Medicare can actually push HEMS toward rationality
Friday, June 24, 2016
Many would argue that the helicopter air ambulance industry in the U.S. as currently constructed is economically irrational and unsustainable. Too many helicopters, flying too few hours, charging patients whatever they like and a political backlash not far in the distance. The question is, what can we do about it?
The linchpin of the current irrational competition is the federal Airline Deregulation Act (ADA), legislation that was never intended to govern the air ambulance industry but has been misapplied by the Department of Transportation.
The DOT considers any aircraft that hauls a paying passenger — prone or otherwise — as an "airline." This prevents states from imposing rate structures or limits on the numbers of air ambulances that can be based in their jurisdictions. It also encouraged air ambulance companies to overcompete in prime markets, while underserving others.
Barring a new Supreme Court ruling, the curious interpretation of the ADA likely will remain. Fortunately, there is another federal remedy.
In 2002, Medicare doubled the air ambulance payment with predictable result: The number of medical helicopters increased from 545 in 2003 to 1,020 in 2014, and annual Medicare spending on helicopter EMS increased by 434 percent between 2002 and 2009.
When Medicare increased payments, it ostensibly did so to improve care quality, but it made no provisions for it. Indeed, one could argue that under the ADA, it had no authority to mandate specific helicopter type or category to be used. However, it could easily do so now indirectly by mandating patient care standards — such as required speeds of loading and offloading, minimum size of patients to be accommodated, and types of procedures to be performed in the air ambulance, including CPR, chest intubation, etc.
The industry has been clamoring for higher Medicare reimbursement rates. Perhaps these patient standards should go along with them as a way of defacto driving marginal providers with marginal equipment from the marketplace.
I, for one, would rather not be strapped to a stretcher then pushed and pulled and squeezed for 12 minutes until I can be fitted into the back of a repainted narrow cabin wreck reclaimed from a Nigerian swamp, thank you. (Of course, by then I will have bled out, but that's beside the point.)
Yes, more Americans than ever before are under the protection of an air ambulance that can provide the much-heralded "golden hour" coverage. On balance, that's a good thing — unless, of course, the helicopter in question is a piece of junk, the charge for it is usurious, and the outcome is no better than ground transportation.
It's time for some rationality to be imposed on the system, and attaching some conditions to higher Medicare reimbursement rates might be a good place to start.
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