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City of Sturgis questions proposed VA ambulance reimbursement model

C.J. Keene
South Dakota Public Broadcasting

A new Veterans Affairs proposal could change how ambulance services are reimbursed for trips to VA clinics. That has the attention of one West River community.

The city of Sturgis will send a letter to the state's DC delegation formally opposing the newly proposed VA ambulance reimbursement model.

Sturgis Ambulance Director Shawn Fischer spoke at the most recent council meeting. She explained the changes.

“What is happening is the VA wants to go to paying either the Medicaid or Medicare rates – whichever is lowest for that state," Fischer said. "With our Medicaid rates being so low, it will be Medicaid rates we are reimbursed if we do a transfer for the VA.”

That translates to an estimated reimbursement of $4.36 per mile against operating costs of roughly $12 per mile. Under the current model, ambulances are reimbursed $18 per mile. Fischer used an example of a hypothetical patient transfer to Denver to highlight the problem.

“As you see on Denver, 437 miles is what were being reimbursed," Fischer said. "At the current time we’re being reimbursed $7,876.80. With the new reimbursement it will be $1,899.18 – a difference of $5,900. This is going to be very detrimental for a lot of ambulance services, ground or air.”

Further, ambulances are only reimbursed with passengers in tow. That becomes a problem for a one-way trip to Denver, or if patients at home aren’t interested in service.

“We go out 30 miles to a car wreck even, and all three patients sign refusals, we get zero pay on all that and you just went 60 miles without reimbursement," Fischer said. "Every time we go to a call here in town, every time we go to the jail for a refusal – all of those are miles on your ambulance you aren’t getting reimbursed anything.”

Fischer advocates for the VA Emergency Transportation Access Act, which she said would create a more effective advisory committee to evaluate rates for ambulances.

C.J. Keene is a Rapid City-based journalist covering the legal system, education, and culture