⚠ PRELIMINARY: NOT FOR PUBLIC USE: These models are unfinished and calculations have not been verified or finalized. They are intended solely for internal discussion purposes. Data and outputs may be inaccurate or incomplete. These models do not represent a policy position, recommendation, or official stance of NCRETAC, its board members, volunteers, or staff.

Model 04: Payer Mix & Revenue Model | NCRETAC Colorado EMS

← All Models Model 04: Payer Mix & Revenue Model Revenue Analysis v2.5

Filter:

Coverage key: <15% Critical 15–40% High gap 40–80% Partial >80% Well-covered Gap & Coverage reflect current slider CR%

County	911 Calls	IFT Est.	Avg Miles	Uninsured	Revenue	Gap	Coverage

County Detail

Gap by Designation — Both Methods at Current CR%

How to read this chart

What you seeThree bar pairs show the annual structural gap for Urban, Rural, and Frontier counties under both revenue methods. Darker bars = APCD floor (conservative); lighter = GADCS ceiling (optimistic). The slider adjusts both.

What it meansThe frontier bars are much taller relative to the population served. Frontier counties have the highest costs per resident and the lowest billing recovery regardless of which method is used.

What this means for policy: The funding problem is concentrated in counties that cannot solve it locally. The structure of the problem requires the state to act.

Billing Cost Coverage vs. Uninsured Rate Each dot = one county. X axis: share of residents without health insurance. Y axis: how much of EMS structural cost billing revenue actually pays.

How to read this chart

What you seeEach dot is one county. Horizontal = uninsured rate; vertical = billing coverage % of cost. Teal = Urban, blue = Rural, red = Frontier. Click a dot to see county detail below.

What it meansThe downward slope shows that more uninsured correlates with lower billing coverage — a compounding disadvantage. Counties doing worst here are doing worst for structural reasons not fixable through better billing.

What this means for policy: These counties require a state funding source calibrated to the actual cost burden.

Y axis = APCD-method billing revenue ÷ CCECBI structural cost. Uninsured: 2024 County Health Rankings. Color = CMS designation.

Revenue Methods

GADCS Ceiling: RAND/CMS GADCS December 2024 — mean all-payer revenue $1,147/transport × 911 call volume. Most favorable assumption; does not penalize Colorado for higher uninsured rates or IFT revenue drag.

APCD Floor: CIVHC CO APCD FY25 commercial rates (A0427, DOI-region weighted) + CMS Medicare base + $9.15/loaded mile mileage (2026 CF) + Medicaid at 80% of Medicare + IFT volume (20/30/35% by tier) + county uninsured adjustment (2024 County Health Rankings).

Both methods shown side-by-side. The gap between them is the reimbursement uncertainty range for Colorado EMS.

Payer Mix Tiers (APCD FY25)

Urban: 37% Medicare · 20% Medicaid · 33% Commercial · 10% Self-pay. Commercial rate $1,254–$1,281 (Mile-High, Foothills).

Rural: 40% Medicare · 22% Medicaid · 28% Commercial · 10% Self-pay. Commercial rate $1,129–$1,285 (8 RETACs).

Frontier: 42% Medicare · 24% Medicaid · 22% Commercial · 12% Self-pay. Commercial rate ~$1,225 (SLV, SE Colorado).

Medicare: CMS CO PUF A0427. Medicaid: HCPF FFS standard. Uninsured adjusted per-county.

Limitations & IFT Note

The CDPHE ePCR dataset captures 911 scene transports only. IFT volume (estimated 20–35% of total transports by designation) is from national literature — not Colorado agency data.

IFT is set to zero for the 15 counties with no in-county hospital. The removed IFT volume is redistributed proportionally to hospital-bearing counties within the same designation tier. Four CCECBI hospital-count corrections applied (Alamosa, Chaffee, Grand, Huerfano — confirmed via ESO/UCHEMS destination data).

Structural costs from CCECBI v1.0. Uninsured rates: 2024 County Health Rankings. Not for individual agency financial benchmarking.

Payer Mix & Revenue Analysis

Revenue Methods

Payer Mix Tiers (APCD FY25)

Limitations & IFT Note