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Ground Ambulance Billing And Prices Differ By Ownership Structure.

Loren Adler¹, Bich Ly², Erin Duffy³

¹Loren Adler (ladler@brookings.edu), Brookings Institution, Washington, D.C.

Health Affairs (Project Hope)

|January 18, 2023

Summary

Most emergency ground ambulance transports with commercial insurance may lead to surprise medical bills. Private ambulance services, especially those owned by private equity or publicly traded companies, charge more than public ones.

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Area of Science:

Health Economics
Health Policy
Emergency Medical Services

Background:

The No Surprises Act aims to protect patients from surprise medical bills but excludes ground ambulance services.
Understanding the financial landscape of ground ambulance services is crucial for patient protection.

Purpose of the Study:

To compare pricing and billing practices between private and public ground ambulance organizations.
To investigate the impact of ownership structure (private equity, publicly traded) on ambulance costs and surprise billing.

Main Methods:

Creation of a novel dataset identifying ground ambulance organization ownership.
Analysis of pricing and billing data for commercially insured emergency ground ambulance transports (2014-2017).

Main Results:

Approximately 28% of emergency ground ambulance transports resulted in potential surprise bills.
Private-sector ambulances showed higher allowed amounts, patient cost sharing, and surprise billing potential compared to public-sector ambulances.
Ambulances owned by private equity or publicly traded companies exhibited higher costs and patient liability than other private entities.

Conclusions:

Significant patient financial liability exists within ground ambulance services.
Ownership structure, particularly private equity and publicly traded models, influences pricing and billing, leading to disparities compared to public services.