The air ambulance industry has been in the headlines for quite some time now. Most recently, however, it was because the state of Wyoming was attempting to regulate it. The hurdle was (and is) a federal regulation that prohibits state governments from interfering in the affairs of air ambulance industry. However, the attempts were rejected by CMS. Wyoming had proposed that the states must be allowed a say in the matters of air ambulance industry. It had done so to keep the cost of medical flight services at bay as they have been getting steeply expensive recently.
Does this Mean the Air Ambulance Industry has Won?
The answer is “yes.” At least for now, the air ambulance industry seems to have won. The CMS verdict favors the medical flight service providers. They will not be subjected to any state control and will be free to fly across state borders and also charge the consumers what they feel is the right amount.
The industry had feared that if they are forced to come under insurance networks, they will then have to conform to the reimbursement rates that are set by the insurance organizations. This was especially worrying since the rates have not been revised in over a decade. Moreover, since bidding system to offer services for a particular state would have come into picture, there were high chances that some insurance companies would have gone out of business.
What does it Mean for Consumers?
Consumers will now have access to a wide range of air ambulance companies. This means they will be able to avail specialized medical flights during emergencies. Since the profitability will remain unchanged, the air ambulance industry would find it financially encouraging extending their reach to remotest parts of the country. There, however, is one drawback. Since insurance companies have not still revised their reimbursement rates, the consumers are at risk of high out-of-pocket expenses.
A recent survey has shown that medical flight services are now more open to insurance network participation. In fact, the numbers have gone up by a healthy 20%. It has also been seen that the medical flight services and insurance companies are holding intense discussions and negotiations surrounding in-network arrangements.
The reason behind this change has been the huge increase in consumer demand and also to steer clear of the negative publicity that both the industries have been subject to in recent times. The efforts by the state governments to regulate air ambulance pricing and also getting insurance companies onboard with their cost-controlling measures have seen a lot of backlash recently.
The Medical Flight Services and their Cost Compulsions
The refusal of the insurance companies to take cognizance of the fact that maintaining medical flight services is an expensive affair – some say – was the cause of all the misunderstanding. Air ambulance companies usually spend a fortune to remain on standby for emergencies. The cost, of course, is then transferred to their services. When insurance companies refuse to foot these costs, the burden unfortunately is transferred to the patients who avail the service. This is a practice that is popular as ‘balance billing’.
How In-Network Coverage Helps
Customers are able to enjoy discounted and ‘fair’ out-of-pocket expenses to cover medical flight services when in-network coverage becomes a reality. In an ideal world, all air ambulance services providers must be in-network. However, the onus of it does not lie only on these emergency service providers. The insurance organizations too must be willing to reimburse a fair amount. Otherwise, it simply does not make business sense for medical flight services to join any network.
The good news, however, seems to be that both these industries are coming around and finding common grounds to work together.
When it comes to communities funding air ambulance services, United Kingdom leads the way, and there is no doubt about it. It is the involvement of the locals that makes it happen. People are known to undertake several community efforts, no matter how small, to keep the medical flights funded. From marathons to selling cookies, people contribute in their own way through innovative fund-raising efforts. The question that such undertakings raise is this: does this method work across the board? The answer to this simple question, however, is quite complex and the success is dependent on several factors. Let’s take a look at some of them.
The Absence of Significant Private Air Ambulance Companies
In a country like the United States, there are several private players who do an exemplary job to provide air ambulance coverage. They span a wide network of rural areas with zero compromise on quality of transport. The problem, however, is the price that they charge. In the absence of adequate insurance coverage, they can turn out to be a huge challenge to pay off. Of course, there is the issue of network coverage and surprise billing that has got the country concerned lately. This is the prime factor that is pushing people to look at alternate means of funding air ambulance services.
Community Funding is Not Always Successful
The estimated cost of keeping air ambulance services floating runs over a million dollars. Even the most successful charitable medical flight services do not rely solely on community funding to satisfy this need. Governments and corporate organizations play an active role in their funding. Moreover, prominent personalities are known to raise awareness and extend support to raise awareness about the services. In the United States, however, such an ecosystem is completely missing. Unless there is a concerted effort to get it in, such efforts are bound to fail.
There has been much anticipation surrounding the new air ambulance bill that aims at curtailing surprise billing practices. However, experts opine that the draft leaves much to be desired for both parties – the payers and the air ambulance service providers. The feeling is that the lawmakers have tried to take a middle ground so as to not displease the air ambulance industry or the medical insurance industry.
From the insurance industry point of view, the fact that it suggests an in-network rate even for those medical flight service providers that are out of network seems like a big win. The provision is something that payers have wanted all along.
From the air ambulance industry point of view, the draft allows for arbitration if there is a dispute with regards to the billing. However, since this comes in the backdrop of a set rate, the industry is not too happy about it.
How is the Air Ambulance and the Wider Healthcare Industry taking it?
The American Hospitals Association has strongly opposed the draft. Their reasoning is that it harms the rural hospitals by limiting the access that patients currently have. The association went as far as saying it is a ‘windfall’ for the insurers ‘at the expense of’ community hospitals. American Association of Medical Colleges too has opposed the draft.
America’s Health Insurance Plans has displayed its dissatisfaction surrounding the provision for arbitration.
More about Arbitration
When it comes to air ambulance companies, arbitration will only be possible for amounts over $25,000. The industry is also expected to provide two years’ worth of data pertaining to costs. This data would be provided to US Transportation Secretary as well as HHS.
The air ambulance industry has been vocal in raising the concerns surrounding patient safety as well as closure of medical bases. They also pointed out that the current insurance payouts by Medicare and Medicaid do not cover even 40% of the costs.
There is no disputing the fact that the most important consideration when acquiring an air ambulance is the aircraft itself. However, once this is zeroed down upon, other considerations come into play. The prime among these factors is the interior of the aircraft. In this context, it must be borne in mind that aircraft manufacturing companies do not usually build one specifically for the air ambulance industry. They are designed for business. Once acquired, these aerial vehicles are then customized for medical transport. The following become the basic considerations for effective customization:
- Crew comfort
- Ease of access
- Ease of loading and unloading the patients
- Medical equipment accommodation
What Makes a Good Structure for Air Ambulance?
The entry, in other words, the cargo door, plays a vital role. The bigger this aspect is the better, as it facilitates easy on-boarding and off-boarding of patients. Cabin room is another factor that holds high importance. Since medical equipment needs to be kept handy during flights, cabin room matters. Plus, leaving just a little space for the patients and the crew is not advisable as it poses an operational challenge when the situation is critical.
Cabin floor is among the important factors. It is quite possible that the floor gets dirty during the course of patient care. Blood, bodily fluids, and even spillage of medicines are sometimes unavoidable. However, all these must be easily cleanable later as they can pose a health risk. Electrical outlets, high ceilings, fresh air distribution, low vibration, sound proofing are some of the other considerations.
While most of these factors can be customized post purchase, some aspects like low vibration and sound proofing are inherent features of an aircraft. More and more aircraft manufacturers these days are developing aerial vehicles that are meant specifically for the air ambulance industry. The change has come about due to the increasing demand.
With rural hospitals in the United States closing down at an alarming rate, telemedicine is among the tools, along with air ambulance services, that is filling the void. Imagine a possibility where telemedicine is made available in medical flights. It would have a lasting impact on efficiency, quality of care and also costs. In this guide, we discuss the various possibilities in some detail.
Doctors Take Cubicles for Air Ambulance Services
Telemedicine essentially is an internet-enabled concept where the doctor in front of a computer relays real-time information through video conferencing. Of course, there needs to be a medical professional on the other end too, so that the physician’s instructions are followed correctly. An emerging trend today is telemedicine centers where tens of physicians behind cubicles offer remote healthcare services. This is especially helpful for people residing in rural parts of the United States where getting adequate medical help on time can be a real challenge.
Not All Emergencies can be Handled Online
Of course, there are going to be situations where personal medical attention becomes imperative, and if the situation is serious, it can demand air ambulance services. What if the patient is critical and the paramedic onboard needs expert medical advice? It is in situations like these that telemedicine can help air ambulance services. With professionals practicing a wide range of specialties, it becomes easy to get the right help at the right time for air ambulance companies.
A Tie up is Necessary
Today, there exist several telemedicine businesses that hire tens of doctors. However, there is a gap and that is collaboration between telemedicine industry and air ambulance services. Such a move will enhance patient care while cutting costs as air ambulance companies can do away with having physicians at the site all the time. It can be a pay-per-service model. Moreover, the medical flight service would have instant access to an array of medical specialties.
Spinal cord injuries unfortunately are among the most serious ones and can leave the patients in need of high level of medical care. Prolonged rehabilitation is almost always a requirement. However, getting to the hospital, especially if they are located a huge distance away, can be a challenge. This is where air ambulance services come into picture. Fixed wing air ambulances are best suited in the situation. They are quick, which means travel time is minimum and the patient does not have to go through hours of discomfort-filled travel. Moreover, the fixed wing air ambulances themselves are sans bumps, making it safe for the patient.
Air Ambulance and Patient Needs
Worsening of the current injury is a possibility during patient transport. The air ambulance must therefore have the right equipment and the right experts onboard to make this journey a smooth one. The care during the transit has a huge bearing on the ultimate outcome post recovery. Risks like pulmonary embolism and deep vein thrombosis are high. The crew must be cognizant of this fact. Many patients who develop spinal complications also suffer from bladder and bowel disorders. It is something that the staff must be ready to handle.
Why Medical Flights are the Best Choice
Most air ambulance companies facilitate seamless coordination between the ground ambulances and the air ambulance itself. The transition becomes flawless and the patient is assured of good care. Moreover, the fixed wing air ambulances these days are nothing less than highly sophisticated intensive care units. This means that any complications that can potentially occur en route can be efficiently handled. The cost of the air ambulance can be a concern for people. However, by doing the right research and proper negotiation keeping the insurance provider in mind, the issue can be solved efficiently. In the end, what matters most is the full recovery of the patient.
Most air ambulance rescues are enabled by helicopters and the sound that they generate can be a huge hindrance for communication. Working around this problem is vital to keep the communication ongoing between crew members and also to maintain the efficacy of it. Active noise cancellation is one such technology that has brought about a paradigm change in the air ambulance industry. It simply does away with unwanted noise and makes the communication clearer. Helmets have now become a playground for newer technologies. However, while employing technology to make communication seamless, the weight of the helmets can be a concern.
Air Ambulance Rescue Helmets
Ergonomics and weight of helmets have become as important as the communication systems that they host. With all the technology, care must be taken to ensure that they do not hinder the rescue efforts.
Most helmets are connected to the helicopter intercom systems so that they can hear what is going on at any given point. Radios also play a major role here as communication with the ground team is also vital. Most helmets have a built-in radio receivers and speakers too but switching between the two can sometimes be a challenge. This is where customization comes into picture.
Customization of Air Ambulance Crew Communication Devices
There are several companies out there that churn out customized communication devices. Air ambulance organizations can get exactly what they want through them. For instance, switching between radio equipment and intercom would be truly a seamless process. However, there are a few drawbacks.
The main con is the price. Customization comes at a premium and the trade off between the utility and the price can be skewed. The other factor is aftermarket service, which might be poor, unavailable or highly expensive. Plus compatibility with changing technology can turn out to be a headache.
Air ambulances must factor in all the elements discussed above to come up with the best possible communication solution.
Imagine a situation where a patient is in a life-threatening situation and a medical flight is an absolute necessity. The treating physician recommends an air ambulance. However, when a call is placed for dispatch, the service provider refuses to comply. The reason behind this is bad weather conditions. The hospital then calls several other service providers until they find one that is willing to take the risk. This is called medical flight shopping. While this might seem to be a logical recourse for the patient, it is not always desirable. The risk taken by the patient and the crew is huge in such circumstances. Why do air ambulance service providers agree to such a call?
The Pressures on the Medical Flight Industry
There are over a thousand medical flight service providers in the United States. This means they have to divide the existing customer base within themselves. Plus, most of these businesses are privately funded so profits matter. Rejecting patients for whatever reason does not serve the profit motive of these investors. Hence, the crew is compelled to take the call of answering to the need. However, this eventually places a huge financial burden on the patient. Let’s understand how.
The Out of Network Issue
In a situation where the need for medical flight service is huge and time is short, the patient does not really have the option of choosing a service provider. Most often, the service that he or she ends up with is one that is not covered by the insurance provider. While the insurance might cover a base rate, medical flight companies do not always comply with such rates. As a result, the patient is later compelled to cough up a steep price that the medical flight company charges in the form of balance bills. Medical flight shopping thus is a high-risk and expensive affair – a practice that must be relooked.
Prince William has spoken out about the psychological toll that the air ambulance industry takes on individuals that power it. Having worked as an air ambulance pilot himself, it has often been witnessed that when he highlights the issues concerning the industry, the world takes notice. He did it again recently this month. He shared how he had to, sometimes, ferry children who were in critical condition and how it ‘took him over the edge’. He called the air ambulance industry professionals to be open about the mental health challenges that they encounter on a regular basis and to seek help.
Seeking Help trough Colleagues
People sailing in the same boat often understand and are empathetic towards each other. Same is the case with air ambulance industry professionals. It becomes easy to open up to fellow colleagues about issues that affect them mentally. Talking things out is known to lighten the woes of the mind and to get a better perspective of life. Family and friends too can be a great source to get those nagging thoughts out of the mind. Awareness must be created in the industry. It must be conveyed that talking it out is healthy.
Mental Issues and Employers
Mentally healthy employees are always more productive. Plus, it is the responsibility of the employer to take care of the employees. This is not limited to physical well being but also the mental well being. The air ambulance industry today is governed heavily when it comes to safety of the crew and the patients when in midair. This ensures physical well being. However, laws must be enacted to protect mental well being of the workforce too. Easy access to mental health professionals is prime among them. It must be noted, in this context, that many players in the air ambulance industry are cognizant of this need and have created an ecosystem to promote mental health.