News & Updates

The Centers for Medicare & Medicaid Services (CMS) is on the cusp of possessing the data needed to make long anticipated changes to the Medicare fee-for-service (FFS) ground ambulance payment system. It has been more than two decades since CMS revised these payment rates through a negotiated rulemaking process that was exclusive of actual cost data or inflationary considerations. Since then, the cost structure of ground ambulance entities has changed. CMS is now using the Ground Ambulance Data Collection System (GADCS) to gather ambulance cost data, as required by Congress, to offer an improved understanding of the costs of delivering ground ambulance services. Given the potential of GADCS data to improve the adequacy of Medicare FFS reimbursement rates, the American Ambulance Association developed a similar data collection device, referred to as Amber, to test these data with its membership of ground ambulance entities. Amber offers a glimpse into the current challenges of the ground ambulance industry.[i]

Health Management Associates, Inc. (HMA) assessed the Amber dataset for response rates and data quality, along with responses containing calendar year 2022 financial data. Amber response rates were low, but sample volumes were on par with prior industry surveys conducted in the past by federal agencies. The Amber sample is representative of the industry’s wide variation in entity size and geographic service area. Amber data are reliable for calculating margins, but some aspects of these data also signal that ground ambulance entities, particularly smaller entities, may have had difficulty with variable definitions or the submission process. We observe that Amber would be improved by including information on uncompensated care and more details on medication supply costs.

The 2022 financial data from Amber suggest that Medicare FFS margins, at -6 percent, had declined since GAO’s 2010 assessment and that the share of costs associated with labor has increased. Amber data also suggest that the cost structure of smaller ground ambulance entities and rural and super-rural entities differs from that of larger and more urban entities. Margins for small and rural entities are lower.

Based on our assessment of the Amber dataset and its 2022 financial, we offer several recommendations to policymakers and stakeholders. These recommendations are intended to improve future cost collection efforts that may inform payment reforms to enhance the payment accuracy of the Medicare FFS payment system for ground ambulance services.

• Provide additional educational support to respondents to improve consistency of data reporting
• Streamline and modify data collection devices to adhere to industry trends and challenges
• Develop a standardized method for assigning ground ambulance entities to geographic service area for research purposes
• Collect data on ground ambulance uncompensated care and bad debt
• Collect payer level data for cases involving treatment without transport
• Collect targeted data on top 10 medications by cost to accurately reflect costs in payment rates
• CMS should consider collecting ground ambulance cost data on a semi-regular basis
• CMS should consider phasing in the use of GADCS data to ensure that the data reflect the diversity of ambulance entities and consistent reporting of key financial variables

This week the Nevada Ambulance Association honored our class of 2025 Stars of Life in Carson City! Our incredible group of stars were recognized at an awards banquet followed by a day of meetings with their representatives in the Nevada State Legislature. Congratulations to our 2025 Stars of Life! 

Corina Barker, Paramedic FTO- American Medical Response
Drew Borkowski, Paramedic FTO- Community Ambulance
Heather Bushey, Flight Nurse- Care Flight
Cody Del Toro, CCT Paramedic- Community Ambulance
Joseph Ketcham, Paramedic FTO- MedicWest Ambulance
Dale Miller, Sr. Communications Supervisor- REMSA Health
Timothy Mitchell, Flight Paramedic- Mercy Air
Samantha Steen, Flight Nurse- Mercy Air
Ryan Yarbrough, Paramedic- REMSA Health

On Saturday, December 21, the American Relief Act of 2025 (H.R. 10545) became law and thereby averted a partial federal government shutdown. Of critical importance to ground ambulance service organizations, H.R. 10545 also extends the temporary Medicare ambulance add-on payments of 2% urban, 3% rural and 22.6% super rural through March 31, 2025. In addition, the new law wipes clean the PAYGO scorecard preventing a potential 4% cut in Medicare reimbursement for ground ambulance and other Medicare services.

The House of Representatives passed by a vote of 366 to 34 the Continuing Resolution (H.R. 10545) to extend funding for the federal government just hours before reaching the previous funding deadline of midnight on December 20th. The Senate then passed H.R. 10545 by a vote of 85 to 11 late that evening. The CR funds the federal government primarily at current funding levels through March 14, 2025.

The negotiations on the American Relief Act were extremely tense with a more robust initial legislative package, which would have extended the Medicare ambulance add-ons for two years, being replaced with a slimmer bill with fewer and shorter health care provisions. The extension of ground ambulance service payments ended up being just one of twenty-five provisions in the final 118-page Continuing Resolution, which was originally over 1,600 pages.

The American Ambulance Assocation will continue to push for a longer extension of the ambulance payments at percentages higher than the current levels upon the expiration of the CR. 

Check out pictures from the September 3 Nevada Ambulance Association board meeting at the Nevada Hospital Association conference in Lake Tahoe!

The Nevada Ambulance Association regrets to share the passing of longtime EMS leader and friend Patrick Wells Smith, former CEO of REMSA and Care Flight. Our thoughts are with his family, friends, and former colleagues. 

His obituary and funeral details are published to the AIMHI website. 

Rest in peace, brother.

Last week, 19 exceptional EMS providers were honored at the first-ever Nevada Stars of Life. Check out all of the photos from Carson City on the NAA Facebook page!

Eric Thyr
Advanced EMT
Community Ambulance

Warren Archer
REACH Air
2019 Nevada Star of Life

Warren Archer is proud to be serve his community as both a Registered Nurse and a Paramedic. Although he retired at a young age, he continues to put his full heart into medica flight and volunteering for rural ambulance services.

Warren has served in EMS for the last 25 years. He has been a nurse for 15 years, and has 12 years of flight experience. He embodies professionalism and compassion when interacting with each of his patients. Warren always seeks ways to brighten up a person’s day.

Warren is also quick to share his knowledge and talents with others. He teaches AHA courses through IHC and serves as the training officer for Piute County EMS. He also acts as coordinator for Utah EMS for children,

Warren has been married to his beloved wife, Bonnie, for 43 years. Together they raised four wonderful children—two daughters and two sons.  He has seven grandkids, of whom he is very proud. In addition to his mobile healthcare credentials, Warren is a licensed massage therapist and a talented sculptor.

Sarah Pehrson
Reach Air
2019 Nevada Star of Life

Sarah Pehrson lives in Spring Creek, Nevada. She has been a nurse for 12 years and has been flying for the last 2½ years. Even before she attained her nursing credentials, Sarah was involved in healthcare and deeply committed to doing what is right for her patients.

Sarah will take time to ask questions and truly listen to those in her care. She is honest, caring and compassionate about what is right for the community she lives in and patients she has been called to serve. She helps with community events, and recently even began a fire fighting course in order to be able to volunteer in even further service to her community.

Sarah has a deep love for her family. Her husband, Wade, two boys, and little girl are the highlight of her life. Wade is a high school teacher and coaches the wrestling team. She is very supportive and helps with team fundraisers. When her schedule permits, she joins Wade to travel with the team.

Sarah is a skilled, empathetic healthcare provider who is loved by many people around her. Reach is proud to call her a 2019 Nevada Star of Life.

Dillon Decker
Flight Paramedic
2019 Nevada Star of Life

Dillon Decker is a Flight Paramedic for REACH based in in Ely, Nevada. Dillon is passionate about mobile healthcare because it empowers him to give others a second chance at life.

An experience recently shared with his flight partner, Ty LaRiviere, truly showcases their dedication to EMS. The patient was a three-year-old girl who arrived at the Emergency Department in arrest for unknown reasons. Upon further examination, it was determined that she had endured extreme abuse.

The team showed an overwhelming amount of compassion, empathy, and professionalism when caring for this little girl. They assisted the ED team with resuscitation, they prepared her for flight, then whisked her to Primary Children's Hospital. Because of the injuries she had sustained, her oxygen saturation repeated plummeted during flight. The pair leveraged their skills and experience to troubleshoot the ventilator and delivered her to Children Hospital alive and in better condition than when they picked her up.

Dillon and Ty did everything humanly possible to help her fight for life. Tragically, as sometimes happens in mobile healthcare, the tiny patient eventually succumbed to her injuries. However, she will not be forgotten by the heroes who never gave up trying.

When not caring for others, Dillon enjoys rock climbing, backpacking, hunting, video games, and spending time with his two beloved dogs.