You have all heard the phrase ‘if you’ve seen one ambulance service, you’ve seen one ambulance service,’ right? Generally speaking, I dislike that phrase. When it comes to ulitization metrics, however, I must admit the phrase fits perfectly. If you were to ask fifty ambulance services for their utilization rate and how they came to that number, you would likely get as many answers back. Some are proud to have a high utilization rate in the eighties or nineties, because they are getting the most out of their staff. Others are boastful about a utilization rate in the middle taking pride in their organization’s ability to take care not to overload their crews in a 24-hour shift and still others, maybe a bit sheepishly, report a utilization rate in the teens. One thing I have learned over the past several years, however, is that very few services calculate their utilization in the same way – so when we compare utilization rates, we are not comparing apples to apples.
Utilization Metrics & Service Volume Part I was the topic of the Cost Data Collection webinar series put on by the American Ambulance Association on January 15th and, if you missed it, you need to circle back and watch it on-demand. Rebecca Williamson, Angie McLain, and Scott Moore walked participants through the history and progression of ambulance cost data collection, the calculation of utilization metrics, and the importance of all services counting the hours in the same way. Most importantly, they outlined how CMS will likely define eligible transports. Medicare Advantage, for example, is not included, so services need to have the ability to separate transports by the payor. Specifically, the total number of Medicare Part B transports from all other payer types. Having your accounts set up and understanding the full gamut of your reporting capabilities now is a must; if you need to make changes, December 2019 is not the time to do it.
I know what you’re thinking. You are probably wondering how the monster services that spread regionally or even across multiple states can compare apples to apples with services that are small, low volume, or primarily volunteer? Or perhaps you’re wondering how you can compare your intra-facility transfer only service with the service that is running emergency and non-emergency 911 calls and covers stand-by events along with intra-facility transports? CMS cannot possibly view all ambulance services the same way, because they are not all the same, right? This is one point the AAA is focusing on as we do not believe prior cost data collection efforts appropriately accounted for differences in provider types and service delivery.
The truth is, we do not know the answer to every question we have, but the AAA is working tirelessly to ensure CMS requests and collects data in the fairest and most accurate way possible. There are differences between how ambulance services are staffed and deployed; nobody is arguing this fact. All ambulance services, can, however, utilize the same definitions and ratio for calculating utilization which gets us closer to the goal. “We recognize that there are baseline metrics common to all provider types,” says Moore, “and we are working to make sure CMS understands why the data might look different.” Having the ability to separate your transports by the payor source accurately, and report metrics on your type and class of service will also play a role in how your service is categorized and selected to participate in cost collection.
The moral of the story here is that we all need to sit up and pay attention to what is happening with cost collection in EMS; this is not a wait it out and catch up next year situation. If you’re ready to dig into more about this topic, I’ve got some great news. Mark your calendars for March 19th, when our team of experts will present Utilization Metrics & Service Volume Part II. If you are a silver or gold ACE subscriber, this webinar is included with your subscription. AAA staff will automatically add subscribers to the webinar.
Looking for more ambulance cost data collection content? Visit www.ambulancereports.org. You will find both free resources and paid subscriptions are available to fit your budget and help your service prepare for the future of EMS.