What Do Paramedic Reimbursements Have To Do With Emergency Room Wait Times?

Aug 29, 2018

Allegheny Health Network's parent company Highmark is launching a pilot program to reimburse emergency services companies, even when patients don't end up at the hospital.

Currently, most insurance companies won't cover EMS treatment of a patient unless they're taken to a hospital. This means people sometimes end up in the ER for conditions that could be treated on site.

However, in January Anthem Blue Cross Blue Shield began paying for “treat and no transport" calls in the 14 states it operates in -- Pennsylvania is not one of them. Highmark is the Pittsburgh area's Blue Cross Blue Shield insurer.

During the 6-month pilot program, Highmark will cover EMS treatment for some conditions outside of a hosptial, according to Bob Wanovich, Highmark's vice president of strategic sourcing.

"If there's a real medical need and the EMS responds and they provide treatment to a Highmark member, we're saying we're going to step up and pay for that as part of your coverage," Wanovich said. "That's good for the member and that's good for EMS."

EMS will be reimbursed for treating low blood sugar, asthma attacks and seizure disorders in Highmark members 18 years and older.

Wanovich said this new system also means better tracking of patients who receive emergency services.

"This program allows us to now follow up with that patient through AHN, and make sure they get the follow [up] care that they really need," Wanovich said.

An Allegheny Health Network staff member will reach out to patients within 48 hours of treatment.

AHN's System EMS Medical Director Joe Clark said this pilot might create positive trickle-down effects for emergency room physicians, who could have more time to treat more urgent cases. Highmark will track if emergency room traffic decreases during the pilot, which could speed up response time for other ER patients.

"This gives another option to the patient to stay at home, follow up with their family physician, to stay at home with the comfort of their family," Clark said.

A bill that would require this kind of reimbursement from insurers like Highmark passed the state house last year, and is awaiting action in senate committee. A separate bill that would require both private insurers and Medicaid to reimburse emergency services providers for on-site treatment passed the senate in June and awaits action in the state house.

In June, Sam Marshall, president of the Insurance Federation of Pennsylvania, told Keystone Crossroads he supported the bill, even though it could raise rates for policy-holders. 

“The hope is that this won’t be a major cost increase, and that it will improve the quality of care for policy holders, but also the availability of needed ambulance care,” he said.