Health Care:

States Assume Leadership Role in Providing Emergency Medical Services

HRD-86-132: Published: Sep 30, 1986. Publicly Released: Oct 30, 1986.

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In response to a congressional request, GAO reviewed the status of emergency medical services programs in the United States, specifically: (1) the effect of the transition from federal to state leadership under the Preventive Health and Health Services block grant on local emergency medical services; and (2) the significant issues and barriers affecting the appropriate and timely delivery of local emergency medical services.

GAO reviewed six states' practices and found that: (1) states have taken more control of financing and regulating the local delivery of emergency medical services; (2) states have increased funding for emergency medical services by 28 percent since 1983; (3) states could better coordinate their federal highway safety funds with their overall emergency medical services strategies; (4) more than 50 percent of the nation does not have access to the emergency telephone number 911 because of high installation and operating costs and local ambulance services' reluctance to join an areawide telephone receiving system, resulting in less timely delivery of emergency services; (5) many rural areas lack advanced life support ambulance services; (6) many states do not have specialized trauma centers; and (7) because trauma centers treat a disproportionate share of severe cases, the averaging aspect of payment under Medicare's diagnosis-related groups (DRG) method may not adequately compensate them. GAO believes Congress should: (1) promote broader 911 coverage by implementing a federal loan program to finance 911 start-up costs and permitting existing loan funds to be used by local governments for 911 implementation; and (2) permit local areas to replace outmoded communications equipment using block grant funds.

Recommendation for Executive Action

  1. Status: Closed - Implemented

    Comments: The Department of Health and Human Services (HHS) is continuing to address trauma center issues in the context of broader specialty center issues. In this regard, HHS has instituted several processes for analysis of potential improvement in DRG classification. Also, it may include trauma centers in future research, and deal with trauma DRG in reports to Congress on DRG refinement and outlines.

    Recommendation: The Secretary of Health and Human Services should direct the Health Care Financing Administration (HCFA), as part of its continuing assessment of DRG, to determine whether they have an adverse financial impact on trauma centers. The results of this analysis should be considered along with other factors in assessing the need for a change in the trauma-related DRG payment rates. The Secretary should also direct HCFA to determine whether Medicaid reimbursement rates set by the states have an adverse financial effect on trauma centers as part of its review of each state's reimbursement criteria and methods.

    Agency Affected: Department of Health and Human Services


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