With hospitals shuttering across the country and patient access to emergency medical care under threat, air medical services are increasingly critical. Unfortunately, the bills that some patients receive for these services often become the big story. But while a fix is needed, there are proposals before Congress that are the wrong solution.
As the president and CEO of the Association of Air Medical Services, I believe patients have the right to access critical emergency care and not be stuck with an unwieldy bill from this life-saving service. In fact, the air medical providers we represent have patient advocates for that very reason — to advocate for insurers to cover emergency medical transportation costs. But we recognize more must be done. That’s why I am alarmed as Congress considers proposals that seek to address patient costs by forcing a devastating impact on access to care where lives are on the line.
Timely access to healthcare is essential, especially when emergencies such as strokes, heart attacks, car accidents, etc., happen. Air ambulances get to patients quickly, sometimes in locations that are difficult to reach, and provide high-quality patient care and swift transportation to the most appropriate medical center for each patient in need. This service is especially critical in rural areas, where hospital closures — 83 since 2010 — have made distances to hospitals even greater.
That’s why congressional proposals to carve air medical out of the Airline Deregulation Act — found in an amendment by Rep. Rob Woodall, R-Ga., to the Federal Aviation Administration Reauthorization Act, and in standalone legislation by Sen. Claire McCaskill, D-Mo. — are so dangerous. They would open the air medical industry up to a patchwork of state regulations, essentially creating borders in the sky and making it more difficult for patients to get to the care they need.
More than 30 percent of air ambulance transfers cross state borders. In some states, such as Missouri, that number jumps to 50 percent. If you happen to live on the border of two states, this bill means that an air ambulance provider might be forced to take you to a hospital in-state, even though the closer hospital, or the hospital that most suits your needs (one with a stroke center, cardiac center, pediatric/neonatal center, or level 1 trauma center, as examples) is across the state line. A study published by the American Heart Association found that taking patients who suffer from severe coronary artery disease directly to a percutaneous coronary intervention-capable hospital, bypassing a closer hospital without that capability, improves patient outcomes.
While Rep. Woodall and Sen. McCaskill’s intentions may be to ease the financial burden on patients who need an air medical transport, they actually do nothing to address patient costs.
What’s really at issue here are the outdated reimbursement rates from public and private insurers. Medicare and Medicaid reimbursement rates for air ambulances haven’t been updated in nearly 20 years, and some bad actors in the private insurance industry use this to justify underpaying of this expensive service. The Ensuring Access to Air Ambulance Services Act (H.R. 3378/S. 2121) would require the Centers for Medicare and Medicaid Services to collect cost and quality-of-care data from every program in the air medical community, to have the data independently analyzed by CMS and the Government Accountability Office, and then update their reimbursement rates based on actual cost data, thereby eliminating patients’ exorbitant bills.
If Medicare pays closer to the costs of actually providing services, less will be shifted to private insurers. Private insurers and air ambulance providers will then have federal data to use in negotiations for in-network agreements, and insurers could actually cover the cost of care.
This is coming at a time when a recent Kaiser Family Foundation report found that insurers are only spending 68 percent of premiums on actual healthcare costs — down from 75 percent in 2017 and 88 percent in 2015. To stick with the Missouri example, where the average insurance premium is $646, why aren’t emergency medical transports more adequately covered?
With FAA Reauthorization, Woodall’s amendment and McCaskill’s bill set to be discussed in Congress in the upcoming weeks, the time is urgent. It is crucial that we address the actual problem of patient costs, not severely reduce the ability of air medical providers to help patients in need. The wrong solution will hurt those we are all trying to protect: patients. The wrong cure won’t solve an issue we all agree is a problem.
Richard Sherlock is the President and CEO of the Association of Air Medical Services.
