New analysis for Medicare savings related to prior authorization of non-emergency ambulance transport

A recent article in the JAMA Health Forum by Mathematica Health Experts examined the impact of a demonstration by the Centers for Medicare and Medicaid Services (CMS) that implemented prior authorization for repetitive repetitions. , scheduled non-urgent ambulance transport services (RSNAT). CMS and the US Department of Health and Human Services’ Office of Inspector General previously cited RSNAT as a Medicare-reimbursed service vulnerable to misuse. The study found that by targeting this service, the program led to a 77 percent decrease in RSNAT costs, saved about $1 billion in total Medicare costs from 2015 to 2019, and had little or no negative impact on patient access or health outcomes.

The Medicare RSNAT Prior Authorization Model (RSNAT-PA) was a CMS pilot program to evaluate the impact of prior authorization for certain non-emergency ambulance services. The study examined the link between prior authorization for Medicare coverage of transportation costs and Medicare costs, patient access to care, and health outcomes for trial Medicare beneficiaries pilot

Mathematica’s analysis found that the savings far outweighed the estimated administrative costs to CMS of implementing prior authorization, which are less than $40 million annually. In addition to cost savings, the study found no clear evidence of material changes in patient health outcomes. The Mathematica analysis included 1.7 million Medicare beneficiaries.

“Our results suggest that there was a dramatic reduction in use and payments for RSNAT services, and a saving in the total cost of care. We found no evidence of increased use of emergency ambulances, emergency department visits, or unplanned hospital admissions,” said Andrew Asher, Mathematica Senior Fellow and co-author of the paper. “Based on our findings, prior authorization could be an effective strategy to reduce inappropriate use of health services when targeted appropriately.”

This article comes from a multi-year evaluation contract conducted by Mathematica for CMS to review its prior authorization demonstrations. Mathematica’s team of evaluation, program integrity, clinical, and Medicare transportation experts examined these demonstrations and provided CMS policymakers with rigorous evidence of program impacts.

As noted in a CMS release, the Office of the Actuary certified the RSNAT-PA model and the CMS Administrator approved it for national expansion in September 2020 based in part on the evidence provided by Mathematica in this study.

About Mathematica: Mathematica is a research and data analytics consultancy driven by a mission to improve the well-being of people and communities. We innovate at the intersection of data science, social science and technology to translate big questions into deep insights. Working closely with decision makers and change agents, we are reimagining the way the world collects, analyzes and applies data to solve pressing challenges.