SOAR responds to article entitled “Taking Patients for a Ride,” published in the May 2017 issue of Consumer Reports

While the Consumer Reports article “Taking Patients for a Ride” addresses an important subject— emergency air medical transport as a healthcare service for patients – unfortunately, it paints an incomplete picture of how air medical transport services work, and fails to acknowledge many of the external factors that impact the industry’s ability to deliver services to consumers across the country. 

The article focuses on the high medical bills that patients can receive after being transported by helicopter following an emergency. Without question, we need solutions that take the patient out of the middle and ease the balance billing issues with air medical services. However, in order to have a meaningful, solutions-oriented dialogue, it’s critical that we first understand why these bills can be so high for some patients. The article only briefly alludes to the problem of cost-shifting, and does not discuss in adequate depth the underlying economic factors that cause cost-shifting and ultimately result in large bills

– Reimbursement rates provided by Medicare, Medicaid, and many private insurers, are drastically below the true cost of service. The average Medicare reimbursement is 30-50% of actual transport costs; Medicaid rates vary by state, but nearly always pay less than Medicare. In some states, as low as $200 for a transport (whereas the average cost of fuel alone for one transport is $450.)

– Many private insurers set rates arbitrarily, which do not reflect the true cost of a transport and leave patients in the middle.

7 out of 10 transports are patients with Medicare, Medicaid, or no insurance. This means that providers are being drastically under-reimbursed on 7 out of 10 transports, and the remaining transports are essentially paying for the whole system. This cost-shifting to cover costs is the root of the problem of balance billing and must be addressed. 

The article cites the “deregulation of the airline industry in the late 1970s” as a reason for high medical bills, but provides no additional context and leaves out significant facts. The reporter is referring to a critical piece of federal legislation called the Airline Deregulation Act (ADA), which is a carefully-crafted law that, among other things, allows emergency air medical providers to operate under a unified and predictable regulatory system. More than one-third of emergency air medical transports are across state lines, and providers fly across state lines on a daily basis. The ADA is essential because it 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. In short, the article draws the unsupported conclusion that a uniform and predictable regulatory system harms patients, and nowhere does it acknowledge the very real benefits of this system for patients, particularly in rural parts of the country.  

There is very little explanation of how emergency air medical services actually work, including with regard to how they are dispatched, who makes the call, and in what scenarios an emergency air medical helicopter would be called in.  

– While ground ambulance transport is also a critical element of emergency health care service, in many kinds of emergencies, the patient is given the best possible chance at survival or recovery when they can reach an appropriate emergency facility as quickly as possible; often helicopter transport makes that possible. The transports carried out by air medical services are the most serious, time-sensitive cases—including trauma, traumatic brain injury, strokes, heart attacks and spinal-cord injuries, as well as high-risk obstetric, neonatal/pediatric, and transplant patients.

 Emergency air medical providers never self-dispatch. They respond, as required by law, and are only called in when a physician or first responder has deemed it medically necessary. They are required to respond regardless of a patient’s ability to pay for the services and with no prior knowledge of what kind of insurance (or lack thereof) that patient has. The priority is safe transport while delivering the best care possible to give the patient the best chance at survival and recovery, often times, saving the patient’s life.

The article implies that it is reasonable for it to be up to an insurance provider, after the fact, to determine whether a transport was medically necessary. With emergency air medical transports, the decision of whether a transport is “medically necessary” or not is made by either the responding emergency personnel on the scene, or an attending physician.

Finally, the article advises that consumers should question the approach of first responders in an emergency. This is severely irresponsible at best, and arguably dangerous. This premise falsely assumes that a patient necessarily has the capacity to do so. 

In conclusion, while SOAR shares some of the concerns that this article raises around balanced billing and getting the patient out of the middle, we are focused on finding comprehensive, durable solutions that ensure that all communities continue to have access to this vital health care service.