DHA Launches Demonstration Project for Prehospital Blood Transfusion Reimbursement

The Defense Health Agency (DHA) announced a five-year demonstration project that will test a separate add-on reimbursement for prehospital blood transfusions provided during eligible ground and air ambulance transports under TRICARE.

The demonstration, which begins Jan. 1, will evaluate whether the payment model improves outcomes for trauma patients, reduces total cost of care, expands access to prehospital blood transfusion and provides a sustainable reimbursement methodology for ambulance providers.

The Federal Register notice announcing the demonstration specifically recognized that it is being conducted due to concerns related to reimbursement for prehospital blood that were raised by AABB, America's Blood Centers, the American Red Cross and the Prehospital Blood Transfusion Initiative Coalition. The groups argued that Medicare's bundled Advanced Life Support, Level 2, payment does not adequately cover the costs associated with providing prehospital blood transfusions and may limit patient access.

Under the demonstration, eligible ambulance providers may receive reimbursement based on either the applicable hospital outpatient blood product payment rate or the invoiced cost of the blood product, whichever is higher. Providers may also receive a separate reimbursement for transfusion administration services.