The Complexity of Measuring Uncompensated Care in EMS
written by Adam Heinz, chief operating officer
REMSA Health provides $9.5 million in uncompensated care to our community. This includes care for patients who are unable to pay, as well as care provided on scene, but no transport was needed. It is our privilege to care for the communities we serve and in many cases, we are the community’s safety net heathcare provider.
When it comes to measuring uncompensated care in EMS systems, reaching consensus can be challenging, especially since each system is fundamentally different—variations in system design (fire-based, third service, hospital-based, private), geographic coverage, call volume, payer mix, and local/state reimbursement structures all influence how care is delivered and how it is ultimately paid for. In some communities, a higher proportion of Medicare, Medicaid, or uninsured patients significantly shifts the financial picture, while others may have different commercial payer dynamics or supplemental funding mechanisms. Additionally, differences in how agencies calculate cost of service, allocate overhead, and account for readiness (not just transport) further complicate efforts to align on a single methodology.
These variables make it difficult to establish a true “apples-to-apples” comparison across systems, and they often lead to differing interpretations of what constitutes uncompensated care—whether that’s rooted in billed charges, allowable rates, cost recovery, or readiness and response capacity that is never directly reimbursed.
That said, REMSA continues to work alongside many high-performing, high-value systems across the country to better understand these nuances and identify practical ways to bring more consistency to how we define, measure, and communicate uncompensated care. Through collaboration, benchmarking, and shared data initiatives, we’re working to move the conversation toward more standardized approaches—ones that not only improve comparability, but also strengthen our collective ability to educate policymakers, partners, and the public on the true financial realities of EMS. Importantly, the methodology we use to calculate these figures is likely conservative and may not fully capture every cost, operational demand, or unreimbursed aspect of readiness and response that EMS systems absorb.
