Well this might not come to you as a surprise because you might have witnessed this yourself. According to one survey conducted by Kaiser Family Foundation, about 40% of US citizens have revealed that their families have received a medical bill despite being covered by medical insurance. This is a growing problem for the country as insurance companies are seen restricting the number of providers in their networks. Of course, out of network providers are not covered by insurance companies. In this context, the question arises, is it the same logic behind huge medical flight bills that people across the country are witnessing?
Medical Flight Bills and Insurance Network
A majority of industry experts believe medical flight service providers willingly stay out of insurance networks. The reason is simple, they lose the freedom to charge what they feel is fair for their services. It is also felt that there is a huge disparity between what the medical flight industry believes is a fair payout and what the insurance industry pays. The middle ground, it seems, is something that has not been achieved so far. The issue has not gone unnoticed by the lawmakers. However, the opinion is divided as to who is responsible for the huge bills.
Efforts by Lawmakers to Bring Down the Bills
Several attempts have been made to limit the amount that can be charged for medical flight services. From trying to ban balance billing to compelling air ambulance companies to come under insurance networks, several innovative efforts have failed. The reason behind this is the Airline Deregulation Act of 1978. Designed to create a competitive environment to keep the price of this essential service down, it precludes the state governments from intervening in the matters of air ambulances. Only the Federal Government is authorized to make changes.
Bystanders are often left wondering how to handle emergency situations. If the medical necessity is grave enough to warrant a medical flight, live streaming the emergency situation to the first responders through video streaming can be quite helpful. With the connectivity and mobile enablement that the world enjoys today, making this possible is not a tough ask. All it would take is an app that covers privacy, consent and similar concerns. The chances of the injured or ill getting immediate help becomes easy. Bystanders can get instructions from qualified first responders.
Addressing the Privacy Concern
The app will certainly help the patients immensely; however, there can be privacy concerns. The solution – treatment, if needed, can be delivered after an expressed consent from the patient. Moreover, the video need not be recorded or stored on either ends, both the patient and first responders. In fact, the kind of application is already being used in United Kingdom. A dedicated solution like this to emergency response centers, can do a lot of good. Since every medical flight covers a huge amount of distance, people, especially in rural America, can benefit significantly.
The Need for Medical Flight Can be Gauged
In situations where there is no qualified medical professional to make a decision whether the patient needs emergency medical flight services, the mobile app can be of immense help. The ‘medical necessity’, which plays a huge part in insurance approvals, can be determined quickly and effectively so that the patient is free of such worries from the word go and where applicable, an informed decision can be made.
Integration of such an app widely is important. If each player in the medical flight industry comes up with a unique platform to execute this, it would be a disaster. What the industry needs is a common platform so that execution becomes easy.
Imagine this: the medical flight has emergency personnel seated in it and is en route to pick up a patient in a remote area but there’s one crucial member of the crew missing. Guess who? The pilot! Yes, that’s right! The medical flight technology is slowly moving toward autonomous flights that are sans pilots. If this sounds like science fiction to you, here’s a surprise. SkyRyse, which is a Silicon Valley start up, is already testing autonomous helicopters in emergency settings. It is known to have carried police and emergency personnel safely in response to mock emergency calls and the testing will continue.
How Safe is the Autonomous Medical Flight Technology?
Experts feel that it is quite safe. It is believed that the flights use the same technology that is used in driverless cars. A combination of software and hardware that is continually monitored from the control room and a medical flight that is controlled by itself – that about sums up what this technology is all about. Although the technology is still in a nascent stage, it will make huge strides in the days to come. A lot of this technology’s development will depend on machine learning and artificial intelligence which will allow it to learn the nuances of flying without any human intervention.
The Factors that will Make this Technology a Success
Ask yourself this question, “Am I ready to take a medical flight that does not have a pilot?” Trust of the customers in the new technology is going to be a decisive factor. Then there is the cost. It is a tussle between the cost of acquiring such a technology and the return on investment that it ultimately brings. Will this new technology demand high maintenance cost? Or will it reduce it? Regulations are another factor. Innovations that have the potential to give rise to safety risks typically take longer to get government approvals. For now, it’s a wait and watch for all of us.
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.
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.
The life of medical flight professionals can be quite adrenaline pumped most of the time but that does not preclude them from the responsibilities that come with being a part of the air ambulance industry. The training, the safety measures and the need to be on the call all the time are just some of the tasks that they are expected to undertake. Of course, the gratitude that they receive for saving lives is an additional bonus that perhaps every medical flight professional enjoys. Most people who become a part of the air ambulance industry very well know that they are stepping into a high stress job.
The Routine Tasks of Medical Flight Professionals
While the pilot is expected to run routine checks to keep the chopper health up, the medical flight crew members are required to ensure that all inventory and medical equipment are in place, the batteries are all charged up and basically ensure that all equipments are working fine so that they can effectively respond to emergencies. The station duties can range from keeping a tab on the blood fridge and logging fridge values to cleaning and taking out the trash. Each member assumes a responsibility when they are docked in the hangar.
Responding to Emergencies
While the medical flight professionals usually conduct several station duties, they subconsciously are always anticipating an emergency call. The moment it comes in, they are expected to leave everything and take up the duties that enable them to face the emergency effectively. They immediately do all that is needed to know about the patient health condition and equip the medical flight with all the necessities. The medical staff are alerted in the nearest appropriate hospital and logistics are quickly and efficiently taken care of. It should be noted that, in view of the fact that the entire routine is quite stressful, the crew is always allowed enough rest hours every day and are encouraged to get enough relaxation between shifts.
There are several terms used to describe a situation where a medial flight does not arrive even after a call. The reasons behind this could be several but it is important to categorize these using appropriate terminologies so that an organization that owns the medical flights can optimize and also gauge its effectiveness. It makes gathering of meaningful data easy. Let’s explore these terminologies in some detail.
Cancelled Medical Flight Calls
The category ‘cancelled’ should only be used to describe those situations where the medical flight has taken off, but it is asked to return when it is en route to the patient’s location. The reason behind this could be demise of the subject that warranted the air ambulance service in the first place or a change in situation where it is felt that the medical condition is not serious enough to warrant a medical flight.
Stand Down of a Medical Flight
When the risk of flying to a particular location is too high, the mission to serve the patient is usually abandoned. All such instances must be categorized under ‘stand downs’. This directly affects the dispatch rate but it is a call that must be taken keeping the safety of the crew in mind.
The decision to abort a medical flight mission is usually only taken when the weather condition is too harsh to fly. Missions can also be aborted owing to mechanical problems or inability to fly during bad light.
Once all the missed flights are segregated in the above categories, it becomes easy for the medical flight service provider to gauge what is causing the changes in the dispatch rates. Any areas of improvement such as night vision must be dealt with so that superior service and better dispatch rate can be achieved. The categorization also helps medical flight organizations to set targets and better organize themselves.
When faced with an emergency situation concerning the life of a loved one, cost is the last thing that you want to worry about. However, it is always wise to have an idea of the costs involved in emergency situations and medical flight services are one of those. With the cost having doubled over the past decade, you must know what to expect if you’re opting for a medical flight. While most of the costs will be covered by your health insurance, you would still want to keep the costs low as you might be forced to pay the unapproved balance amount as it so often is seen happening.
The Cost of Ground Transportation
One cannot completely discount the fact that a ground ambulance may be required to transport the patient. It becomes an absolute necessity when it’s a fixed-wing medical flight, which can only take off from an airport. Even choppers can, at times, not reach the patients owing to the terrain and ground ambulance services may be needed.
The Destination of the Medical Flight
This is an obvious factor. The longer the medical flight, greater the cost. The nearest appropriate treating facility might be quite far and sometimes across borders – all this ultimately translates into higher cost.
Medical Flight Landing Fees
The landing fees depend on the duration that a medical flight uses the landing facility. This becomes a part of the final bill.
Type of Medical Flight and Number of Medical Staff
Long flights typically demand fixed-wing air ambulances. These can be more expensive than choppers. They are generally better equipped and considered more comfortable. The number of medical staff is also a criterion. Certain medical conditions demand that professionals in more than one field of medicine be present in the air ambulance and this can push the costs up.
While there may be other cost factors too, the ones discussed above are the major ones.
The advancement in medical flight performance has a lot to do with the development in oxygen equipment in recent times. Typically, medical flights make use of portable oxygen equipment at altitudes less than 10 thousand feet above the sea level and fixed oxygen equipment if attitudes above 10 thousand feet are achieved by the air ambulance on a regular basis. Typically, the oxygen equipment consists of storage system, tubing, gauges, and mask. Traditionally, oxygen has been carried in gaseous form; however, the new advancements in technology have made way to solid stage oxygen which allows for carrying of greater quantities of oxygen.
Equipment Check Before the Medical Flight Takes Off
It must be ensured that all occupants of the medical flight are well aware of how to don and doff oxygen masks and fit the head harness properly. They should also be knowledgeable about checking the pressure gauges and indicators. Of course, it’s also necessary to check them for faults before the flight. The paramedics would do all these checks for the patients aboard the medical flight.
Each oxygen container is designed to withstand altitude up to a certain level. This must be taken into consideration before embarking on the medical journey. The expected duration of breathing and the duration of the flight are other aspects that must be considered.
Types of Oxygen Masks and Regulators
Continuous flow regulator ensures a 100% flow of oxygen. This usually contains a re-breather mask that allows the user to reuse some of the exhaled oxygen.
Demand and pressure demand works by providing oxygen to the user on demand. In other words, the oxygen only becomes available when the user is inhaling. Such oxygen usage is very stable and can be used up to 10 thousand feet above the sea level. This type of oxygen release becomes necessary in fixed wing aircraft where there travel long distances, often across continents.