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Ambulance squads could lose $1.37 million in Medicare reimbursement


North country ambulance squads stand to lose a total of $1.37 million in Medicare reimbursement through 2018 if the federal government doesn’t act on an expiring provision, according to a news release issued Wednesday by U.S. Sen. Charles E. Schumer.

Private, nonprofit and volunteer squads in Jefferson, Lewis, St. Lawrence and Franklin counties could lose $239,079 in Medicare reimbursement for 2014 alone, which some local providers say will just add to the present financial pressure.

“Even at 2 percent, being conservative, it’d probably be in the vicinity of $20,000 to $30,000 a year,” said Mark A. Tuttle, outgoing chief operating officer at Lewis County Search and Rescue, Lowville. “We probably will be able to adjust and do OK. If this’ll be a reoccurring process, it won’t take too many cuts like that to have to rethink.”

Before that happens, Mr. Schumer said, he will “fight to ensure this funding does not expire in 2014.” According to the news release, Mr. Schumer aims to include a five-year extension of funds in the Permanent Sustainable Growth Rate legislation that the Senate Finance Committee will work on today.

“Across upstate New York, residents deserve top-notch emergency services, but if Congress doesn’t act by Jan. 1, critical Medicare reimbursements for our ambulances and emergency services will lapse,” he said in the release. “Our ambulance providers require these reimbursements — which are already less than the cost of service — to continue to provide the highest quality of care possible and invest in the latest medical equipment.”

According to the news release, Medicare reimbursements for ambulance squads began decreasing in 2002, even though reimbursements would “lag well below the actual cost of service.” Since then, Congress passed temporary supplemental payments, on a year-to-year basis. Extending that to five years will allow squads to continue operating at more sufficient levels.

With an approximate annual budget of $600,000, Mr. Tuttle said, Lewis County Search and Rescue is able to cover the towns of Lowville, Martinsburg, Greig, Watson, Denmark, Pinckney and Montague. The squad has seen increased supply costs for each of its three vehicles, such as cardiac monitors, which have increased from $70,000 for a five-year lease purchase to $106,000.

Increased costs met with lower reimbursement rates is an issue that many area squads are experiencing. At Thousand Islands Emergency Rescue Service, Clayton, Executive Director Roland G. Churchill said IV catheters have gone up 300 percent in the last few years, and in seven years, purchasing a cardiac monitor outright has gone from $12,000 to $31,000.

With just a $356,000 annual budget, he said, the Clayton-area squad cannot afford to lose about $15,000 to $17,000 annually in Medicare reimbursement adjustments. While an average TIERS call costs $512, the average Medicare reimbursement is only $312.

“If it’s not adjusted, we’ll get stuck with that rate in 2014 and beyond,” he said. “Our survivability to operate is probably in jeopardy because we cannot operate at a loss. We have to, by New York state law, pick up that person and taken them to the hospital. We can’t refuse them like some doctor’s office can. How do we make up for that? More pancake breakfasts, roast beef dinners and asking for the public’s help.”

He said the squad’s board of directors rings its hands daily over the mess.

“It’s a troubling trend, without a doubt,” Mr. Churchill said.

He said if this trend continues, he fears some nonprofit squads in particular may have to either drastically change, or eliminate their service altogether.

Federal insurance reimbursement makes up more than half of the income for TIERS, Lewis County Search and Rescue and Gouverneur Rescue Squad.

Mark A. Deavers, Gouverneur Rescue Squad director of operations, said with a $700,000 annual budget, there’s only a little wiggle room left. So long as a cut isn’t long-term, the squad will survive, he said.

As squads face this Medicare issue, Mr. Churchill said, there is some good news: the summertime woe of some squads having to wait upward of 90 days for federal insurance reimbursement has whittled back down to the normal 30-day time frame.

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