It is a short question that demands an elaborate answer. As the rural hospitals close at a rapid rate, air ambulances are playing a vital role in bringing patients quick access to emergency rooms. It is believed that, currently, a quarter of the population in the United States of America do not have access to medical care within an hour. It is air ambulances that fill this gap. A report reveals that 80 rural hospitals have closed in the past decade and over 700 rural hospitals, it is believed, will be closed in the next 10 years. Air ambulances are turning out to be critical services.
Time is a Factor that Air Ambulances Manage Well
A Federal rule says that air ambulances can traverse between state borders without having to worry about state regulations. This allows for seamless travel across borders without any regulatory hassles. If the states are allowed to regulate the air ambulance industry, it might so happen that traversing these now-free state borders could become lengthy or challenging to say the least.
A statistic says that over 30% of air ambulances cross borders annually. The state laws, if different from each other, might make flying the skies tricky, prompting the air ambulances to fly to another state because the regulations are less tedious. A report by American Stroke Association says that brain juries not getting treatment in time can result in fatality or poor recovery. That alone should be an argument enough in favor of Federal regulation.
It’s All About Reimbursements
The reimbursements rates by insurance companies have remained unchanged for over two decades. This puts a lot of financial stress on air ambulance service industry. Unable to get adequate cost coverage, organizations are compelled to go to the patients. Most disheartening is the fact that the patients who pay for this service are insurance holders but without adequate coverage.
Let’s understand the scenario with a hypothetical situation – a patient has suffered a serious injury and is in Carthage, Missouri. It is felt that the most appropriate facility to treat the patient is in Joplin, which is just about 12 miles from where he is. A medical flight is summoned, in spite of the ground ambulance being ready to take the patient. The medical flight takes about an hour to reach the patient and another 15 minutes to reach the treating facility. A week elapses, just when the patient is thanking his stars that he was lucky to receive the treatment on time, he is slapped with a balance bill of $25,000. The insurance company has covered $20,000 of the total $45,000 bill. The once happy patient is now contemplating mortgaging his house to pay off the balance bill.
The Argument Against Medical Flight Company
The insurance company argues that the ground ambulance was readily available and the destination was just 12 miles away, which would have taken the ground ambulance about half an hour to reach. Yet, a medical flight was called in, even though it took an hour for it to simply reach the patient. The insurance company feels there was no need for the medical flight service in the first place and refuses to cover the bill in full. In the outset, the argument seems right but only until what the medical flight company has to say.
Looking at the Situation from the Medical Flight Company’s Angle
Medical flight companies do not and cannot choose to take a call whether they want to fly a patient. They are summoned by the hospital and the medical necessity is decided by the treating physician. Come to think of it, the treating physicians usually have a sound logic behind suggesting an air ambulance service. The ground ambulance might not be best suited, owing to the patient’s condition.
What needs to be done in contradictions like these is following a middle ground and for this, there needs to be a mechanism in place where things are sorted out between medical flight and air ambulance companies. Until that happens, the patient will continue to suffer.
Imagine this – you pay for a smartphone in full and then realize that you are only allowed to use certain features in it but not all. How would you feel about that? Would you have bought it had you know about this fact during the time of purchase? Now, take the case of air ambulance coverage provided by insurance companies. Don’t you deserve to know the kind of coverage that you get? Whether you would be monetarily covered in your neediest hour when your health demands urgent medical care? You need to be sure you will be taken to a well-equipped treating facility and that the expense of carrying you to that destination is covered by the insurance provider. Unfortunately, that is not the case today.
Not All Insurance Providers are the Same
There are several health insurance providers out there who cover the air ambulance charges at a fair rate but there are others who do not. On the other hand, it is not under the control of the air ambulance service providers to choose patients. They ask no questions; they simply respond to emergencies. When this act turns into a haggle for money, it becomes a problem. The result, often, is balance billing – the part of the bill that remains uncovered by the insurance provider. The balance bill, ultimately, becomes the responsibility of the patient to pay, despite having insurance coverage. The amount can be so huge sometimes that it can push a common man towards bankruptcy.
Patient Advocacy by Air Ambulance Service Providers
Most air ambulance service providers have a robust policy when it comes to patient advocacy. Such programs are mainly targeted towards helping patients course through the complexities of insurance. However, the question is, why should such programs be necessary. All that is needed is a fair rate at which insurance companies reimburse the air ambulance service providers. As the insurance companies and air ambulance companies sort this matter out, what ultimately comes out is something that we all need to keep an eye on.
If you are a patient who is in a medical serious condition and fighting for life, would you be okay with an air ambulance professional who is fatigued and has been working a shift of almost 24 hours? Would you perceive this condition to be grave for your life? Although air ambulance personnel these days are not expected to work abnormally long hours, this fact is something you should know about. In this context, one must note that 24-hour shifts were a practice, if not common practice, prior to 1997. We bring you a research conducted in this regard by the US National Library of Medicine National Institutes of Health, which is a part of National Center for Biotechnology Information, a US Government undertaking.
The Findings of the Report were Astounding and Contrary to Popular Belief
The primary objective of the research was to assess the psychomotor agility and skill performance of the air ambulance personnel when they worked 12-hour shifts versus 24-hour shifts. The data gathered pertaining to 24-hour shifts belongs to the pre-1997 era. The data collected was compared with times when the air ambulance industry was mandated to work for limited number of hours as against the time when shifts spanning 24 hours were not alien. Intubation – a critical task that is undertaken routinely – was used as a scale to measure the efficiency of the air ambulance professionals. Surprisingly enough, there was hardly a difference between ‘overworked’ professionals and the ones who worked reasonable hours.
How Do Air Ambulance Professional Manage to Work at Optimal Efficiencies?
The answer may lie in the fact that failure is not an option when lives are at stake. No matter what the level of fatigue, when people who are driven by passion and compassion are put in a situation where the outcome depends on how they perform, the chances are they will try their best and come out winners. The fact is also an ode to the dedication of the professionals belonging to the air ambulance industry.
Medical air transport professionals are usually the first to respond to emergency calls and trauma scenes are sometimes very stressful to handle with death and serious injuries being a part of it. Medical air transport professionals do not even get time to let the situation sink in as they are expected to act immediately. This can cause quite a lot of mental trauma to them. Added to this is the physical stress of the entire situation where they have to move the patient, equipment, etc., so that lives can be saved.
Common Mental Ailments among Medical Air Transport Personnel
Research shows that depression, PTSD or post-traumatic stress disorder, fatigue and anxiety are highly prevalent among medical air transport professionals. The tragedy of the matter is that they do not often get time to introspect into their mental wellbeing because of the situations that they often find themselves in where they are expected to be highly reactive to the surroundings. By the time they realize their mental state, they are already deep into these psychological ailments. While it is a shared responsibility of the employers and the personnel, here are some tips to stay mentally healthy.
Tips for Mental Health
- Increasing mindfulness through meditation: Meditation allows people to take a step back and introspect. All the deeply buried feelings come to surface and one becomes in-tuned with his or her own mental state. The ability to detach oneself from sufferings around is greatly increased.
- Confiding in others: Every person has friends or colleagues that they can talk to. Getting certain things out of our system can help. It’s a sort of an outlet. Medical air transport professionals can also make use of in-house psychologists to open up. Even keeping a journal can help.
- Exercising to reduce stress: Endorphins that result from exercise can get rid of stress to a huge extent. Air ambulance professionals must make physical activity of their choice a part of their daily routine.
Finally, it is vital that people speak out when they are under stress. There is nothing wrong in seeking help when it is warranted.
Imagine heading a business where customers only pay you 30% of the time in full and the remaining 70% only pay you 50% of the cost. How would your business survive? This is precisely the situation of most air ambulance companies in the United States of America say industry experts. What adds insult to the injury is the fact that there is a outcry about the charges both in national media as well as people, not to mention the politicians who are trying to pin all the blame on air ambulance companies. Most players in the industry say that air ambulance business is getting harder by the day to run.
Air Ambulance Companies Asked to Do More
Rural hospitals in the US are closing down at a rapid rate. More and more rural patients are veering towards the services extended by air ambulance companies. However, the fact remains that air ambulance services are expensive and the costs are not being reimbursed by health insurance providers citing several reasons. While the most common is the ‘lack of medical necessity’ others simply have a small ceiling of reimbursements that have not been revised for a very long time.
Most of the Air Ambulance Costs are Fixed
Costs of running a medical base is, on an average, about USD 3 million a year. This amount accounts for about 85% of the costs and are fixed. These include maintenance of the aircraft, hangar, support staff, crew and the like. Then there are write-downs that are either forced upon the air ambulance companies or the ones that they undertake themselves on humanitarian grounds. All this adds up to a huge amount. Plus, there are always the running costs such as fuel which is also quite expensive. Industry experts feel that the demand for the services provided by air ambulance companies is going to increase considering that the population is aging, and that something needs to be done on a war footing to make the reimbursements commiserate with the services provided.
We have been citing the reluctance of insurance companies to revise their payment charts, in keeping with the time and also several air ambulance companies that simply refuse to budge down when it comes to the pricing.
This time around, Missouri Insurance Department has come up with a report that reveals, on an average, people of Missouri are paying about USD 20,000 for an air ambulance services. Of course, this is a whopping price for a common person, not just in the state but anywhere in the world. The report further said that close to USD 26 million was billed by air ambulance companies in the year 2017. Of this, 12.4 million is what people had to bear, taking into consideration deductibles and co-pays.
Does the Report Vilify Air Ambulance Companies?
This was a question that air ambulance industry advocates would raise without a doubt and not for any frivolous reasons. Balance Billing, which forces patients to pay the amount when insurance companies refuse to clear the air ambulance bills, had no mention in the report. The reason stated for this was ‘insufficient data’. One could even say that the lack of this data, sort of makes the report a little lopsided.
High Fixed Cost was Cited by Air Ambulance Companies
One aspect that should be appreciated about the air ambulance companies is that they have not shied away from saying the amounts charged to the patients are pretty steep. They have also expressed their helplessness in containing this, as the fixed costs of maintaining a medical flight is very high. However, what goes against the favor of some air ambulance companies is the fact that they are unwilling to come in the network of insurance providers.
As we have always stated, the air ambulance industry and the insurance industry need to come together to find a middle path, so that the common person does not have to bear the burden of huge bills.
It has almost become a norm to blame organizations that offer medical flight services but not many people take the time or the effort to understand why they charge so steeply. While it cannot be denied that there is a definite profit motive as these are commercially operated organizations, there is more to their expenses than what meets the eye. The costs are not simply limited to the fuel that is utilized, there are far wider factors in play that push the costs up and we explore some of these.
The Major Expenses that All Medical Flight Services Must Meet
Typically, an air ambulance does not undertake more than three missions in a day. For the rest of the time, this highly expensive machine is simply forced to sit idle. Moreover, it does not fly a single mission several days in a year. While this is a fact, the cost of the funds raised to acquire it continues to compound. Same is the case with the base; medical flight services need a place to park the choppers and fixed-wing aircrafts throughout the year and the rent is, obviously, an added cost that needs to be borne.
The Expenses of Maintaining a Highly Qualified Team
Highly experienced pilots, paramedics, nurses and the technicians are just some of the staff members that medical flight services need to hire. Then, there are support staff, operational staff and the management staff too.
Utmost care is taken to ensure that the crew is properly rested. This translates into stipulated work hours regardless of there being a call for medical flight services or not. Of course, many of the crew members also take care of other duties while the air ambulance is docked; nevertheless, it is an expensive affair. Constant upgrades and training are other sources of expense, not to forget the expenses of remaining compliant with ever-changing regulations.
Psychosis can be a real problem for air ambulance professionals as they try to offer the best possible care during transport. Most often, specialists are relied upon to care for such patients during air ambulance travel. However, there are often cases where psychosis is simply a result of the situation that the patient is in and not necessarily a pre-existing condition. Therefore, the air ambulance professionals do not necessarily have any means to expect a situation like this. The reasons for the condition may be several and the response can vary from case to case. We look at some of such scenarios and discuss the best way to handle them.
Drug-Induced Psychosis on Air Ambulance
Crystal meth, cocaine, and a few designer drugs can induce severe psychosis in patients where they exhibit paranoid and panicky behaviour. The first course of action in such cases is administration of an antipsychotic drug. Restraints are not usually necessary unless the patient needs immediate IV medication. In such cases, a mild manual restraint is, most often, enough. However, unexpected display of physical strength during psychosis can warrant more effective and long- lasting restraints until hospital care is made available. The air ambulance professionals, in such instances, must ensure that the pulmonary function of the patient is not compromised in any way owing to the restraints.
Handing Patients with Pre-existing Mental Ailments
An example would be a schizophrenic who might need both medications and restraints to ensure smooth air ambulance travel. Usually, a qualified medical professional accompanies the patient in such situations. Then, there are also those patients who suffer from mild psychosis. The first approach to handle them is simply soothing words. Keeping such patients calm is often a matter of saying the right thing. Accompanying family members who know how to handle the patient are a huge help in cases like these.
The life of medical flight professionals can be quite adrenaline pumped most of the time but that does not preclude them from the responsibilities that come with being a part of the air ambulance industry. The training, the safety measures and the need to be on the call all the time are just some of the tasks that they are expected to undertake. Of course, the gratitude that they receive for saving lives is an additional bonus that perhaps every medical flight professional enjoys. Most people who become a part of the air ambulance industry very well know that they are stepping into a high stress job.
The Routine Tasks of Medical Flight Professionals
While the pilot is expected to run routine checks to keep the chopper health up, the medical flight crew members are required to ensure that all inventory and medical equipment are in place, the batteries are all charged up and basically ensure that all equipments are working fine so that they can effectively respond to emergencies. The station duties can range from keeping a tab on the blood fridge and logging fridge values to cleaning and taking out the trash. Each member assumes a responsibility when they are docked in the hangar.
Responding to Emergencies
While the medical flight professionals usually conduct several station duties, they subconsciously are always anticipating an emergency call. The moment it comes in, they are expected to leave everything and take up the duties that enable them to face the emergency effectively. They immediately do all that is needed to know about the patient health condition and equip the medical flight with all the necessities. The medical staff are alerted in the nearest appropriate hospital and logistics are quickly and efficiently taken care of. It should be noted that, in view of the fact that the entire routine is quite stressful, the crew is always allowed enough rest hours every day and are encouraged to get enough relaxation between shifts.