COMMENTARY: Take emergency transport patients out of the middle

Rep. Ruth Briggs King recently penned an opinion piece about the high cost of emergency transport, in which she discussed the impact of balance billing for air medical transport services on patients. (“The high cost of emergency transport,” Feb. 18) The representative’s intentions are laudable — to bring relief to patients stuck in the middle with a balance bill. Unfortunately, her analysis and proposed solution missed the mark.

Air medical services are a critical lifeline for thousands of patients across the country, patients who shouldn’t have to worry about whether these services are paid for. But if insurers pay their fair share and Congress acts to update 20-year -old Medicare and Medicaid reimbursement rates, they won’t have to.

When someone has an accident, is suffering from a stroke or heart attack, or goes into premature labor, the first responder or physician can call for air medical transport. Why? Because they’ve made a determination that it will take too long to get the patient to a hospital by ground ambulance, and the health risks of a long transport time could be severe. Some 90 percent of patients being transported by emergency air medical services are suffering from serious events — like stroke or heart attack — or physical trauma. Air medical providers do not self-dispatch.

Providers of air medical transport must be ready to deploy 24 hours a day, seven days a week, 365 days a year with their advanced aircraft fleet and highly trained clinicians and pilots. Operating an air medical base costs, on average, $3 million annually. Eighty-four percent of those costs are incurred, because teams must be ready to respond to a call at all times.

Air medical is an essential service, but it’s become even more essential in rural America as hospitals around the country shutter their doors. Hospitals have been closing at a rate of one per month since 2010, and hundreds more are on the brink of closure, meaning patients will have to travel further to access emergency care.

In fact, 85 million Americans live more than an hour by ambulance from a Level 1 or Level 2 trauma center, making air medical transport the only way for them to get the emergency care they need. Seven out of 10 patients transported by air medical services have Medicare, Medicaid or no insurance coverage at all. However, the current Medicare reimbursement rate hasn’t been updated in nearly two decades, and when it was updated, it relied on information that is now more than 20 years old. Medicaid reimburses at even lower rates, sometimes not covering even the cost of fuel. This means that the cost of providing the service is shifted onto patients with private insurance.

While some private insurance companies reimburse appropriately, others do not. Some insurers do not include air medical service providers in their networks or, after the fact, claim that the transport was not medically necessary, leaving the patient with a large, unexpected bill. Air medical services are required to transport all of their patients regardless of the patient’s ability to pay.

That’s why Congress must enact the Ensuring Access to Air Ambulance Services Act of 2017, H.R. 3378/S. 2121, which would require air medical providers to submit their cost data so Medicare can update its payment system to reflect the actual costs of providing care. The bill also provides reasonable reimbursement relief to providers by updating the fee schedule to ensure access to emergency air medical services is preserved.

Private insurance carriers must also step up to the plate. Emergency air medical services have patient advocacy programs that help patients as they work with their insurers to cover the cost of the care. Insurance companies should include these services in their networks so that patients are not left in the middle. Including these services in network would not substantially add to the cost of insurance for consumers because air medical services represent only about one half of one percent of the average insurance premium. In fact, analysis by state legislatures in Montana and Kentucky have separately found that the average increase in a health insurance premium to cover the full cost of air medical services ranges from $1.70 to $3.48 per month, a small amount to ensure access to life saving care and transport.

Rep. Briggs King and others across the nation are right to worry about patients who get a balance bill for their emergency air transport. However, a state-by-state legislative approach won’t fix the problem. The solution must include Medicare reimbursement rate relief and an insurance industry willing to cover these vital healthcare services. Patients deserve nothing less.

Carter Johnson is spokeswoman for the Save Our Air Medical Resources (SOAR) Campaign.

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