EMS shutdown survival: What leaders need to know now

From Medicare cuts to billing delays, Asbel Montes joins Rob Lawrence to share practical strategies EMS agencies can use to weather the reimbursement storm

In this episode of the EMS One-Stop podcast, we tackle the fast-moving realities of a federal shutdown and what it means for EMS finance, reimbursement and day-to-day operations.

Rob Lawrence sits down with Solutions Group’s Asbel Montes — a veteran of EMS reimbursement and policy expertise — to decode where Congress is (and isn’t), what CMS’s temporary claims hold really means, and how ambulance services can protect cash flow while preparing for potential reprocessing chaos if extenders aren’t promptly restored.

Beyond the headlines, Montes lays out a pragmatic playbook: build a Plan B for cash continuity, align with your billing team on reprocessing workflows, and model exposure across payers tied to the Medicare fee schedule. The conversation then widens to balance billing — why federal change is unlikely soon and why state-level action is delivering practical protections — before closing with leadership lessons on adaptation, data and telling EMS’s story as a guide, not the hero.

Memorable quotes from Asbel Montes

“Our extender expired — that’s that additional payment that we get from Medicare of that 2%, 3%, 22.6% — it expired September the 30th, and it was tied to the House-approved CR that went over to the Senate.”

“We’re solutions givers, as we say here at Solutions Group, not crisis managers. And if you have a plan, I can at least execute a plan.”

“What turned out to be a smaller amount, now the cost associated with it, you started to really understand the complexities that really happened in people’s AR.”

“If this lasts longer than 15 days … then I would basically have a plan in place. So I would be trying to find out from my billing team … what is your contingency plan to ensure I don’t see a hiccup in cash moving forward?”

“The only way government can really invoke change is to make it hit where it hurts. And that’s what’s going on right now. They’re hitting the pocketbook and our industry is grappling with it right now.”

Additional resources

• Asbel Montes: The government shutdown’s ripple effect on healthcare
• The Leadership Lab with Asbel Montes

Episode timeline & key moments

00:21 – Why the shutdown matters to EMS reimbursement and operations

01:21 – Montes’s 101: role at Solutions Group; 28 years in EMS finance and policy

02:40 – Historical context: number and length of shutdowns; current Hill outlook

03:48 – The ambulance extenders expired (2% urban, 3% rural, 22.6% super-rural); CMS claims hold window

05:03 – Planning posture: realistic timelines; “we’re solutions givers, not crisis managers”

06:12 – Back-of-the-napkin math: short-term dollars vs. long-term reprocessing burden

07:43 – 2015–2016 déjà vu: retroactive fixes and the heavy lift for back-office AR

10:26 – Secondary impacts: VA eligibility, appeals, enrollments during a prolonged shutdown

11:11 – The “three-legged stool” for leaders: (1) have a plan with billing; (2) reconcile accounts & patient balances; (3) prevent cash-flow lag if more than15 days

14:06 – Framing the moment: “hurricane shutdown” response and recovery mindset

15:43 – Balance billing at the federal level: committee work, political pain and why movement is unlikely soon

18:19 – State action wins: consumer protections and access; examples of Medicare-indexed approaches

20:24 – Why ground ambulance stayed out of federal NSA; local regulation and state primacy

22:42 – “All politics are local”: using EMS’s public visibility to advocate for patients and providers

23:09 – Adaptation over preservation: seize the 6-18 month window; let data and clinicians lead reform

27:13 – Lawrence’s “Darwinism” takeaway: adaptation as survival

28:31 – The Leadership Lab podcast: purpose, cadence and upcoming guests; Montes’s leadership journey

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