Don’t let state borders on Earth block medical services from the air

As policymakers prepare for major discussions about health care next year, it is important that rural communities not be left out of those conversations.

Health care obstacles for rural America are unique, and at the core of this reality is the issue of access — across the board, people living in rural America face diminishing access to health care services. This is not just a problem for rural communities, but for our health care system as a whole.

One critical link in bridging the access gap is emergency air medical transport by helicopter.

{mosads}Emergency air medical services are a key element of emergency response, especially for people who have limited-to-no access to trauma care facilities.

In fact, there are 85 million Americans who currently can only reach a Level 1 or Level 2 trauma facility within one hour if flown by helicopter. In cases of strokes and other traumatic injuries when “time is tissue,” key differences can be made with regard to saving a life or preserving quality of life when proper care is administered as quickly as possible.

Compounding that is the fact that 70 percent of emergency transports are from rural or super rural areas at the point of pick-up. With rural hospitals closing their doors at alarming rates, Americans need access to emergency air medical services now more than ever.  

But there is a fundamental and growing problem that threatens the delivery of these critical services and without solutions communities will lose access. With the air medical transport industry convening this week in Charlotte, N.C., at the industry’s largest convention of the year, these issues will be top of mind.

And early next year, lawmakers will have the chance to work toward meaningful solutions.

Currently, air medical services are reimbursed at unsustainable rates by government insurance (Medicare/Medicaid), and by some private insurance providers who refuse to acknowledge the true cost of service. The average Medicare reimbursement for a transport is about 50 percent of the true cost of service, and Medicaid tends to be even less — sometimes as low as $200 per transport (which is less than half of the cost of fuel alone for one trip.)

When you look at the breakdown of the coverage for patients transported, it paints a very worrisome picture: 7 out of 10 transports are covered by Medicare, Medicaid, or are uninsured.

That means that 70 percent of transports are being under-reimbursed at woefully low rates, resulting in cost-shifting that puts unsustainable pressure on the remaining transports to pay for the whole system.

An important solution lies in updating the Medicare reimbursement rate for air medical services, a fix that would go a long way to resolve the reimbursement shortfall for these services.

Another one lies in keeping the Airline Deregulation Act (ADA) intact, which would ensure a unified and predictable regulatory regime governing all aspects of air medical operations.

Next year, some who do not understand the consequences may work to open the ADA and exempt air medical transport services in a misguided attempt to address billing issues. Doing so would have devastating effects and could lead to bases closing and less access, particularly in rural areas.

Exempting air medical services from the ADA would give states the authority to regulate a wide range of issues in relation to the aviation aspects of a licensed carrier — including where and when they are able to fly — creating borders in the sky; severely impacting aircraft safety; and creating a patchwork of regulations and requirements on an industry that flies across state lines on a daily basis.

It would limit patient care decisions made by referring physicians and would curtail the availability of services and critical access to healthcare, and, again, rural communities would suffer the most.

To put it into perspective: Over one-third of all air medical transports are across state lines. An intact ADA ensures that, when an emergency occurs, the closest appropriate aircraft can deploy and transport a patient to the closest appropriate facility, regardless of state, county, or municipal boundary.

We must avoid creating borders in the sky that prevent patients whose lives depend on timely transport and treatment from receiving it.

In 2017, we must work to find solutions in the right places by addressing the reimbursement issues and keeping the ADA intact. Communities and patients, especially in rural America, are depending on it.

Amanda Thayer is the spokesperson of the Save Our Air Medical Resources (SOAR) campaign, a national campaign aimed at preserving access to emergency air medical services.

The views expressed by contributors are their own and not the views of The Hill.