OIG Report – Medicare/Ambulance

TO: AAA Membership

FROM: David M. Werfel, AAA Medicare Consultant

RE: OIG Report on Utilizations of Medicare Ambulance Transports

On September 24, 2013, the Office of the Inspector General (OIG) issued a report entitled Utilization of Medicare Ambulance Transports 2002 – 2011, OEI 09-12-00350. The report lists the increases in ambulance transports and suppliers paid by Medicare Part B fee-for-service from 2002-2011, comparing many different categories. The report does not make any recommendations, nor does it look at the factors that could lead to certain increases (e.g. new suppliers, population shifts, etc). This is the type of report that policymakers read so the AAA is currently developing a response to the report that does examine factors for some of the increases.

OIG Regional Inspector General Timothy Brady will be speaking on the findings of this report at the AAA Annual Conference in Las Vegas in November. Mr. Brady will also present on questionable billing characteristics in 2011 and case studies of fraudulent providers and actions by the OIG to prevent and reduce waste, fraud and abuse. The presentation will be a general session held on Tuesday, November 19, at 11:00 am local time. For information on registering for the AAA Annual Conference, please go to: http://www.the-aaa.org/default.asp?contentID=513.

Listed below are some of the statistics cited in the report. All are for increases from 2002 to 2011:

•the number of ambulance transports paid by Part B increased 69%.

•the number of Medicare beneficiaries receiving ambulance transports increased 34%, while the number of beneficiaries increased only 7%.

•the number of ambulance suppliers increased 26%.

•the number of ambulance suppliers providing BLS non-emergency transports nearly doubled.

•the number of transports to/from dialysis increased 269%.

•the number of transports to/from hospitals increased 55%.

•outpatient transports for partial hospitalization services at community mental health centers increased 829%.

•the origin of transports from the scene of the acute event to a hospital increased 112%, accounting for 13% of all transports to a hospital.

•the number of transports from a residence to a hospital increased 51%, accounting for approximately half of all transports to a hospital.

•emergency transports to a hospital increased 65%.

•non-emergency transports to a hospital increased 14%

•ALS emergency transports to a hospital increased 69%.

•BLS emergency transports to a hospital increased 60%.

•15 diagnosis codes, used for billing ambulance transports, increased 100% and were for 35% of all transports to a hospital.

•there were 40% more outpatient visits to non-hospital facilities vs. 27% for all fee for service beneficiaries.

•of those noted in the bullet above, there was an increase of 829% to partial hospitalization program services at mental health hospitals.

•utilization increases varied tremendously by state with Utah being the lowest (8%) and California the highest (289%). Other states with very high increases were VA, SC, GA and NJ.

•10 states had increases of 100% or more.

•payments increased 130% compared to 74% in overall Part B payments.

•ESRD patients increased 24%, but ESRD patients transported by ambulance increased 85%.

 

The report includes many charts and a few graphs that you will want to see. The entire report can be downloaded at http://oig.hhs.gov/oei/reports/oei-09-12-00350.pdf