Like hospital emergency departments, EMS agencies are safety net providers, responding to all patients who access 911, regardless of the patient’s socio-economic status. Often, EMS agencies provide medical care to these patients, but are not compensated for those services, either by insurers, or the patients themselves (uninsured/self-pay).

Uncompensated care exacerbates the on-going financial crisis in EMS, which is a key driver of the EMS staffing crisis. An industry news tracker has chronicled over 2,000 local and national EMS news reports since 2021, and 82% of the news reports highlight the EMS economic and staffing crisis.

NAEMT and the Academy of International Mobile Healthcare Integration (AIMHI) distributed a survey related to the impact of uncompensated care in EMS. Twenty eight (28) agencies representing diverse types of EMS systems in both urban and rural communities responded to the survey. PWW|AG analyzed the data provided by the respondents and summarized the findings.

The results from the survey detail the level of uncompensated care provided by the respondents, and we applied these finding to the U.S. EMS systems to quantify the likely cost of unreimbursed care to America’s EMS agencies.

View National Survey Report on Uncompensated Care in EMS

View Uncompensated Care Survey in EMS Data Set (by agency type, response volume and state)

Summary of Findings:

• Data from survey respondents for 2019, 2021 and 2023 reveals that self-pay patients represent 13.3%of the overall patients treated by the EMS agencies that responded to the survey.
  • For these patients, the average collection across the agencies was $232.30, on an average patient charge of $1,538.41, representing a 15.1% collection rate. 

• Data recently provided by the Public Consulting Group (PCG) derived from Medicaid cost reports found that in 2021, the average provider cost for responding to a call and transporting a patient to a hospital was $2,351.34.
  • Therefore, for 13.3% of EMS responses, on average, the uncompensated care cost is $2,119.04 per patient ($2,351.34 - $232.30). 

• According to a report from the National Association of State EMS Officials (NASEMSO), there were 15.9 million EMS patient transports in 2018.
  • Applying the uncompensated patient percentage of 13.3%, this means that 2,114,700 of these transports are provided at a loss of $2,119.04 per transport, for a total cost of uncompensated care of $4.5 billion.