Of course, it all begins with the aircraft model that a medical flight company purchases. Each aircraft is different in some way or the other. However, once the purchase is made, there are certain aspects that one must consider to ensure that the medical flight is fit and convenient enough to provide the healthcare that is expected of it. Here, we discuss a few of those in some detail.
The Floor of the Medical Flight
The floor is a very critical part of the medical flight. It must be such that the in-flight as well as maintenance crew must be able to clean it efficiently and quickly. The emergencies that come a medical flight’s way can involve a lot of blood and other elements, which need to be cleaned out as quickly as possible to maintain hygiene. This might necessitate floor drains and the design must be such that modifications like these can be easily made. Also, the floor can see a lot of heavy equipment which is often moved with little care for the floor itself, so the floor must be sturdy enough to take such abuse.
Important Considerations that Must be Kept in Mind
Today, it is necessary that an aircraft has modern connection facilities such as USBs. Customization is another factor. Depending on the situation, the crew must be able to quickly put in cabins, add/remove seats and/or stretchers. Proper mounts for medical devices must already be in place. While all such facilities bring in a high level of convenience, safety remains the primary concern. For this reason, all the modifications must be certified by a competent agency.
Care must be taken to make use of the space available to the maximum. For instance, the stretcher must be able to double up as a bed that can be immobilized on the flight. Plus, the space beneath the stretcher could be used for storage by building custom cabinets. It is obvious that a one-size-fits-all approach generally does not work; however, a creative approach to the medical flight interiors can go a long way to make it comfortable and efficient.
The medical flight industry is highly competitive with hundreds of organizations offering this emergency service around the world. With insurance companies not always covering the full cost of the medical flights and people being wary of the high price involved, the question that is being contemplated is whether lowering the standards of service within the legal realm a viable option. Among the cost factors are maintenance, fuel, hangars, and staff. While the first three are almost impossible to control, staffing is something that most are looking at. Here are a few things that some medical flight providers around the world are considering according to a recent survey by ITIJ.
Cutting Down Medical Flight Staffing and Training Costs
Of course, the more experienced professionals such as doctors, nurses, paramedics and pilots come at a huge cost. But then, there are low-cost medical flight service providers who lower their standards when it comes to hiring standards. It must be noted in this regard that staffing is among the highest recurring expense for most companies.
Training can be expensive too. In order to maintain accreditations, constant training programs need to be held and medical flight companies must make way for the accreditation agencies to evaluate them. All these activities can push the costs high. Doing away with accreditations can cut the cost to some extent and this is among the reasons why several medical flight service providers veer away from them.
Containing the Cost of Equipment
The medical flight industry is constantly evolving, especially when it comes to technology. Using outdated equipment that is still legally acceptable is a choice that many air ambulance companies are contemplating today.
The question that one must ask in this context is whether this is the right path to take. People are entitled to best care possible at reasonable costs. How this can be achieved is a question that only future will tell.
The common assumption, most often, is that a patient is always flow to the nearest treating facility when an air ambulance is employed. However, this is not always true, although the nearest facility is taken into consideration owing to the cost as the nearest one would obviously cost the minimum. What people need to understand is that air ambulance is a live-saving service and not a cost-saving service. The primary criterion is therefore not just the nearest but also the most appropriate treating facility. For instance, a burn victim may be carried by the air ambulance to the nearest burn care center, although a highly specialized trauma care is just a few blocks away. Again, the primary intent here is to save lives.
Other Considerations taken Into Account by Air Ambulance
The paramedics have a huge say in deciding the treating facility. Of course, they cannot suggest any specific hospital as this would give a leeway for bias but they can specify the kind of facility that the patient should be flown to. Typically, the choice is between the following during medical emergencies:
- Trauma Centers
- Burn Centers
- Cardiac Care Centers
- Stroke Centers
- Pediatric Hospitals
What Happens When a Patient is Involved in a Multi-Casualty Incident?
Natural disasters, for instance, can result in multiple people in need of urgent care. In cases like these, it is impossible for one hospital to take care of all the incoming casualties, no matter how close it is to the incident. An air ambulance in such a situation will look for appropriate facilities, regardless of the distance.
Does Patient Choice Come into Picture?
There might be instances where your health insurance covers you in one particular hospital but not the other; it is fair to request the air ambulance service provider in such instances to fly you to the one that will not affect your coverage. However, one has to mindful whether the cost of air ambulance service, in such cases, is covered or not. It is wise to consult your case worker in a situation like this.
It is a short question that demands an elaborate answer. As the rural hospitals close at a rapid rate, air ambulances are playing a vital role in bringing patients quick access to emergency rooms. It is believed that, currently, a quarter of the population in the United States of America do not have access to medical care within an hour. It is air ambulances that fill this gap. A report reveals that 80 rural hospitals have closed in the past decade and over 700 rural hospitals, it is believed, will be closed in the next 10 years. Air ambulances are turning out to be critical services.
Time is a Factor that Air Ambulances Manage Well
A Federal rule says that air ambulances can traverse between state borders without having to worry about state regulations. This allows for seamless travel across borders without any regulatory hassles. If the states are allowed to regulate the air ambulance industry, it might so happen that traversing these now-free state borders could become lengthy or challenging to say the least.
A statistic says that over 30% of air ambulances cross borders annually. The state laws, if different from each other, might make flying the skies tricky, prompting the air ambulances to fly to another state because the regulations are less tedious. A report by American Stroke Association says that brain juries not getting treatment in time can result in fatality or poor recovery. That alone should be an argument enough in favor of Federal regulation.
It’s All About Reimbursements
The reimbursements rates by insurance companies have remained unchanged for over two decades. This puts a lot of financial stress on air ambulance service industry. Unable to get adequate cost coverage, organizations are compelled to go to the patients. Most disheartening is the fact that the patients who pay for this service are insurance holders but without adequate coverage.
Let’s understand the scenario with a hypothetical situation – a patient has suffered a serious injury and is in Carthage, Missouri. It is felt that the most appropriate facility to treat the patient is in Joplin, which is just about 12 miles from where he is. A medical flight is summoned, in spite of the ground ambulance being ready to take the patient. The medical flight takes about an hour to reach the patient and another 15 minutes to reach the treating facility. A week elapses, just when the patient is thanking his stars that he was lucky to receive the treatment on time, he is slapped with a balance bill of $25,000. The insurance company has covered $20,000 of the total $45,000 bill. The once happy patient is now contemplating mortgaging his house to pay off the balance bill.
The Argument Against Medical Flight Company
The insurance company argues that the ground ambulance was readily available and the destination was just 12 miles away, which would have taken the ground ambulance about half an hour to reach. Yet, a medical flight was called in, even though it took an hour for it to simply reach the patient. The insurance company feels there was no need for the medical flight service in the first place and refuses to cover the bill in full. In the outset, the argument seems right but only until what the medical flight company has to say.
Looking at the Situation from the Medical Flight Company’s Angle
Medical flight companies do not and cannot choose to take a call whether they want to fly a patient. They are summoned by the hospital and the medical necessity is decided by the treating physician. Come to think of it, the treating physicians usually have a sound logic behind suggesting an air ambulance service. The ground ambulance might not be best suited, owing to the patient’s condition.
What needs to be done in contradictions like these is following a middle ground and for this, there needs to be a mechanism in place where things are sorted out between medical flight and air ambulance companies. Until that happens, the patient will continue to suffer.
Imagine this – you pay for a smartphone in full and then realize that you are only allowed to use certain features in it but not all. How would you feel about that? Would you have bought it had you know about this fact during the time of purchase? Now, take the case of air ambulance coverage provided by insurance companies. Don’t you deserve to know the kind of coverage that you get? Whether you would be monetarily covered in your neediest hour when your health demands urgent medical care? You need to be sure you will be taken to a well-equipped treating facility and that the expense of carrying you to that destination is covered by the insurance provider. Unfortunately, that is not the case today.
Not All Insurance Providers are the Same
There are several health insurance providers out there who cover the air ambulance charges at a fair rate but there are others who do not. On the other hand, it is not under the control of the air ambulance service providers to choose patients. They ask no questions; they simply respond to emergencies. When this act turns into a haggle for money, it becomes a problem. The result, often, is balance billing – the part of the bill that remains uncovered by the insurance provider. The balance bill, ultimately, becomes the responsibility of the patient to pay, despite having insurance coverage. The amount can be so huge sometimes that it can push a common man towards bankruptcy.
Patient Advocacy by Air Ambulance Service Providers
Most air ambulance service providers have a robust policy when it comes to patient advocacy. Such programs are mainly targeted towards helping patients course through the complexities of insurance. However, the question is, why should such programs be necessary. All that is needed is a fair rate at which insurance companies reimburse the air ambulance service providers. As the insurance companies and air ambulance companies sort this matter out, what ultimately comes out is something that we all need to keep an eye on.
If you are a patient who is in a medical serious condition and fighting for life, would you be okay with an air ambulance professional who is fatigued and has been working a shift of almost 24 hours? Would you perceive this condition to be grave for your life? Although air ambulance personnel these days are not expected to work abnormally long hours, this fact is something you should know about. In this context, one must note that 24-hour shifts were a practice, if not common practice, prior to 1997. We bring you a research conducted in this regard by the US National Library of Medicine National Institutes of Health, which is a part of National Center for Biotechnology Information, a US Government undertaking.
The Findings of the Report were Astounding and Contrary to Popular Belief
The primary objective of the research was to assess the psychomotor agility and skill performance of the air ambulance personnel when they worked 12-hour shifts versus 24-hour shifts. The data gathered pertaining to 24-hour shifts belongs to the pre-1997 era. The data collected was compared with times when the air ambulance industry was mandated to work for limited number of hours as against the time when shifts spanning 24 hours were not alien. Intubation – a critical task that is undertaken routinely – was used as a scale to measure the efficiency of the air ambulance professionals. Surprisingly enough, there was hardly a difference between ‘overworked’ professionals and the ones who worked reasonable hours.
How Do Air Ambulance Professional Manage to Work at Optimal Efficiencies?
The answer may lie in the fact that failure is not an option when lives are at stake. No matter what the level of fatigue, when people who are driven by passion and compassion are put in a situation where the outcome depends on how they perform, the chances are they will try their best and come out winners. The fact is also an ode to the dedication of the professionals belonging to the air ambulance industry.
Medical air transport professionals are usually the first to respond to emergency calls and trauma scenes are sometimes very stressful to handle with death and serious injuries being a part of it. Medical air transport professionals do not even get time to let the situation sink in as they are expected to act immediately. This can cause quite a lot of mental trauma to them. Added to this is the physical stress of the entire situation where they have to move the patient, equipment, etc., so that lives can be saved.
Common Mental Ailments among Medical Air Transport Personnel
Research shows that depression, PTSD or post-traumatic stress disorder, fatigue and anxiety are highly prevalent among medical air transport professionals. The tragedy of the matter is that they do not often get time to introspect into their mental wellbeing because of the situations that they often find themselves in where they are expected to be highly reactive to the surroundings. By the time they realize their mental state, they are already deep into these psychological ailments. While it is a shared responsibility of the employers and the personnel, here are some tips to stay mentally healthy.
Tips for Mental Health
- Increasing mindfulness through meditation: Meditation allows people to take a step back and introspect. All the deeply buried feelings come to surface and one becomes in-tuned with his or her own mental state. The ability to detach oneself from sufferings around is greatly increased.
- Confiding in others: Every person has friends or colleagues that they can talk to. Getting certain things out of our system can help. It’s a sort of an outlet. Medical air transport professionals can also make use of in-house psychologists to open up. Even keeping a journal can help.
- Exercising to reduce stress: Endorphins that result from exercise can get rid of stress to a huge extent. Air ambulance professionals must make physical activity of their choice a part of their daily routine.
Finally, it is vital that people speak out when they are under stress. There is nothing wrong in seeking help when it is warranted.
Imagine heading a business where customers only pay you 30% of the time in full and the remaining 70% only pay you 50% of the cost. How would your business survive? This is precisely the situation of most air ambulance companies in the United States of America say industry experts. What adds insult to the injury is the fact that there is a outcry about the charges both in national media as well as people, not to mention the politicians who are trying to pin all the blame on air ambulance companies. Most players in the industry say that air ambulance business is getting harder by the day to run.
Air Ambulance Companies Asked to Do More
Rural hospitals in the US are closing down at a rapid rate. More and more rural patients are veering towards the services extended by air ambulance companies. However, the fact remains that air ambulance services are expensive and the costs are not being reimbursed by health insurance providers citing several reasons. While the most common is the ‘lack of medical necessity’ others simply have a small ceiling of reimbursements that have not been revised for a very long time.
Most of the Air Ambulance Costs are Fixed
Costs of running a medical base is, on an average, about USD 3 million a year. This amount accounts for about 85% of the costs and are fixed. These include maintenance of the aircraft, hangar, support staff, crew and the like. Then there are write-downs that are either forced upon the air ambulance companies or the ones that they undertake themselves on humanitarian grounds. All this adds up to a huge amount. Plus, there are always the running costs such as fuel which is also quite expensive. Industry experts feel that the demand for the services provided by air ambulance companies is going to increase considering that the population is aging, and that something needs to be done on a war footing to make the reimbursements commiserate with the services provided.
We have been citing the reluctance of insurance companies to revise their payment charts, in keeping with the time and also several air ambulance companies that simply refuse to budge down when it comes to the pricing.
This time around, Missouri Insurance Department has come up with a report that reveals, on an average, people of Missouri are paying about USD 20,000 for an air ambulance services. Of course, this is a whopping price for a common person, not just in the state but anywhere in the world. The report further said that close to USD 26 million was billed by air ambulance companies in the year 2017. Of this, 12.4 million is what people had to bear, taking into consideration deductibles and co-pays.
Does the Report Vilify Air Ambulance Companies?
This was a question that air ambulance industry advocates would raise without a doubt and not for any frivolous reasons. Balance Billing, which forces patients to pay the amount when insurance companies refuse to clear the air ambulance bills, had no mention in the report. The reason stated for this was ‘insufficient data’. One could even say that the lack of this data, sort of makes the report a little lopsided.
High Fixed Cost was Cited by Air Ambulance Companies
One aspect that should be appreciated about the air ambulance companies is that they have not shied away from saying the amounts charged to the patients are pretty steep. They have also expressed their helplessness in containing this, as the fixed costs of maintaining a medical flight is very high. However, what goes against the favor of some air ambulance companies is the fact that they are unwilling to come in the network of insurance providers.
As we have always stated, the air ambulance industry and the insurance industry need to come together to find a middle path, so that the common person does not have to bear the burden of huge bills.