Policy In Perspective

Almost seven years ago, the Centers for Medicare & Medicaid Services (CMS) launched an initiative to test a possible solution to improper use of ambulance rides, long cited as a major source of waste and abuse in the Medicare program. The idea was pretty simple: Require companies that provide patients with repetitive, scheduled, non-emergent ambulance transport (RSNAT) for certain types of health care, such as dialysis or cancer treatments, to get prior authorization from CMS before providing service and submitting a claim for payment. Mathematica evaluated impacts of the initiative, which was implemented in the District of Columbia and eight states. Because non-emergency ambulance service use is rare in the Medicare program, the study focused on Medicare beneficiaries who are most likely to use RSNAT services—those with end-stage renal disease and/or severe pressure ulcers. Those two groups account for about 85 percent of Medicare RSNAT claims, so any change in use and spending would be most detectable amo