Association for Public Policy Analysis & Management

Between 2012 to 2016, over 31% of 911 EMS activations in the United States involved Medicare patients. However, Medicare reimbursement rules restrict the profitability of an ambulance encounter. Therefore, Medicare reimbursement rules could impact the treatment and transportation decisions of EMS providers for Medicare patients. Using the 2012 to 2016 National Emergency Medical Services Information System data, I estimate a regression discontinuity design to determine how Medicare reimbursement rules impact the treatment and transport decision of an EMS provider, the final destination of a transported patient, and the use of condition codes that qualify transport by an EMS provider as medically necessary. I find that Medicare reimbursement rules increase the probability of being transported by the ambulance, that the final destination of a transported patient was a hospital, and the probability that if a patient was transported that the patient was listed with a condition code that qualifies a transport by an ambulance to be medically necessary. That is, I find that Medicare reimbursement rules incentivize ambulance companies to disproportionately transport Medicare patients and to upcode to ensure that those transports are deemed medically necessary, resulting in an increase in unnecessary expenditures of approximately $18 million per year.