a "ridiculous incentive" to funnel patients to the most high-cost setting. Most private insurance plans discourage emergency room use by imposing higher copays, and some state Medicaid plans are trying similar tactics.
Appearing at the same event, the chief medical officer for the New York City fire department endorsed Medicare's experiment. Dr. David Prezant said his agency is overwhelmed with non-emergency calls and transporting patients to a hospital is a time-consuming process that keeps ambulance crews needlessly tied up.
"If only 20 percent of our calls no longer required transport to an ED (emergency department), we would save lives in cases when every second counts," Prezant said.