Researchers find big disparity in Mass. ambulance payments

Emergency transportation in a publicly-owned ambulance in Massachusetts costs about twice the national average, according to an upcoming report from the state's Health Policy Commission.

The report, which has not been publicly released yet, shows disparities in how much insurance payers are charged for ambulance services in Massachusetts between publicly- and privately-owned ambulance companies, and between commercial insurers and public insurance such as MassHealth.

Nationwide, commercially-insured patients pay an average $761 for an ambulance trip from a municipally-owned emergency medical services company, compared to a $1,578 charge in Massachusetts, researcher Diana S. Váscones told the HPC's Market Oversight and Transparency Committee at a meeting on Wednesday.

Of the 1.5 million EMS patient transports in Massachusetts in 2019, commercial insurance payers paid municipal ambulance services roughly double what they paid private ambulances per transport. Most payments for middle-tier services were between $500 and $1,000 for private ambulances and between $750 and $2,500 for municipal transports.

Publicly-owned ambulance services are commonly tied to fire departments, although there are some cities that have standalone EMS departments, such as Boston and Fall River. In 2019, there was about a one-to-one chance of being picked up by a private versus public ambulance.

Even as emergency trips have gotten more expensive for everyone over the last six years, payments over $2,000 for municipal ambulances have doubled from 17% in 2017 to 34% in 2020 for similar care.

When asked why emergency trips were so much more expensive in publicly-owned vehicles, Váscones said "we don't have the clearest picture of that."

"We do think that it may be related to differences in payer contracting with private versus municipal services. It may be that payers are less likely to contract with municipal services," she said.

She added it is something the commission plans to look into further.