EMS1 on MEDPAC's Impact on Ambulance Services

In December 2024, the Centers for Medicare & Medicaid Services (CMS) released the first report from the Ground Ambulance Data Collection System (GADCS), highlighting that the costs of providing ambulance services—across public, private, and nonprofit providers—often exceed current Medicare reimbursement rates. The report was notable for including a broad range of provider types, unlike earlier studies by the Government Accountability Office (GAO), which excluded certain providers due to concerns about data reliability.

In March 2025, the Medicare Payment Advisory Commission (MedPAC) reviewed the GADCS report. During this process, MedPAC excluded data from providers that share operational costs with other services (like fire departments or hospitals) and those with costs significantly higher than the average. This resulted in the removal of over half of the services included in the original dataset.

The article suggests that EMS agencies may need to focus on internal strategies—such as adopting telehealth, improving transfer protocols, and optimizing deployment—to manage costs and sustain operations, regardless of changes to Medicare payments.

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ARRIVES Act

Arkansas Act 1021, known as the ARRIVES Act (Arkansas Revenue Investment in Vital EMS Systems), represents a crucial first step toward strengthening our state’s EMS infrastructure.

This newly enacted framework legislation lays the groundwork for assessing the needs of ambulance providers and establishing a fair and strategic method for distributing funds—particularly in underserved areas. These areas, often described as “healthcare deserts,” rely heavily on EMS to bridge the gap in access to essential medical services.

While the ARRIVES Act doesn’t allocate funding just yet, it sets the mechanism for how future resources can be distributed, ensuring that regions with the greatest service gaps can receive proportionate support.

However, this is just the beginning. The EMS industry is facing an unprecedented convergence of challenges:

- A shrinking and overburdened workforce

- Skyrocketing operational costs

- Inadequate reimbursement from public and private payers

- Increasing reliance on EMS as frontline healthcare in areas lacking clinics or physicians

The Arkansas Ambulance Association is committed to pushing forward. While no general funds have been appropriated to fund ARRIVES yet, the Association will continue to advocate for dedicated investment in EMS to ensure life-saving services remain accessible to every Arkansan—urban or rural.

During the week of April 25, 2025, Governor Sanders signed a new law requiring all public schools in Arkansas to implement a Cardiac Emergency Response Plan (CERP), aiming to improve emergency preparedness and save lives. This achievement was made possible by dedicated advocates who shared their stories, raised awareness, and pushed for change. Many of them were present at the bill signing to celebrate the passage of Act 352, a testament to the power of community-driven advocacy.

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Arkansas has become the 25th state to join the United States EMS Compact. This will enable EMS clinicians to deliver care across state lines.

The Recognition of EMS Personnel Licensure Interstate Compact (REPLICA) enables Emergency Medical Services (EMS) personnel to practice across state lines. Over 20 states have already enacted this compact. It grants licensed EMS professionals from one member state the Privilege to Practice in other member states, supporting efficient and flexible EMS response.

To join the EMS Compact, states must enact uniform model legislation without making substantive changes.

The Arkansas Department of Health issued a press release on April 10, 2025 confirming an active measles case in Arkansas for the first time since 2018. 

The Department of Health has provided some guidelines for all EMS personnel that provide clinical guidance for responders. See guidelines here:  PPE-Transport Measles Guidance for EMS 4-11-25 .pdf

Adopted March 1, 2025: Joint Position Statement on Criminal Liability for Alleged Deviations from Clinical Standards of Care in Emergency Medical Services 

This Joint Position Statement from several National EMS Organizations outlines guidelines for determining when criminal liability should apply to EMS clinicians for alleged deviations from clinical standards of care. It stresses that:

EMS clinicians should be held accountable within a just culture, which emphasizes organizational systems that contribute to errors.

Criminal liability for medical errors should be carefully considered, as it can deter EMS professionals from reporting errors, potentially worsening patient safety.

The statement proposes a four-part inquiry to evaluate whether criminal charges are appropriate:

• Was the action within the EMS clinician's duties?
• Did the action involve a deviation from clinical standards?
• Was it intentional or grossly negligent?
• Will criminal liability serve justice?

The statement also highlights concerns about the impact of criminal liability on EMS recruitment and retention, especially during a workforce crisis, and advocates for non-criminal forms of accountability such as civil or administrative actions for medical errors.

MedPac Meeting RECAP (3/6/25): Ground Ambulance Data

The Medicare Payment Advisory Committee (MedPAC) held the first of several Commission discussions related to the statutorily mandated report to review ground ambulance payment policy in light of the Ground Ambulance Data Collection System on March 6, 2025. In addition to the Ground Ambulance Payment Report, the agenda covered physician fee schedules updates, updates on reduction in cost-sharing for critical access hospital outpatient services, an overview of Medicare insurance agents, overview on Medigap, overview on home health care in Medicare Advantage, and institutional special needs plans.

The Bipartisan Budget Act (BBA) of 2018 required CMS to collect data on ground ambulance services through the Ground Ambulance Data Collection System (GADCS). MedPAC must analyze this data to assess Medicare payment adequacy and geographic cost variations, with a report due by June 15, 2026. Commissioners will review the data and guide the workplan. The American Ambulance Association noted the analysis will include cost data stratification by service type and level, as well as potential staffing differences. It will also examine data from a range of organizations, challenges for rural and super-rural providers, and comparisons of rural definitions. Additional focus areas include hospital vs. on-scene treatment, ownership data, treatment in place, payment impacts on response and transport decisions, the effect of “wall time” on costs, and differences between “loaded” and “unloaded” miles. 

MedPac Mandated Report: Payment for Ground Ambulance Services

Stay tuned for more information and updates on upcoming MedPac meetings!

The International Journal of Emergency Medicine Continuous published an article on a study that evaluates the impact of the American Heart Association's Mission Lifeline initiative on STEMI care in Polk County Fire Rescue (PCFR). By analyzing EMS data from 2015 to 2023, researchers found that Mission Lifeline protocols, such as prehospital 12-lead ECGs and hospital pre-activation, significantly improved EMS-to-balloon (E2B) times and STEMI triage accuracy. The percentage of patients meeting the 90-minute E2B time improved from 74% in 2015 to 84% in 2019, while under-triage rates dropped below 1% after 2020. These findings highlight the effectiveness of standardized, protocol-driven EMS interventions in optimizing STEMI care and improving patient outcomes.

EmergencyInsights - Infectious Disease Preparedness

EMS providers face significant risks from infectious diseases while responding to emergencies. Common threats include respiratory viruses, tuberculosis, hepatitis, HIV, meningitis, MRSA, and gastrointestinal illnesses. Effective infection control measures—such as proper PPE use, hand hygiene, sharps safety, equipment decontamination, vaccination, and exposure management—are crucial for reducing transmission. EMS agencies must ensure ongoing training, stockpile essential supplies, and implement outbreak response protocols. By staying informed and following best practices, EMS professionals can protect themselves, their patients, and the public while delivering high-quality care.

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JEMS: Safe guarding EMS Clinician Data

The Interstate Commission for EMS Personnel Practice has adopted Position Paper 2025-01 to strengthen data security protections for EMS clinicians. Amid rising cyber threats, EMS personnel face increased risks of identity theft and data breaches due to inconsistent licensure data safeguards. The Commission’s initiative aims to balance credential transparency with security by limiting public access to sensitive information, restricting bulk data disclosures, and implementing stricter verification processes. Recognizing EMS data protection as a national security issue, the Commission urges all states to adopt these standards, ensuring EMS professionals receive the same protections as other frontline responders.

https://www.jems.com/ems-management/safeguarding-ems-clinician-data-a-critical-step-in-protecting-the-workforce/