The Centers for Medicare & Medicaid Services (CMS) recently published the Year 1 and Year 2 cohort analysis of the Medicare Ground Ambulance Data Collection System (GADCS) Survey, and it’s packed with valuable insights. Want to know how ambulance services across the United States stack up in terms of operations, costs, and revenue? You’re in the right place. Check out the full report here.
For the first time, providers who participated in the program can see how their operational data compares to others nationwide. This benchmarking process is an excellent tool for understanding how your organization’s costs and revenues measure up.
Although the Year 3 and Year 4 Cohort Analysis has yet to be released, it is evident that this information will greatly assist policymakers with the task of establishing reimbursement rates within the Medicare program.
What is the GADCS Survey?
The GADCS Survey was established to gather detailed data on how ground ambulance services operate. Historically, the lack of detailed operational and financial data hindered effective policy-making and appropriate payment rate determinations for ground ambulance services.
As part of the program, providers were asked to submit data on vehicles, facilities, labor costs, responses, revenue, and other ambulance service costs over a 12-month period. Missing the deadline came with a steep penalty—a 10% reduction in Medicare Part B payments under the Ambulance Fee Schedule (AFS) for a full year.
Key Findings from the GADCS Report
Participation Rates
Out of 4,529 organizations selected:
- 95% (4,321) initiated the GADCS process.
- 85% (3,694) completed reporting by the deadline.
- 3,712 valid responses were included after excluding incomplete and non-Medicare billing submissions.
The first two years of the GADCS Survey showed strong participation, according to statistics from CMS’s report. As anticipated, for-profit and smaller service providers accounted for most of the unsubmitted responses, largely due to operational constraints such as limited resources, time, and labor.
Organizational Characteristics of EMS Providers in the GADCS Report
Who Owns These Organizations?
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- 55% are run by the government (think city or county EMS services).
- 30% are privately owned.
- 15% are private non-profits.
Where Are They Located?
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- About 60% operate in urban areas.
- The other 40% serve rural communities.
These stats show a good mix of providers, giving a well-rounded look at how ambulance services operate across the U.S.
What the Financial Numbers Tell Us About EMS Providers
The GADCS Report gave us a peek into the financial side of ambulance services, offering a snapshot of the ground ambulance industry’s cost structure and revenue sources. While the figures below are averages and can vary widely between providers, they help paint a broad view of the overall landscape.
Ambulance Services Total Cost Breakdown
- Labor Costs: Paying staff is the biggest expense, making up 69% of total costs—about $18.8 billion of the $27.2 billion reported.
- Vehicle Costs: Fuel, maintenance, and licenses for vehicles like ambulances and fire trucks accounted for 10% of total costs.
- Facility Costs: Utilities, insurance, and upkeep of facilities made up 4% of total costs. Urban facilities were generally more expensive to operate than their rural counterparts, however, rural providers reported narrow profit margins and, in some cases, even reported losses.
- Revenue Sources: Medicare and Medicare Advantage brought in 42% of total transport revenue. For-profit providers relied less on Medicare compared to government and nonprofit services. The median annual revenue per provider was $1.6 million.
This financial breakdown can help providers see how they stack up against others in the industry.
Operational Insights
The report also sheds light on how providers operate and manage their transport volume:
- Service Volume: Of the 31.2 million ground ambulance responses, 73% resulted in patient transport. Notably, the top 10% of organizations with the highest transport volumes handled 67% of all transports.
- Transport Numbers: The median number of transports was 1,200 a year, but 25% of ambulance providers had fewer than 500.
- Response Time: The median emergency response time was 9 minutes, with an average of 12 minutes. Rural providers experienced longer response times, largely due to the extensive service areas they cover.
- Staffing Models: Government organizations primarily used static staffing models, while for-profit organizations favored dynamic staffing models to match service demand.
- Volunteer Usage: Only 17% of for-profit providers used volunteers, compared to 61% of nonprofits.
These stats give a clearer idea of how different types of providers operate and handle the demands of their communities.
Guidance for EMS Providers
If You’ve Already Submitted
Use the report to benchmark your operations against national trends. It’s a great way to identify areas for improvement or validate your current strategies.
If You Haven’t Submitted Yet
There’s still time! CMS has extended many deadlines, giving providers a chance to complete their surveys without penalties. Make sure your data is complete and accurate to avoid a potential 10% Medicare Part B payment reduction.
Since the program began, Public Consulting Group (PCG) has equipped numerous providers with the resources and guidance needed for smooth submissions. Whether you need tools to handle the process in-house or prefer us to manage the entire survey for you, we’re here to help. Interested? Click here to schedule a consultation.
Why This Data Matters
So, why does all this data matter? It’s not just numbers on a page—it’s key information that policymakers can use to set reimbursement rates for ambulance services.
Looking ahead, policymakers are likely to rely on this data to develop new policies and evaluate the effectiveness of current Medicare payment rates. Even though the GADCS initiative is set to wrap up by the end of 2025, the impact of this data will likely stick around, influencing decisions for years to come.
For EMS providers, this means staying tuned. These insights could lead to changes in how services are reimbursed, potentially improving financial sustainability and highlighting the true costs of running ground ambulance operations.
The findings from the Year 1 and Year 2 GADCS Report mark a big step toward greater transparency and efficiency for both providers and policymakers. This initiative could lead to more accurate reimbursement rates, helping EMS providers better serve their communities while maintaining financial stability.