Bi-Partisan Federal Legislation H.R. 3378 and S. 2121 are designed to preserve access to trauma centers, cardiac and stroke centers, burn centers, neo-natal and pediatric intensive care centers, and other critical-levels of healthcare for nearly 85 million Americans who live in predominately rural areas that don’t have those services.

The legislation will:

  • Preserve access to Level 1 and 2 trauma centers for almost 1/3 of the American population who doesn’t live within an hour of a Level I or Level II Trauma Center (by ground transport) and would not be able to receive emergent care in a timely manner.
  • Hold the air medical industry transparent and accountable to the public by requiring 100% industry reporting of quality-of-care AND cost data by all transport providers.
  • Increase the quality of patient care for patients throughout America, and increase the efficiency the air medical industry by making quality reporting publicly-available information.
  • Reform Medicare payments for patients flown by Emergency Medical Services (EMS) helicopters. Without this legislation, 85 million Americans could lose timely access to critical healthcare.

H.R. 3378 was introduced by Rep. Jackie Walorski (R-IN), Rep. Suzan Delbene (D-WA), Rep. Bill Johnson (R-OH), and Rep. Raul Ruiz (D-CA).  S. 2121 was introduced by Senators Dean Heller (R-NV), Michael Bennet (D-CO), and Cory Gardner (R-CO). 

AAMS Statement in support of H.R. 3378

Why the need for H.R. 3378/S. 2121?

Let’s Do the Math

Emergency air medical services are not immune to the rapidly rising costs of uncompensated medical care in this country.  A single-night’s hospital stay can cost more than $20,000.  2/3 of Americans are covered by state or federal programs that pay well under the cost of services, have insurance plans that may not cover air medical transports, or are outright uninsured.  In 2014, emergency air medical services conducted over 90,000 transports for Medicare fee-for-service patients in need.

Current Medicare rates, actually set in 1998, are considerably outdated and are not at all connected to actual cost data.  For every 10 patients flown, 5 are on government insurance like Medicare and Medicaid, neither of which pay close to the cost of an average transport, and 2 pay nothing at all.  7 out 10 air medical transports are uninsured or outright underinsured.


An independent air medical provider cost study, conducted and published in April 2017, by Xcenda, LLC, estimated that in 2015, Medicare payments covered only 59% of Medicare emergent transport costs.1

Medicare reimbursement rates that do not sufficiently cover the costs of providing care, coupled with uncompensated care costs associated with treating uninsured patients, have significant cumulative economic effects and could affect rates for emergency air medical services across the entire marketplace—and threaten patient access to these necessary services.

1Includes costs and revenue reported for Medicare fee-for-service and Medicare Advantage patients.


Are You 1 in 85 Million?

We must preserve and improve access to health care for millions of Americans.

Emergency air medical services have dramatically improved access to healthcare for millions of Americans.

Due to the continuing closures of rural hospitals, 85 million Americans now live more than an hour from the closest Level I or Level II Trauma Center, requiring critically ill and injured patients to be transported much longer distances with ICU levels-of-care.  Increasingly, emergency air medical services are the only access to definitive health treatments and diagnosis.

Where is your closest trauma center, and in the event of an emergency, how would you get there?

National View of 15 Minute EMS Helicopter Response Areas as of September 2016


How Air Medical Services Work

When a traumatic accident or acute injury/illness occurs, air medical services are requested by a first responder at the accident scene or a physician from a referring hospital.  Emergency air medical transport providers are then required to respond (within aviation safety considerations).

90% of air medical transport patients have suffered a serious cardiac event, stroke, or trauma. Rapid transport and immediate medical intervention during flight can give the patient the best chance at survival and recovery, often times, saving the patient’s life.

“In an emergency, the rule is almost always “the faster, the better.”

Emergency air medical services operate on a 24/7/365 basis – and crews must be ready to respond at any moment, even if no emergent transports are requested.  It costs, on average, $2.7 million per year for an air medical base to maintain round-the-clock readiness.  Air medical crews involve highly-trained pilots, paramedics, nurses, and other medical professionals, and state-of-the-art medical, aviation, and safety equipment.

Just like a hospital emergency room, emergency air medical services are required to respond when requested, and incur the costs of a transport without knowing whether they will be paid for their services.  The priority is providing the highest quality-of-care and the most effective and rapid transport directly to the appropriate medical facility in order to give the patient the best chance for survival, recovery, and quality-of-life after a traumatic accident, illness, or injury.

The air medical industry is facing an unsustainable future. Operating costs are rising, the population is aging, and hospitals are closing, especially in rural areas.  The demand for emergency air medical services will continue to rise, yet 70% of our transports are unpaid or underpaid. Current Medicare rates were never based on the cost of providing the service, and must be updated to reflect the modern costs. Without the long-overdue and significant reform to the Medicare reimbursement rate afforded by H.R. 3378, millions of Americans stand to lose emergency air medical services, often the only access to definitive health treatments and diagnosis.