October 2, 2017
Dear AAMS Members,
It’s hard to believe, but fall is now in full swing, and I’ll soon be seeing you in Fort Worth, Texas for the 2017 Air Medical Transport Conference. Thanks to your continued involvement and support, I’m pleased to provide you with an update on AAMS and MedEvac Foundation activities since our last membership meeting this past December in Charlotte.
With a new administration in the White House, AAMS’ Government Relations efforts have been very busy throughout 2017. AAMS worked hard to stay on top of the ever changing climate in Washington, while still working to advocate on behalf of the entire industry this past year:
Throughout the year, AAMS Govt. Relations efforts were focused on Republicans efforts to repeal and replace the Affordable Health Care Act. We covered several of these topics for our members including: Tax Credits and HSAs, and CMS Releases ACA Market Stabilization; the original House Bill and the final bill that was passed; U.S. Senate’s reveal of their “Better Care Reconciliation Act” (BCRA) and the drama as it played out on Capitol Hill throughout this past summer. While the Healthcare Repeal and Replace efforts stalled this summer on Capitol Hill, AAMS continued to keep an eye out for our members on this vital topic, and are staying on top of the new movement on Healthcare Reform front that has begun again on Capitol Hill. We will continue to keep you informed as those efforts continue.
Returning to AAMS this year is our brand new Vice President of Government Relations Christopher Eastlee (formerly the President of the Air Medical Operators Association). At AMOA Chris focused on issues of aviation safety in the air medical industry. As AAMS Vice President of Government Relations, Chris will focus on legislative affairs and regulatory issues related to healthcare, aviation, and other policy areas that affect the air medical and critical care ground medical transport industry and support AAMS’ mission to represent the entire industry and preserve access to safe, effective air medical and critical care ground transport throughout the United States.
Another topic that AAMS Government Relations efforts have had to stay on top of throughout the entire year is the “21st Century Aviation Innovation, Reform, and Reauthorization Act” (H.R. 2997). AAMS opposes two provisions of H.R. 2997:
- ATC Privatization: While there are numerous provisions in the House bill that AAMS supports, such as provisions to expedite the equipment installation and certification process, AAMS joins multiple general aviation organizations, including HAI, GAMA, NBAA, AOPA, and NATA in opposing the privatization of the ATC.
- Air Medical Billing Regulations: AAMS and HAI also oppose Section 512 of the bill, which would require the separation of air medical service billing into aviation and “non-aviation” related services. The Provision: (1) Mandates a far-reaching, open-ended, burdensome, and duplicative new regulatory regime; (2) Would pierce the Airline Deregulation Act’s (ADA) preemption provision, inhibiting the delivery of life saving emergency transportation services across state lines; (3) Did not have the benefit of the report and findings of the pending AAMS-supported Government Accountability Office (GAO) study on air medical cost, billing, and reimbursement issues when it was introduced; and (4) Introduces the concept of separating the charges of an air carrier into what could and could not be regulated by states.
On the Senate side the FAA Reauthorization bill became S. 1405. Since neither the House nor the Senate debated their respective committee-passed FAA bills (H.R. 2997 and S. 1405) during September, Congress needed to enact a short-term extension for the FAA and aviation programs before the expiration of their authorization on September 30th.
In April, AAMS was pleased to announce the publication of the Air Medical Services Cost Study Report, conducted by the independent research firm Xcenda LLC. AAMS commissioned the study in response to an evident need for reputable, independent research, specific to air medical transport, to quantify the costs associated with providing emergent air medical transports. Further, the study examined the appropriateness of the 2002 Medicare rate-setting methodology for air medical services and current payment adequacy. The resulting report provides independent substantiation of actual costs to the Centers for Medicare and Medicaid Services (CMS) and Members of Congress. Through various forms of communication (industry conferences, newsletters, and other means), Xcenda targeted recruitment from air medical providers billing Medicare in 2014, the most current billing information publicly available at the time of this study. A detailed cost data collection tool was distributed to providers who volunteered to participate. The study group included fixed-wing, rotor-wing, for-profit, non-profit, independent and hospital-based providers. Cost data were aggregated and analyzed at a per-transport and per-base level. Differences between program types, tax status, size, and geographic location were also examined. The study’s respondents represent 51% of all air medical bases nationwide and captured 46% of air medical services billed to Medicare.
Highlights of the findings include:
- The median reported cost of an emergent air medical transport is $10,199;
- Medicare payment rates cover only 59% of actual costs on average;
- Over 1/3 of respondents reported negative margins for emergent air medical services;
- The percentage of the U.S. population covered by air medical services, within a 15-to-20-minute response area, has grown from 71.2% in 2003 to 86.4% in 2016; and
- Air medical services improve access to level 1 trauma centers for 87 million Americans who would not be able to receive emergent care in a timely manner otherwise.
Also this past spring, while all of Washington was wrapped up in the Healthcare Debate, AAMS continued to keep an eye on important various healthcare issues, including important insurance programs for our Children’s Transport Teams such as the funding for The Medicare Access and CHIP Reauthorization Act (MACRA) reauthorized the Children’s Health Insurance Program (CHIP). Today, AAMS continues to watch Capitol Hill’s efforts on funding of insurance programs for CHIP and ACA.
During the month of January, AAMS’ Region VI Director Susan Smith and the AAMS Public Relations Team put together and released a video aimed at informing the public about the dangers posed to HEMS providers by UAVs/drones in low altitude airspace. The film, which was recorded in December, 2016 at AMTC v2.0, features safety advocates including Stacy Fiscus, Chair of Vision Zero. It encourages drone owners to visit ‘www.knowbeforeyoufly.org’ for more safety advice. Back on May 22 this year, the FAA Drone Rule was overturned by the courts. A federal appeals court threw out the FAA’s registration rule for drones flown recreationally; stating it directly contradicts current law forbidding such a requirement. The 2012 law reauthorizing the agency precluded it from putting forward “any rule or regulation regarding a model aircraft.” A three-judge panel of the U.S. Court of Appeals for the D.C. Circuit said the regulation couldn’t be clearer that it applies to hobby drones as defined by the law. AAMS continues to be an advocate for the air medical community and industry around Drone Safety, recently the AAMS Vision Zero Campaign published a letter by Erik Bratton, Hospital Wing’s Director of Safety, calling on Congress to enact legislation to promote drone education and to require registration.
Back in 2015, AAMS, and other air medical organizations, came out in support of Crash Resistant Fuel Systems (CRFS). In July this year, Rep. Perlmutter and Rep. Polis introduce the Helicopter Fuel System Safety Act. The act requires all newly manufactured helicopters be built with safer fuel systems and, within 18 months of enactment, all newly manufactured helicopters comply with the recommendations from the Rotorcraft Occupant Protection Working Group, which will significantly reduce the risk of post-crash fires.
At the end of July, the Government Accountability Office (GAO) released its report, titled “Air Ambulance: Data Collection and Transparency Needed to Enhance DOT Oversight,” which affirmed the Department of Transportation has the authority, under current law, to address industry data collection and consumer issues. AAMS Supports the GAO Report Recommendations:
- “Communicate a method to receive air ambulance-related complaints, including those regarding balance billing, such as through a dedicated web page that contains instructions on how to submit air ambulance complaints and includes information on how DOT uses the complaints.”
- “Take steps, once complaints are collected, to make pertinent aggregated complaint information publicly available for stakeholders, such as the number of complaints received by provider, on a monthly basis.”
- “Assess available federal and industry data and determine what further information could assist in the evaluation of future complaints or concerns regarding unfair or deceptive practices.”
- “Consider consumer disclosure requirements for air ambulance providers, which could include information such as established prices charged, business model and entity that establishes prices, and extent of contracting with insurance.”
AAMS fully supports additional transparency and consumer protection actions on the part of the DOT along the lines of the report’s recommendations and is working to improve the industry’s transparency with regard to both costs and quality-of-care. AAMS and its member companies were pleased to work with the GAO in developing this report and appreciate their efforts in reviewing these issues and providing specific recommendations for addressing them.
At the beginning of August this year, AAMS announced its support of the bi-partisan legislation, H.R. 3378: Ensuring Access to Air Ambulance Services Act, introduced by Rep. Jackie Walorski (R-IN), Rep. Suzan Delbene (D-WA), Rep. Bill Johnson (R-OH), and Rep. Raul Ruiz (D-CA). AAMS applauds Rep. Walorski, Rep. DelBene, Rep. Ruiz, and Rep. Johnson for their efforts to understand the significant challenges that face air medical providers across the country and actively work towards a solution. AAMS also praises the continued efforts of Chairman Pete Sessions (R-TX), a longtime champion of the need for Medicare payment reform in air medical transport. This legislation would establish cost and quality-of-care reporting requirements for the industry and implement a Value-Based Purchasing (VBP) Program beginning in 2024. It would also reform the Medicare fee schedule for air ambulance services, starting with temporary, noncumulative payment increases to providers followed by rebasing air medical reimbursements in 2021 based on the actual costs reported.
Member Reminder: AAMS fully supports this legislation, and encourages members to contact their Members of Congress to ask them to cosponsor H.R. 3378. The House of Representatives website provides a tool at the top of their homepage for identifying your Member of Congress by zip code. More Information on H.R. 3378: AAMS background on the legislation and the need to reform outdated Medicare rates and Cosponsors of H.R. 3378.
At the beginning of September this year, AAMS also signed on to a multi-association letter to the President’s Commission on Combating Drug Addiction and the Opioid Crisis to share our thoughts on how their report and recommendations could be improved. Our collective recommendations included addressing the stigma of opioid addiction, providing adequate funding, strengthening primary prevention efforts, expanding prescriber education efforts, and ensuring access to medication-assisted treatment for those suffering from addiction.
Other than our continuing focus on Capitol Hill, AAMS remains active in many other areas. Take a look at some notable accomplishments since our last membership meeting in Charlotte below.
About the Air Medical Transport Conference (AMTC) v2.0: First off, I want to say thank you, once again, to everyone who made it to AMTC 2016 v2.0. As all of you are aware, the events that occurred last September presented AAMS and the AMTC with various and very difficult challenges. I would like to commend the hard work of AAMS Director of Education & Events, Natasha Ross, and all of the AAMS Staff, for their hard work in regrouping for AMTC v2.0. We fully recognize that AAMS Members’ collective support made the best of very trying circumstances.
In January this year, in hopes of advancing HEMS Safety, the Air Medical Journal released “Reporting Helicopter Emergency Medical Services in Major Incidents: A Delphi Study.” This article examines a consensus-based, HEMS-specific, major incident template with uniform data to facilitate the collection, analysis, and exchange of experiences.
The Medical Transport Leadership Institute (MTLI) celebrated its 20th Anniversary this year. MTLI Graduating classes have steadily grown for the last 5 years. Additionally, recertification continues to grow annually. Special congrats to the 2017 MTLI Graduates.
The Safety Management Transport Academy (SMTA) has seen steady growth and with support of International Board of Specialty Certification (IBSC) who unveiled, in 2016, the newly created Certified Medical Transportation Safety Professional (MTSP-C) designation accreditation certificate to all graduates of SMTA. This year, SMTA also announced its plans for a graduate workshop beginning in 2018. Special congrats to the 2017 SMTA Graduates.
In February this year, the AAMS Members’ Only Discount Shipping Program, Partnership, gave AAMS Members the chance to win $25,000 Get Ready Sweepstakes by enrolling in the program. In the first three quarters of this year alone, AAMS Members have saved over $13,250 in FedEx Shipping Costs through this program.
Newly launched this year were Online Job Fairs for MTLI and SMTA. AAMS also continued our #AMTC17 Online Job Fair. Also, brand new this year to the AAMS Career Center for all job seekers: When you upload your resume to the AAMS Career Center, you can now choose to send it for a one-time free professional resume critique from TopResume.com.
AAMS Public Relations support of AAMS Members has been highly active this year:
AAMS provided its members with talking points about the Consumer Reports article entitled “Taking Patients For A Ride” that came out in April. The talking points addressed the errors made in the article regarding self-dispatch and the dangers of encouraging consumers to question a medical decision made by an emergency doctor or medically trained first responder, in an emergency situation. AAMS also worked to get our response to the article out to the public.
AAMS also worked on several positive stories on our industry:
- Docs Onboard?
- Risk vs. Reward
- Study identifies air medical transport Medicare funding shortfalls
- In Response: We need to protect life-saving air ambulance services
AAMS’ Public Relations efforts actively participated in EMS Week back in May, encouraged participation in a Community Safety Survey: Fire-Resistant Garment Use in June, and during the month of September promoted our members’ responses to Hurricanes and Earthquakes in the U.S., Mexico, and in the Caribbean. On the social media front, AAMS has expanded our outreach efforts to Instagram, in addition to our on-going efforts on Facebook, Twitter and LinkedIn. In fact, AAMS Facebook followers in the past year have grown by 23% . Lastly, AAMS public relations worked with the AAMS CCG and Fixed Wing SIGs to bring community awareness of an important message from LifePort, Inc. about the proper use of clip deck product in ground ambulances.
AAMS Committees have been very active this year:
The AAMS Awards Sub-Committee overhauled the awards descriptions and judging criteria to make the definitions consistent and open more award categories to ground transport programs.
The AAMS KIDS SIG has been busy collecting data and moving forward with the Bedside Times Working Group Project. Led by Dr. Peter Brust, Nemours Hospital created a Red Cap Survey for the KIDS SIG Working Group’s members to report Bedside Times data for the group to evaluate. The goal is that the data will lead to the identification of common causes of Bedside Time delays and work to address those causes with referral hospital community nationwide.
The AAMS Education & Standards Committee reviewed the 2018 National EMS Scope of Practice Model Working Draft provided the following feedback to NASEMSO:
- The changes and the challenges that EMS providers and transport teams face today warrants this change and this critical look at the outdated scope of practice model.
- The trend to having states adopt a national scope is a start. Based on experience, the state scope of practice is not as problematic as the local scope. State policies are published, accessible and up to date and similar to the national scope. In order to bill a ground ambulance transport, billing companies follow CMS definitions of Level of Service (LOS). The issue for billing companies that bill nationally for ground is they need to drill down to the local scope for every geographic area. Obtaining and maintaining all of the local scopes is a challenge.
- The local scopes tend to be restrictive compared to the state. With a changing EMS environment this does not always serve the public well. Local EMS authority dictates and governs scope. Local change in scope is difficult, can be political, and the needs of a community decided by a few.
- Having different scopes for the adjoining county does not foster an integrated system or inter-operability.
- Medics on interfacility transports with critical patients that have an expanded scope are essential. These medics with additional training beyond the scope of the “local” medic need to be clear. Critical Care Paramedic (CCP) needs to be standard and clearly defined. Credentials, certifications, licensure & education were all addressed and defined in the draft. This will need to become transparent on the transport record.
Also, the AAMS CCG and KIDS SIGs are formal and active members of NASEMSO Safe Transport of Children Ad Hoc Committee (STC) committee. Currently, this group is seeking funding for crash testing to be conducted to develop ambulance child restraint system standards.
AAMS’ Safety Committee Chair, Colin Henry, and AAMS’ Vision Zero Chair, Stacy Fiscus, were pleased to announce back in August that the AAMS Safety Committee will now include the members of the AAMS Vision Zero Task Force. The larger committee will take on a more strategic role, deciding where the committee’s efforts should be focused and providing ideas and input on safety-related “hot topics” that are facing air medical and critical care ground transport providers. The Vision Zero Task Force will function as the primary working group.
AAMS community outreach efforts in 2017 took place at several different events throughout the year. AAMS attended HAI (meetings with donors, operators and exhibitors). AAMS exhibited at American Case Management Association (ACMA) National Conference and Case Management Society of America (CMSA) National Conference. During both conferences, AAMS reached out to case managers on behalf of our Fixed-Wing Members, and we networked with our Fixed-Wing Members who attended the conferences. AAMS exhibited in August at National Association of EMS Educators (NAEMSE) Symposium to market AMTC17, SMTA18, and MTLI18. At NAEMSE this year, AAMS also networked with ground providers in EMS Community at this conference, as well as potential AMTC exhibitors.
AAMS international outreach efforts in 2017 took place on two different continents. Earlier this year AAMS Board Chair Dave Evans attended EHAC’s Membership Meeting after Air Med was cancelled for 2017. More recently, AAMS’ Rick Sherlock, Dave Evans and MedEvac Foundation’s Johnny Delgado attended the Aeromedical Society of Australasia and Flight Nurses Australia conference in beautiful Sydney, Australia. This international conference was well attended with delegates from Australia, New Zealand, Asia, Europe, Canada, the United States, and many others.
During ASA/FNA, we were also able to welcome the China Air Medical and Rescue Alliance (CAMRA) into the Cairns Accord. The accord is essentially a partnership between AAMS and the MedEvac Foundation, The Society of Aeromedicine Malaysia, European HEMS and Air Ambulance Committee (EHAC) and now China to work together and learn from each other as it relates to information sharing, participation in education, collaborative research, consultation on strategic priorities and issues of common interest and participation in training initiatives and events. AAMS and the MedEvac Foundation also signed bi-lateral agreements with CAMRA to help their efforts to establish safe and effective air medical transportation.
The AAMS Board of Directors, in addition to the annual election campaigning, has been hard at work trying to tackle the AAMS Membership Reform Efforts. They have been reaching out to all of the members in their respective regions and have received many FAQ about the AAMS Membership Reform effort this year. Just a friendly reminder to all AAMS Members that there will be a ratification vote of membership reform this year during the AAMS Membership Meeting held at AMTC on October 15th, 1600h in the Omni Forth Worth Hotel. If you have not RSVP’d yet, or you need to appoint a proxy to represent your company’s interests during this year’s meeting, you may do so by filling out this online form.
A few additional notable mentions from the MedEvac Foundation include:
- In July this year, the MedEvac Foundation International was proud to announce that it had received Platinum Status on GuideStar. Less than 1% of all non-profits achieve that status and it shows the Foundation’s commitment to transparency and being good stewards for our generous donors.
- The 2017 Scholarship Program for the foundation has been very active this year. In January, the brand new Dr. Suzanne Wedel Scholarship for 2017 MTLI Graduate School was launched and its first recipient Ashely Smith was announced in March. Also in March, MTLI Undergrad Scholarships were awarded to Maika Clement Dang, MD and Jennifer Humphries. In May, the MedEvac Foundation announced the recipient of its 2017 SMTA Scholarship was Andrew Holcomb. We would like to thank Sikorsky, Metro Aviation, and AMOA for sponsoring our scholarships.
- The MedEvac Foundation launched a new fundraising campaign, with the support of AMTC Keynote Speaker Joe Tye, called the Pickle Pledge. This lighthearted and highly effective program helps healthcare organizations foster a more positive and productive culture by helping people be personally more positive and productive. Look around the AMTC for the special Pickle Pledge receptacles and instructions on how your participation will support the MedEvac Foundation International.
- The MedEvac Foundation has many exciting events happening this year at the 2017 AMTC. If you have not yet registered for one of these events (e.g., 5K Run, Top Golf, Silent Auction, or the Program Round Table), please check out these events online and consider registering today. If you did not receive an invite to one of the MedEvac Foundation’s Events, and were supposed to, please contact Tiwanda Settlers-Washington at email@example.com
Again, thank you for your continued support for AAMS and the MedEvac Foundation International, and I look forward to seeing you in Fort Worth in a few short weeks. As always, please share your comments, questions or concerns with me at firstname.lastname@example.org.
CEO, Association of Air Medical Services and MedEvac Foundation International