The Association of Air Medical Services would like to respond to the inaccuracies published in the article, “Taking Patients for a Ride” in the May 2017 issue of Consumer Reports.

The main premise of the article – question your emergency doctor and first responders but trust your insurance company because they know what is best – is simply false.

Air medical providers do not self-dispatch and are only used when requested by medically-trained first responders or physicians, according to dispatch protocols developed by local emergency medical professionals, given the unique needs of regional health systems.  We believe it is irresponsible to suggest to consumers that it is in their best interest to question the judgement of medically-trained first responders and other medical professionals in an emergency situation.  The decisions made by those professionals are done so in an effort to ensure, as much as they are able, their patients receive the appropriate level-of-care based on their best judgement and assessment of the emergency situation.  They are trained to err on the side of caution.  They are trained to err on the side of what is right for patient, not the patient’s insurance company.  To do anything less would be putting a patient’s safety and well-being at risk.

Air medical transport programs provide intensive-care levels of medical care and swift transportation for critically ill and injured patients directly to the appropriate levels of definitive care.  Those patients, who can go by ground ambulances, because in the judgement of the first-responder or physician on the scene conditions do not warrant air medical transportation, should go by ground ambulances.  But the reality is that, in some cases, air medical transport is the best option for a patient in need.

Air medical transport is an expensive service that should only be used when deemed necessary.  That decision should be made by the medical professional at the scene, not by insurance companies.  There are examples across the scope of medicine that highlight the rising costs of retail medicine: out-of-network doctors practicing at in-network hospitals; drug price hikes; air and ground ambulance transport.  In each case, the recurring issue is the inadequate coverage offered to consumers for their emergency care, despite the fact that consumers have been spending their hard earned money on medical insurance policies that are supposed to offer protection.  In many instances, insurers have negotiated fair in-network agreements with air medical providers.  Unfortunately, fair negotiations are not always guaranteed.  In those cases, patients with private insurance are sometimes stuck in the middle, when insurance companies don’t work with healthcare providers (including air medical transport providers) to hold patients harmless and negotiate fair payment schedules.

Consumers have continuously invested in insurance policies that are supposed to provide coverage for them and their families, especially in emergency situations.  Consumers have the right and should take steps to hold their insurance providers accountable.

The article’s comments on accident rates for for-profit providers versus non-profit providers are also inaccurate, and demonstrate a lack of understanding regarding how air medical operators provide services to many hospitals.  If the article had explored that, it would have found companies like Air Methods, PHI Air Medical, Air Medical Group Holdings, and Metro Aviation, do account for 68% of the accidents – but they provide aviation services, either directly or by providing aviation services to hospitals, for over 90% of the aircraft involved in air medical transportation.  An organization’s tax status has nothing to do with the safety of their aircraft; in fact, the air medical industry, both for-profit and non-profit providers, voluntarily initiated a series of the largest aviation safety commitments in the industry’s history – including the installation of night-vision goggle systems, flight data recording and tracking systems, robust operational control centers, and terrain warning systems.  Those same companies then supported FAA regulations that required many of those voluntary safety enhancements.  To suggest that any of those companies suffer the tragedy of an accident without making positive changes to their aircraft and the services they provide is incorrect.  The aircraft and the pilots who operate them are operating at the leading edge of safety.

The air medical industry has drastically improved emergency healthcare access since the implementation of the Medicare fee schedule. However that growth has come in response to the closure of rural hospitals, the increased specialization of hospitals, and increased population growth in suburban and rural communities.  Recent studies show that current Medicare payments fall far short of covering the costs of providing the service, leading to higher prices for non-Medicare patients.

Air medical transport is a highly-effective medical intervention for the most serious and time-sensitive cases – trauma, traumatic brain injury, strokes, heart attacks, burns and spinal-cord injuries, as well as high-risk obstetric, neonatal/pediatric, and transplant patients.  If you or a loved one ever requires an air medical transport, you can be sure that you are receiving the highest level of patient care during timely transport to a medical facility best suited to treat your specific needs.  As this country continues moving towards a regionalized trauma (and time critical diagnosis treatment) system, EMS helicopters now provide timely access to critical care for 1/3 of the American population who do not live within an hour, by ground transportation, of a Level 1 or 2 Trauma center – that’s more than 85 million people.  The need for the service our members provide cannot be underestimated, particularly in rural America.

Consumers have a right to understand the full story of the many benefits their air medical services provide.

AAMS promotes the following solutions to the many issues facing air medical services and the patients we transport:

  • Reform Medicare reimbursement rates for air medical services through federal legislation. When the Medicare air ambulance fee was first developed in 1998, it was not based on actual provider costs. This set the base reimbursement rate well below the cost of providing services. This significant reimbursement shortfall threatens access to all emergency air medical services, especially for rural communities.
  • Require cost and quality reporting mechanisms to provide industry transparency and better educate the public.
  • Support existing federal laws that allow air medical services to transport patients to the closest appropriate facilities, regardless of state, county, or municipal borders.
  • Some insurance companies are willing to negotiate in-good-faith and reimburse for air medical transport services at reasonable rates; AAMS firmly supports ongoing efforts by all of our members provide the same arrangements with other insurers that take patients out of the middle and preserves this essential service.