We have seen far too many medical air services bills going unapproved by insurance carriers. It is sometimes hard to point a finger whether the insurance companies should be held responsible for payment or the medical air services. The state of North Dakota, however, has been trying hard to pass a legislation that ensures the burden is off the shoulders of the patients. However, medical air services seem to be up in arms against this legislation, and they seem to be making a valid point. Here, we look into this law and also the factors that are preventing its implementation.
Medical Air Services and Insurance
People who are not a part of Blue Cross Blue Shield are often left to fend for themselves when a huge medical air services bill comes knocking on their door. The reason is simple: most private insurance carriers do not cover the full air ambulance bills and only pay a part. Also if an air ambulance company is not a participating provider of your particular insurance provider, you might have to bear most of the costs yourself. But choosing the participating medical air services is not always possible when life is at stake.
The Government of North Dakota has realized this and is trying to force medical air services to become participating providers with all major insurance companies. The legislation also is trying to set cost limits, where the air ambulance companies cannot charge more than the upper limit set with the insurance providers.
Medical Air Services are Against the Legislation
Federal laws state that states cannot regulate medical air services. Certain air ambulance companies are vehemently opposing this legislation stating that the law would amount to interference that is beyond the purview of the state governments. In fact Valley Air Med has openly challenged this legislation in US District Court in Bismarck. The US Department of Transportation too seems to be siding Valley Air Med’s argument as it feels medical air services should only be guided by federal laws.
As things stand currently, Valley Med Flight has become a participating provider but has voiced its dissatisfaction with Blue Cross Blue Shield payments.
Megan Gilbreath was a resident of Abilene, Texas. She was an 18-year-old student who was involved in a motor vehicle accident involving her pickup. She had a rollover accident where she sustained a head injury and a broken leg. A medical flight was quick to respond and she was all set to be transported to the nearest medical facility.
However, one major error was committed. The EMT that belonged to the medical flight service had intubated her wrongly. The tube that was supposed to carry oxygen was inserted into the esophagus instead of her windpipe. As a result she was declared brain dead by the time the medical flight took her to the treating facility. All the while oxygen was being pumped to her stomach instead of her lungs.
Are You Safe on a Medical Flight with Mere FAA Regulations?
It must be noted that FAA is a regulating body for flights of all types and not just medical flights. This means the medical flight service providers don’t really have regulations that govern them when it comes to ensuring adequate medical care on the flight. FAA only has the say when it comes to medical flight safety when flying. It concerns itself with issues such as crew safety in bad weather conditions and medical flight during bad visibility at night.
Who Regulates the Medical Flight when it Comes to Standard of Care?
The Airline Deregulation Act of 1978 that paved way for using air ambulances during medical emergencies had one major flaw. It exempted the medical flight service providers when it came to “routes, prices, and services.” This loophole allows the medical flight service providers to have their own standards when it comes to services.
This however does not mean that all air ambulance service providers cut costs when it comes to standard of care. Most medical flight operators maintain high standards of medical care. However, in the highly competitive air ambulance sector, it is possible that there are medical flight service providers who cut corners through not-so-well trained or inadequately trained medical staff.
The Airline Deregulation Act of 1978 does have a provision where the states can regulate the medical aspect of air ambulances; the only condition is that such regulation should not impact the economics of operating a medical flight “significantly.” In essence, there is scope and hope for regulations in this regard.
The Federal Aviation Administration had laid down its groundbreaking safety rules for choppers in February of 2014, popularly known as the HAA (helicopter air ambulance) rule. It mandated that the choppers involved in emergency transport of the patient would have to meet requirements like:
- Inclusion of certain specific safety instruments
- Improved training and testing
- Establishment of control systems for air ambulance transport vehicles
These were only a few requirements that were laid down. Although the initial deadline to meet these requirements was April 22 of last year, it was then extended by a year owing to the difficulties of the air ambulance transport companies to comply with them at such short notice. Most air ambulance transport companies have already complied with the first set of rules, although there is some anxiety in the air ambulance transport industry as the deadline nears.
The Air Ambulance Transport Sector will have to Meet More Deadlines
Although the air ambulance transport companies will have to comply with several of the rules laid down this year, there are some for which the sector still has time. Here’s a breakdown.
Compliance by April 2016: Setting up of operations control center.
Compliance by April 2017:
- Installation of radio altimeters
- Incorporation of warning systems and terrain indicators for choppers
- Meeting qualification criteria for PIC instruments
Compliance by April 2018: Complying with mandated systems to monitor flight data.
Guidance is awaited by the Air Ambulance Transport Industry
The sources in the air ambulance transport industry revealed that it is not possible to comply with certain mandates unless there are clear guidelines by the FAA. Compliance with most of the rules will cost the air ambulance transport operators huge dollars, so obviously, they want to get it right and keep the expenses to a minimum.
For the pilots, crew and the people travelling in air ambulance transport vehicles, the rules will bring in more safety and efficiency. In general, the rules have been well accepted by the air ambulance transport industry so far.
CAMTS accreditation is voluntary. However, several states and some governmental agencies have accepted or required CAMTS Accreditation for licensing, contracts or reimbursements.
Accreditation begins with an application form. The form indicates the service’s intentions to complete the process. The service then receives a Program Information Form (PIF). The PIF consists of a demographic section, a list of bases and a self-evaluation of the service, based on the CAMTS Standards. Response to the PIF self-study also requires attachments that include policies, education materials, quality management and safety processes. The PIF and attachments are submitted electronically within a year of applying for accreditation.
Once the PIF is complete and returned to the CAMTS office, it is reviewed by the CAMTS staff for completeness and sent to two Board members who will review contents for completeness and for additional questions that they document for the site surveyors. Site surveyors are then appointed, based on their experience and background related to the type of service (air/ground; fixed/rotor; critical care, ALS/BLS ground, etc.) they will visit.
The site visit is then scheduled at a time agreeable to both the service and site surveyors and at least 1 month prior to a Board of Directors meeting in order to be placed on the agenda for an accreditation decision. Once onsite the surveyors will conduct a series of interviews of personnel, look at training records, quality improvement programs, safety policies, etc. Their comments and observations are documented for the two Board members who present the program anonymously to the full Board. The programs are always presented by a six digit number – proper names and specific locations are not known by the full Board. If a Board member has a conflict of interest – he or she is excused while the program is presented and the Board deliberates.
The Commission on Accreditation of Medical Transport Systems (CAMTS) is an independent non-profit corporation, comprised of representatives from twenty member organizations, each representing some component of air and ground medical transport. Representatives to the CAMTS Board of Directors bring with them a wealth of experience and knowledge in their field of expertise. The Board of Directors develops and approves standards for all levels of medical transport – both air and ground. As standards are revised, they are shared with the member organizations and medical transport professionals at large for their comments and suggestions.
Accreditation by CAMTS is granted to those programs that voluntarily apply and demonstrate substantial compliance with the CAMTS Accreditation Standards. This is done through submission of documentation as well as a site survey performed by trained CAMTS surveyors, who have a depth of medical transport knowledge and experience.
There is no single “governing body” over medEvac services. Each service is independent, or could be part of a group of similar programs. There are however, several agencies that may have licensing or over sight for medEvac services. For the aviation components, medEvac services must adhere to rules and regulations established by the Federal Aviation Administration (FAA). They are also subject to periodic inspections by the FAA.
Minimal standards for reimbursement and/or licensing could also be established by third party payers (Medicare, Medicaid, managed care organizations) or by local legislation (state, county or city laws). Most states have minimum licensing requirements for medEvac personnel and the service.
In addition, medEvac services may also follow national or regional standards. For those services that are hospital based, if the hospital is accredited by the Joint Commission on Accreditation of Health Care Organizations (JCAHCO) or other such organizations, such as the American College of Surgeons for trauma verification, the medEvac service must also meet those minimum standards.
The Association of Air Medical Services (AAMS), established in 1980, is an international association which serves providers of air and surface medical transport systems. The association, a voluntary non-profit organization, encourages and supports its members in maintaining a standard of performance reflecting high quality patient care and safe and efficient operations.
Built on the idea that representation from a variety of medical transport services and businesses can be brought together to share information, collectively resolve problems, AAMS provides leadership in the medical transport community.
The core purpose of AAMS is to advance safety and quality in air medical and critical care transport.
Every patient in-need has access to safe, quality air medical and critical care ground transport.
AAMS Core Value Statements
Evidenced in behavior that:
Places patient care before self-interest
Celebrates common dedication to teamwork, compassion for patients, and a passion for safety and quality care
Evidenced in behavior that:
Evidenced in behavior that:
Evidenced in behavior that: