WASHINGTON — Federal health advisors on Thursday voted to recommend that Congress continue collecting detailed cost data from ambulance services, saying the information is essential to improve how Medicare reimburses emergency transport providers.
The Medicare Payment Advisory Commission, an independent agency that advises Congress on Medicare issues, approved the draft recommendation by a 15-0 vote, with one member abstaining.
The recommendation calls on Congress to keep the Medicare Ground Ambulance Data Collection System, established by the Centers for Medicare and Medicaid Services under the Bipartisan Budget Act of 2018, but to streamline the process to reduce the burden on providers.
It is part of a broader report mandated by Congress, which can be used to assess the adequacy and accuracy of payments as well as the burden the data collection system places on providers.
According to the commission, the current ambulance fee schedule isn’t largely based on cost data and hasn’t been updated since it was implemented by the Centers for Medicare and Medicaid Services, or CMS.
“The motivation of the data is to allow CMS to better align payments,” said commission chair Michael Chernew. “If CMS wants to change the payment system, it will behoove them to have access to the data.”
The system, now including more than 7,500 records on ambulance providers’ staffing, service volume, costs, and revenues, is intended to give lawmakers a more comprehensive view of how services are being delivered.
However, the dataset contains more than 600 variables, many of which the commission said are not necessary for evaluating ambulance costs. They noted that smaller and rural providers, in particular, have reported difficulty gathering and submitting the information.
Sarah Susalla, president and chief operating officer at Vesper Medical Transport, said her company’s “robust” system made it relatively easy for them to extract and submit the required data, but many providers are not as equipped.
“Some people still use paper,” Susalla said in an interview.
But even though her company doesn’t necessarily struggle to report data, she said they still struggle to stay afloat financially because Medicare reimbursements often fall short of operating costs, despite a temporary payment increase.
On Feb. 3 2026, President Donald Trump signed the Consolidated Appropriations Act into law, which extended temporary increases for 23 months, through Dec. 31, 2027. The temporary boost is 2% for urban areas, 3% for rural, and 22.6% for “super rural.”
Still, Susalla said margins are thin.
“That profit line is very small, and for us, every single penny goes back into the company,” she said.
Data presented at the public meeting showed wide variation in costs depending on provider size. Organizations with low-volume transports reported a median cost of about $2,852 per trip, compared with roughly $914 for high-volume providers.
Susalla said Vesper falls somewhere in between, handling about 25,000 transports annually. On average, she said it costs about $160 per hour to run an ambulance, and Medicare payments often do not cover those expenses.
She added that reimbursement rates also fail to account for the complexity of care. At Vesper, about 20% of their transports involve patients weighing over 300 pounds, which often requires more than one crew member. In some instances, they’ve had to use up to four staff members for a single patient, with no additional reimbursement.
If the data collection system leads to updates in the fee schedule that better reflect actual costs, Sualla said it could ease those pressures.
“It would allow us to have some relief by being able to expand more quickly to meet the needs of hospitals that reach out to us and are looking for ambulance services, Susalla said. “ It would also protect the community and patients by ensuring that ambulance companies are able to have well-maintained equipment.”
According to the commission, the recommendation is not expected to immediately affect Medicare spending or patient access to ambulance services.
The final report, including the recommendation, will be submitted to Congress by June 15.