FAIR Health Presents to Federal Advisory Committee on Ground Ambulance and Patient Billing

August 17, 2023

On August 2, FAIR Health addressed a virtual meeting hosted by the Advisory Committee on Ground Ambulance and Patient Billing (GAPB), Subcommittee on Public/Consumer Disclosure & Protection. Robin Gelburd, President of FAIR Health, shared insights into the utilization and pricing of ground ambulance services.

The GAPB Advisory Committee was established by the Centers for Medicare & Medicaid Services in 2022 as a requirement of the federal No Surprises Act. The Committee’s purpose is to review options for improving the disclosure of charges and fees for ground ambulance services, better informing consumers of insurance options for such services and protecting consumers from balance billing.

Given FAIR Health’s reputation for neutrality and robust collection of ground ambulance claim lines in its data repository, Ms. Gelburd was invited to present data analytics on the utilization and cost of ground ambulance services. The data may help inform the Committee’s future report on best practices, standards and legislative options for preventing surprise bills resulting from ground ambulance transport.

During the presentation, Ms. Gelburd first reviewed the utilization of ground ambulances—evaluating and comparing non-transport versus transport-only services, advanced life support versus basic life support services and emergency versus nonemergency services—in the period from 2018 to 2022. For example, advanced life support services accounted for a slightly larger percentage of all ground ambulance claim lines than basic life support services; the former accounted for 51.3 to 52.3 percent of ground ambulance claim lines in the period studied, while the latter made up 47.7 to 48.7 percent.

Ms. Gelburd also spoke to the top diagnoses associated with ground ambulance rides. From 2018 to 2022, among all types of ground ambulance services, general signs and symptoms were the most common reason for ground ambulance transport; this diagnostic category includes diagnoses such as syncope and collapse, ataxic and/or paralytic gait, tremors, lack of coordination and fever. For basic life support services, mental health conditions were the third most common diagnosis, making up 7.1 percent of basic life support ground ambulance claim lines. Ms. Gelburd revealed that this diagnosis held a smaller percentage of advanced life support claim lines (4.2 percent) and ranked eighth on the list of the top advanced life support diagnoses.

Providing cost insights next, Ms. Gelburd illuminated the variation in average allowed (in-network) amounts for ground ambulance transport in several states. For example, the average allowed amount for an emergency advanced life support ground ambulance ride in California in 2022 was $1,461—approximately $625 more than in Illinois, where the average was $836. Ms. Gelburd also presented average allowed amounts for ground ambulance mileage per statute mile in each state, revealing that Utah had the highest amount per statute mile ($28), while Florida had the lowest ($6).

Other data analytics presented were age distribution of ground ambulance rides, average ground ambulance mileage by state and outcomes associated with ground ambulance transport (e.g., inpatient admission).

In light of FAIR Health’s rich collection of ground ambulance data, we will be offering a data brief that will build upon the presentation we gave to the GAPB Subcommittee and will be freely available on the fairhealth.org website later this month.