Health System Corrects Medicare Compliance Risks and Saves $6M Annually
A large health system had been providing non-emergency ambulance transport to approximately 10,000 chronically ill patients annually, despite the service not being covered by the patients’ health plans. Learn how the health system eliminated this Medicare compliance risk saving $6 million annually.
Non-compliant Ambulance Transport Poses Risk
For the past 10 years, a large health system has provided non-emergency ambulance transport to approximately 10,000 chronically ill patients annually despite the service not being covered by the patients’ health plans. While the health system’s actions were well-intentioned – offering transport for those who lacked the means to pay for it themselves – it created a major Medicare compliance risk. These uncompensated ambulance transport rides cost the organization $6 million annually.
The health system had attempted to make adjustments in the past but struggled to find a sustainable solution and received significant pushback from patients and their providers. Unable to resolve this dilemma on its own, the health system turned to healthcare consulting firm Freed Associates (Freed) to devise and implement a program that would eliminate Medicare risk and help the organization save on its annual uncompensated transportation expenses. Freed’s healthcare compliance consultants had extensive familiarity with this health system’s operations and expertise in change management strategy.
New Process and Change Management Strategy
Freed began by analyzing the provider’s transportation issues and used the data to create a comprehensive change management and education strategy to end current practices and implement a new standard. This strategy needed to be executed carefully but precisely to ensure everyone involved, particularly patients and their referring providers, understood the new practices and transportation options. Most importantly, the desired change needed to allow patients to still arrive on time to their appointments to which they had previously been transported.
The newly devised process started with denying new requests for ambulance transportation for patients without the proper coverage and explaining to patients and their referring providers why this was no longer possible. Simultaneously, patients and providers received information about transportation benefit coverages and alternative, self-pay transportation options.
Patient and Provider Support and Education
To address inevitable questions from patients and their providers about this change in transportation practices, the health system hired two temporary staff members. These resources were trained by Freed on benefit coverage, transportation alternatives and empathetic practices to ensure that all inquiries about this change would be addressed thoughtfully and compassionately. Patients who expressed specific financial concerns about this change were connected with trained social workers to discuss Medicaid enrollment options.
For end-stage renal disease (ESRD) patients, who represented a significant share of those receiving uncompensated ambulance transportation, social workers experienced in dialysis care were engaged on a case-by-case basis to provide support and information. The goal was to provide continuity of care and additional support in helping ESRD patients arrange alternative transportation.
Given referring providers’ prior practice of designating ambulance transportation as a “medical necessity” for their patients, the health system’s client compliance team reminded these providers about the legal definition of this term, based on Medicare and Medi-Cal requirements. The goal was to work in partnership with referring providers to ensure they selected the proper transportation option.
Elimination of Compliance Risk and $6 Million Annual Savings
Within six months, the health system reduced its noncompliant and uncompensated ambulance transportation demand from approximately 10,000 patient visits annually to zero, immediately saving the organization $6 million annually. Most critically, by reaching out to patients directly and providing supportive solutions and alternatives for transportation, no patients missed any medical appointments.
The health system credited Freed’s ability to rapidly change a decade-old practice of uncompensated transportation by instituting a clear, data-driven healthcare change management strategy, developing collaborative solutions with patients and their providers, and training designated professionals to resolve any lingering questions about this change. Patients and their providers were satisfied with the rationale given for this change, the alternative options presented, and the overall handling of their needs.
