By Rick Sherlock
What is a life worth? Bipartisan Federal Legislation (HR 822) — designed to reform Medicare payments for patients flown by medical helicopters — has been introduced in the House and its Senate companion is imminent. Without this legislation, millions of Americans could lose timely access to critical health care. HR 822 will build a payment system based upon actual cost data to ensure access to health care for 80 million Americans who can only access Level 1 or Level 2 Trauma Centers, within an hour, through the use of Emergency Medical Services helicopters.
EMS helicopters, staffed with skilled pilots and highly-trained medical professionals, who are among the best caregivers in the world, provide rapid access to health care, coupled with the highest-levels of patient care, while taking patients to the medical facility best suited to treat their specific needs. Between 1990 and 2005, 339 trauma centers in the United States closed, and between 1991 and 2011, 22 percent of America’s rural hospitals closed. Both trends are expected to continue. EMS helicopters are our nation’s health care safety net for our most serious, time-sensitive cases — trauma, traumatic brain injury, strokes, heart attacks, burns and spinal-cord injuries, as well as high-risk obstetric, neonatal/pediatric and transplant patients. A 2010 study found patients transported by helicopter were more severely injured, had longer transport times and required more hospital resources than those transported by ground. It also found patients transported by helicopter were 22 percent more likely to survive and more likely to be discharged home after treatment when compared with those transported by ground.
Air-medical transport is a highly effective medical intervention for the most critically ill and injured patients, particularly in rural areas where helicopters function as the primary access to definitive and critical care facilities for nearly one-third of America’s population. Its impact cannot be underestimated. EMS helicopters transport roughly 400,000 patients each year.
Air-medical transport can be expensive and is, effectively, a marriage of two large heavily regulated industries — aviation and health care. The cost of a flight can be high, because providers must be ready to respond to a patient, at their most critical hour, 24 hours-a-day, 365 days-a-year.
The costs of maintaining that readiness rest solely on the programs providing the services. The costs can vary based on the cost of fuel, medicine, medical supplies and distances flown. However, the major readiness costs are fixed, based on aircraft costs, the costs of maintaining teams of trained, properly-licensed, experienced professionals (pilots, physicians, nurses, paramedics, etc.), and the safety improvements that ensure the highest-quality patient care is provided in the safest environment possible. It’s all about the patient and our industry’s ability to respond, provide them with the highest quality of care, and get them to the right trauma center during the “golden hour” which can be the difference between them returning home or remaining in the hospital for extensive care.
Air-medical transport is not appropriate for every patient and is used only when requested by a Doctor or a medically-trained first responder. EMS helicopters transport every patient-in-need, without regard to their ability to pay. Today, roughly 14 percent of Americans are uninsured or underinsured, 18 percent are covered by Medicaid, 35 percent by Medicare, and 33 percent have commercial insurance. In the past, commercial insurers have paid rates that provided levels-of-coverage for uninsured, underinsured, Medicaid, and Medicare, all of which pay less than the average cost-per-transport.
“Cost shifting” is no longer sustainable. Some smaller programs and non-profit programs are already closing across America. Without reforming Medicare at the federal level and Medicaid at the state level, many more programs will close, creating gaps in access to health care for millions of Americans.
HR 822 will fix an important piece of the Medicare puzzle while providing near-term stability for the industry, reform its reimbursement structure, and require it to provide cost and quality-of-care data to Congress, the U.S. Department of Health and Human Services, and the GAO for their review and independent analysis. Those data and analysis will form the basis for future decisions on reimbursement levels, which the industry will readily accept. Doesn’t it make sense to base future decisions on verifiable data that are independently analyzed? The systems that provide access to health care in America are not something we can afford to break.
The sound of a medical helicopter is often the sound of someone’s life being saved. By the time we recognize the silence, the system will be broken.
Rick Sherlock is president of the Association of Air Medical Services.
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