Management and Financing of Emergency Medical Services

Abstract

ike other organizations, emergency medical services (EMS) systems have revenues and expenses. The unpredictability of calls and the oftentimes inefficient nature of EMS operations make EMS management and financing difficult. Annually, EMS costs patients, insurers, and the federal government billions of dollars. 1 In fiscal year 2002, Medicare spent $3 billion on ambulance transportation. 1 The insufficiency of reimbursement for the total cost associated with 24 hour, 7 days per week coverage is the subject of constant debate and discussion among EMS managers. Recent modifications to the reimbursement formula used by the Centers for Medicare and Medicaid Services (CMS) has both benefited and disadvantaged many of the more than 18 000 EMS systems in America; 2-4 reducing the gap between costs and revenues for some while increasing that gap for other EMS systems. The purpose of this commentary is to describe the major components of EMS financing and management and to discuss the current and ongoing challenges in EMS financing. Revenues to an EMS system include subsidies from local governments, income from special event support, and reimbursement for transportation of patients. Fifty-five percent