In the words of the late Yogi Berra, “it seems like deja vu, all over again.” In an article entitled, “Medicare Can Actually Push HEMS To Rationality,” the author repeats many of the assertions that have divided the air medical community for years, while not offering any proof to substantiate them.
The author claims the Airline Deregulation Act (ADA) was never intended to govern air ambulances. While this may be opinion, it is not based upon fact. Air ambulances are not airlines but they must meet all Federal regulatory, safety, operating, equipment, maintenance, and other requirements specified by the FAA for all on-demand air carriers, which is exactly what the ADA was intended to address. The same stable regulatory structure that allows all air carriers to fly over state and local boundaries, without the complications of myriad or conflicting state or local regulations, allows air ambulances to transport patients-in-need to the closest, most appropriate medical facilities even if it means crossing a state border. This is critical for patients who live in states without burn centers, nearby trauma centers, or other specialty care centers. It is also important to fixed-wing providers who operate across many states and also to hospitals who receive patients from other states and from around the world. As for Congressional intent, during the original debates on the ADA, the Senate held a discussion specifically addressing air ambulances showing they were indeed recognized as covered on-demand air carriers.
More troubling, the author asserts that Medicare payments and the protections of the ADA allow air medical providers to provide low-quality, and in some cases dangerous healthcare. It is estimated that air medical providers transport nearly 400,000 patients a year. Each of those transports goes through an “after-action” review process designed to review the safety, medical necessity, and quality-of-care provided, during the transport. If a patient had “bled out” after being, “…pushed and pulled and squeezed for 12 minutes…” into an aircraft, the clinicians (not to mention the Medical Director and Program Director) in that program would be held accountable. Additionally, every aircraft (rotary-wing or fixed-wing) is required to be inspected for airworthiness and safety. Aircraft maintenance requires licensed maintenance personnel and requires their work to be signed off by qualified and licensed inspectors. No one in the US is operating with a “…repainted narrow cabin wreck reclaimed from a Nigerian swamp.” If the author can cite specific examples, I imagine the FAA (not to mention legions of trial attorneys) would be interested in hearing of them.
As a potential remedy, the author suggests Medicare should require a certain loading and unloading speed. It is critical that patients be moved, loaded, and unloaded safely and correctly, rather than quickly. I would prefer that clinicians use their advance skills and judgement to load and unload patients as efficiently as possible and not feel pressured to rush through important safety measures or to “push, pull, or squeeze” them into an aircraft in order to beat the clock and meet an artificial time deadline.
Air medical providers are an essential safety net for tens of millions of Americans, especially those living in rural areas of the country. Air medical transports are highly-effective medical interventions, but are NOT appropriate for every patient. They are effective in cases when bringing high-levels of care to patients and swiftly transporting them directly to the right facility can significantly improve their outcomes. We cannot let competitiveness and hyperbole distract us from our industry’s overarching goals.