Perhaps the biggest problem that people who avail medical air transportation services face is unexpected costs that run into thousands of dollars, even when they are covered by their health insurance policies. Now, a new bill has been passed by the state of Virginia that seeks to end this uncertainty. The bill is called ‘Air Medical Transportation; Informed Decision’. The bill was introduced by Jeremy S. McPike and it went into effect on March 1, 2019. It was passed by the House and Senate of Virginia with zero votes against it recently. Here, we discuss what this bill will mean for the common citizens.
What is Virginia Medical Air Transportation Bill All About?
The bill mandates that hospitals establish processes, which necessitate giving an electronic or written notice to the patients or their authorized representatives. The notice should contain the cost implications of availing medical air transportation services. It should also contain the alternative options including emergency ground ambulance options. If the medical air transportation is out of network of the patient’s health insurance, this fact too must be made apparent. Even if the medical air transportation is covered only in part, it has to be brought to the attention of the patient or his/her authorized representative.
What will the New Bill will do for the Patients?
Patients in Virginia will now have the power to choose whether they want to avail medical air transportation services. Further, it will let them know the cost implications beforehand so that they do not get any nasty surprises in the form of huge bills later on. It is a good attempt by the state to bring about transparency in billing.
It is hoped that the medical insurance companies and the medical air transportation industry will ultimately come to an understanding with regards to costs, facilitated by this bill.
Traumatic brain injuries can be fatal and demand urgent medical attention that airambulance services can provide. According to a statistic by the Centers for Disease Control and Prevention, traumatic brain injuries are among the leading causes of disability and even death in the United States of America. To put a number to the extent of its dangerousness, traumatic brain injuries account for about 30% of all deaths associated with injuries. The leading causes of brain injuries in the country are assaults, motor vehicle accidents, sports related mishaps, and falls. While the risk of falls is considered high among senior citizens, sports are a major cause for traumatic brain injuries among the younger population.
Ambulance Sometimes Becomes a Necessity in Traumatic Brain Injuries
The survival rate of a patient increases drastically if he or she receives treatment right on time. This is where airambulance services come into play. If the injury occurs in remote or rural areas where access to adequate neurological care is next to impossible, the only recourse that remains is transportation by airambulance. Among the advantages of using airambulance services apart from the speed is the comfort and facilities that they offer. They are usually better equipped. Also, the chances of secondary trauma owing to transport are almost zero when the airambulance is used for transport.
The Immediate Symptoms of a Traumatic Brain Injury
It must be noted that the symptoms related to traumatic brain injury vary based on the severity of the injury. Patients are usually seen experiencing mild-to-severe changes in personality or behaviour, loss of sensation in any or several parts of the body, muddled or impaired thought process, loss of memory, impairment in vision, slurring of speech, inability to move one or more parts of the body. Airambulance services usually employ specific protocols when traumatic brain injuries are involved and utmost care is taken to keep the patient safe so that the chances of long-term consequences are minimum to none.
According to a recent report by Government Accountability Office, 69 percent of air ambulance flights are not covered by private insurance providers. That is more than two thirds of the air ambulances out there in the country. There are a total of about 20,700 medical flights in the United States of America to put a number to this fact. The median price that was charged by air ambulance companies when a helicopter was involved was about USD 36,400 in 2017. The price shot up to USD 40,600 when the need for medical transportation involved fixed-wing aircrafts in the same year. When the complaints pertaining to balance billing to Government Accountability Office were examined, it was seen that the balance billing amounts were at least USD 10,000.
Consider the Necessity of Air Ambulance Service Seriously
Unfortunately, air ambulance services are hardly a consideration when one opts for a private health insurance. The wise thing would be to ask the agent whether they cover air ambulance services. One needs to do this proactively. Moreover, one must specifically ask which of the air ambulance companies are in-network of the private health insurance provider. Once you come to know of the names, check whether these air ambulance companies offer service in your region specifically. There are a lot of regional medical flight companies in the United States of America. Avoid the off chance that the air ambulance companies covered by insurance do not serve your region.
Be Wise and Purchase Air Ambulance Memberships
Air ambulance memberships can be very cheap. The memberships are usually renewed annually. Find out the air ambulance companies in your region and check what kind of memberships they offer. Opt for a membership that covers your entire family. It would not be a bad idea to hold memberships with more than one air ambulance company. These memberships protect the end customers from balance billing. Another great idea is to suggest your employer to get group memberships for the staff of the company as this can get the price of memberships down significantly.
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.