MedPAC's Ambulance Cost Data:The Case for Trust, But Verify.

MedPAC's June 2026 Report to Congress delivers its long-awaited assessment of the Ground Ambulance Data Collection System (GADCS), the dataset Congress mandated in the 2018 Bipartisan Budget Act to finally answer a question the industry has asked for two decades: do Medicare's ambulance fee schedule payments actually reflect what it costs to run an ambulance service?

On July 8, I'll be joined by healthcare economist Dr. Lisa Grabert for a webinar unpacking this report. Dr. Grabert brings a perspective few others can. She was part of the legislative work behind the BBA of 2018 that mandated this very data collection effort.

Hearing from someone who helped build the framework Congress used to compel this data, and who now studies how CMS and MedPAC use it, will be essential for anyone trying to understand what this report means for the industry going forward.

The findings themselves are notable.

MedPAC found that revenue-to-cost ratios, or RCRs, the amount of revenue an ambulance organization takes in relative to what it costs them to provide service, vary widely by organization type. Low-volume organizations run far lower RCRs than high-volume ones. Urban organizations post higher RCRs than rural ones. For-profit organizations outperform nonprofit and government-run services.

Volume, not geography or ownership structure, emerged as the single strongest driver of cost per transport, with clear economies of scale as call volume rises. Organizations using dynamic staffing models had lower costs than those on static schedules.

These are meaningful findings for anyone advocating for rural add-ons, low-volume adjustments, or a broader rebasing of the fee schedule.

But here's what deserves equal attention.

MedPAC itself flagged serious concerns about the data underneath these conclusions. A majority of ambulance organizations draw significant revenue from local government funding unrelated to Medicare billing, and MedPAC found evidence of likely reporting errors, including some organizations showing revenue-to-cost gaps so extreme they suggest the numbers were entered wrong.

MedPAC's own language is direct: these measures "might not be reliable indicators of payment adequacy."

Some will read that caveat as a reason to be cautious about wider data release. If MedPAC's own analysts couldn't fully clean this dataset, why hand it to a broader pool of outside analysts?

I'd argue it points the other way.

A known data-quality problem doesn't get better with fewer eyes on it. It gets better when independent economists and data scientists can pressure-test the analysis, isolate where the reporting errors are concentrated, and either confirm or correct MedPAC's conclusions before they become the basis for payment policy.

Other provider specialties have already established this precedent. CMS routinely releases claims and cost report data to outside aggregators, academic researchers, and health economists, who then run independent analyses that stand alongside the government's own.

Ground ambulance providers have never had that layer of scrutiny applied to a dataset this consequential.

MedPAC recommends CMS continue collecting this data in a streamlined form.

Before that streamlined version becomes the basis for rate-setting, the industry should be pushing for the same transparency and independent verification other specialties already take for granted.

That's exactly the conversation Dr. Grabert and I will dig into on the webinar.