An insurer has gone to the Kansas Supreme Court dragging a medical flight company. The contention has been that the company has been charging unreasonably high prices for its services. Terming the practice of billing ‘predatory’, the petitioner has asked the court to intervene, although the medical flight industry has been insulated by a federal law that bars states from interfering in the matters of billing. The court is yet to pass a ruling, and the service provider in question is EagleMed. The air ambulance industry argues that high charges towards privately insured people are a way to offset the losses resulting from uninsured people or those with Medicaid and Medicare.
The Tough Competition in the Medical Flight Industry
There are several players in the medical flight industry today. This means more service providers for a limited number of service seekers. This makes it incredibly hard for most companies to stay afloat because they fail to get enough customers to balance the costs. As a result, the cost of maintenance is distributed among those who avail of their services. The federal law acts as a shield allowing these companies to employ this practice.
The Federal Law is Aimed at Staying Competitive
The Airline Deregulation Act of 1978 is a federal law. It is aimed at airlines, and since the medical flight industry is considered a part of aviation and not the healthcare industry, the Act holds good for it too. However, the main purpose of this act is to encourage competition to lower prices. This is not the case with air ambulances. Since the patients have little say in the service providers that they choose during emergencies, the medical flight companies get a free hand to charge as they please. The insurance companies, on the other hand, have not changed their coverage for years together. This translates into lower coverage, and the ultimate burden of clearing the bills falls on the customers.
In January 2019, a deadly air ambulance crash had killed the entire crew. The cause of the crash was harsh weather conditions. It has now been reported that the crash was due to lax safety procedures in place. The service provider in question is Survival Flight. The report comes from the federal investigators who have been looking into the cause of the air ambulance crash. The National Transportation Safety Board has alleged that the company had inadequately managed safety. Moreover, the service provider had not conducted adequate risk analysis before taking up the flight.
The Air Ambulance had Crashed in South Eastern Ohio
It is believed that, at least, two air ambulance service providers had refused to carry the patient who was in an emergency health condition. The cause was poor weather conditions marked by heavy snowing and consequent poor visibility. It is believed that the inclement weather condition was the primary reason for the crash. The medical flight had crashed into the heavily wooded hillside and had broken into several pieces. The pilot Jennifer Topper and crew members Rachel Cunningham and Bradley Haynes were instantly killed. They were 34, 33, and 48 years old respectively.
Was the Flight Undertaken by Flouting Rules?
It must be understood that it is not illegal to fly an air ambulance when it is snowing lightly; however, it is not authorized to fly when the visibility is poor due to heavy snowing, which inhibits the pilot from having a clear view of the ground. Besides, there is a risk of air ambulance freezing. It is believed that, in this case, the poor visibility had led the pilot to undertake some abrupt maneuvers and had resulted in the crash. The incident stands evidence to the fact that some service providers flout the rules in the interest of either helping the patients or making the ends meet.
The adoption of private equity is not just a predicament for the air ambulance industry but the entire healthcare system in the United States. Several financial institutions in the country have shown a keen interest in healthcare in recent times. There is no doubt that it makes the whole sector highly competitive with ready access to funds. However, what bothers most people is the profit motive of private equities. The healthcare and air ambulance industries being more human-centric, it does not seem right to most people that they are viewed as a source of profit. They opine that healthcare must be a pure welfare activity.
What’s the Air Ambulance Industry Got to Lose?
Many people believe that the high prices charged by air ambulance companies are directly a result of heavy private equity investment in them. Investors simply do not want to make any losses, even though the United States is flooded with several air medical transport companies, so much so that the consumer base is starting to look too small. This is causing more idle time for many companies. As a result, their costs are piling up and are being ultimately transferred to the customer.
Will the COVID-19 Pandemic Transform the Industry?
The COVID-19 pandemic has drastically cut down the demand for air ambulance services. The reason behind this is simple. The industry relies heavily on helicopters, which are not built to handle highly infectious diseases like COVID-19. The pandemic has given no adaption time to the air ambulance service providers. The lack of isolation between the crew and the infected patients, in addition to the sanitization needs, has made air medical transport not the best option, at least locally. However, they are still being utilized for international evacuations, although not large in numbers.
Experts opine that, if the prevailing low-demand situation persists, there are going to be several service providers who will be forced to shut down, creating a balance between the number of players in the market and the size of the market.
In the past, the air ambulance industry has proved that it is an indispensable part of the health emergency services in the United States and beyond. The cost of availing the services has been a concern, but that apart, the utility of the air ambulance industry has never been questioned. Today, it plays an important role in repatriating COVID-19 patients from beyond the borders. It is also continuing to play a huge role in offering quality care to people in the rural parts of the United States. However, because of the COVID-19 situation, there needs to be a change in the way this industry functions.
Definition of Medical Necessity has Changed in the Air Ambulance Industry
Of course, we are not referring to medical necessity in the context of insurance coverage, approvals, etc. That remains the same. However, today, hospitals are encouraging people not to visit them unless it is important. The reason behind this is simple; people who already have a serious health condition must refrain from visiting spots that are hotbeds of COVID-19 infections, hospitals being one among these. The air ambulance industry is not completely prepared to handle this pandemic that is of epic proportions.
Recommending Air Ambulance Services Demands Careful Deliberation Today
Most of the helicopters in the air ambulance industry are not isolated enough to separate the patient from the rest of the crew. This poses a threat both to the healthcare workers and the patients. The problem of isolation does not exist in ground ambulances.
Besides, reaching the hospital early does not translate into immediate admissions today. Depending on the symptoms of the patient, he or she might need to be tested and isolated before being treated. The treatment protocols are still evolving. In essence, the physicians recommending air ambulance services should do so only after careful deliberation.
The COVID-19 pandemic is slowly making inroads into rural America. The higher number of elderly people living in rural communities is especially vulnerable now. Moreover, the infection is known to be fatal to people with diabetes, heart disease, and other ailments that impact natural immunity in human beings. All things considered, people living in rural parts of the country must have access to medical flights. However, this is turning out to be a huge problem for organizations that offer air ambulance services. It has again boiled down to balance billing, insurance denials, and financial burden to patients.
Medical Flights Being Denied Coverage is a Concern
Medical flights are a part of an industry that is highly competitive and which is already struggling to stay afloat. The COVID-19 situation has created an emergency of sorts throughout the nation and medical flights need to play a huge role in offering adequate coverage to rural communities. However, the threat of inadequate coverage is limiting its services. In this context, it must be noted that when coverage is denied by insurance companies, the burden is shifted to the patients. This presents a significant financial burden to the patients that can run into several tens of thousands.
The Percentage of Balance Billing is Small but Significant
About 300,000 air ambulance evacuations are carried out every year; of this, 3% end up in balance bills. This is primarily due to insurance denials. Most of these denials are due to the service provider being out-of-network.
The providers of medical flights too have not been keen on going in-network with insurance companies. The reason for this is the fact that reimbursements rates have remained unchanged. However, there is hope. With states like Florida looking to revise insurance reimbursement rates, the scenario could change soon.
Previously, the only use that was being seen for medical flight services amidst the COVID-19 pandemic was the transportation of infected patients from rural America. The reasoning behind this was that the urban part of the nation is better equipped to provide healthcare. However, it was later seen that the rural spread was quite limited. Unfortunately, recent trends have been quite different. While global cities such as New York continue to grapple with the disease, the infection is now seen making way towards inner parts of the nation, especially the rural regions. The reason for this could be several, including people from cities finding save havens in isolated rural regions.
Chronically Ill will Need Medical Flight Services
The Novel Coronavirus is known to increase the risk of people with co-morbidities, especially if they are over 60 years of age. It must be noted in this context that most of the rural population in the United States is old and is at high risk of losing lives if faced by a COVID-19 attack. Imagine someone suffering from cancer and also contracting the disease. The only recourse would be to take the patient to the nearest appropriate treating facility in the shortest possible time. That would, undoubtedly, necessitate medical flight services.
An Industry Struggling to Stay Afloat
The medical flight industry has been at the forefront of evacuating American citizens who are stuck in countries hit by COVID-19. However, it is worth noting here that the industry, which was already struggling to survive due to high costs, has had it even worse amid the pandemic. The demand for services has fallen drastically. Moreover, personal protective equipment has been hard to procure. The biggest hurdle has been the lack of frontline workers as most of them are now fighting the virus on the ground.
We have been quite vocal about the fact that air ambulance services will have a crucial role to play in the fight against COVID-19 as the battle hardens. It seems that the industry is now an integral part of the fight. Amid challenges that are being faced by medical flight crews and companies, they have displayed exemplary grit to keep the services afloat.
Air Ambulance Services are Brining Back Americans
Most internal national borders today stand sealed down. Only those flights that have special permission are allowed to fly between countries. Commercial flights are increasingly being used to fly patients who are not infected. However, there are a lot of Americans out there who are battling COVID-19 infections in foreign lands. Air ambulance companies are now helping evacuate them. The effort is ongoing at a war footing in the Caribbean and Latin American regions. A Florida-based air ambulance company is leading it currently. The medical flight crew consists of two medical professionals and two pilots enveloped in biohazard suits.
Phoenix Air is Leading the Fight in the Air
Phoenix Air, at the current time, is the only air ambulance company that is equipped to tackle highly contagious diseases. It has two Gulfstream G-III aircraft that feature Aeromedical Biological Containment Systems or ABCS. They are capable of carrying 4 infected patients each. The system was put in place during the Ebola crisis and had proved highly successful. The model is now being used to fight the COVID-19 crisis. The medical flight company plans to add two more specialized aircraft to its fleet.
Support for Air Ambulance Operations in the UK
The UK is again leading the way when it comes to offering support for the medical flight industry. It is believed that the Great North Air Ambulance service will now be offered free fuel during the crisis. Fund-raising is a big concern for the industry in the country due to the current COVID-19 situation.
Keeping medical flights afloat during the ongoing COVID-19 spread is turning out to be an uphill task for most air ambulance companies. Several issues that were never thought of before are surfacing now. Shortage is a word that is widespread in the industry today. We take a look at some of the issues that are hindering the functioning of the industry.
Professionals Being Moved Away from Medical Flights
The shortage of frontline, qualified medical staff is a well-known problem in the current scenario. No amount of frontline medical workers is proving enough to tackle the growing COVID-19 pandemic. Obviously, staff serving medical flights is being called to fill this deficit. The development is quite understandable, but it is certainly hindering the air ambulance services.
Lack of Adequate Medical Flights
COVID-19 has given too little time for medical flights to adapt. Isolation facilities are not good enough to carry infected patients in most medical flights. Employing these can, no doubt, put the frontline workers at risk of contracting the highly contagious infection.
Lack of Personal Protective Equipment
Personal protective equipment is essential if emergency workers are to function seamlessly. However, every country around the world is currently facing a shortage of these. This is a huge roadblock.
Fall in Emergency Cases
The lockdown that is being followed in almost all countries around the world has translated into less road traffic, and as a consequence, MVAs have gone down. Also, it is not easy for people to procure illicit substances, so related cases have also gone down. There is, therefore, a slight slump in demand, which is quite welcome.
Once the world goes back to normal, it is expected that the medical flights too will be able to function normally. Until then, the industry will function as efficiently as possible given the constraints.
The job of the air ambulance professionals is tough no doubt but it has gotten tougher owing to the ongoing COVID-19 pandemic. Today, the healthcare workers are exposed to the risk of contracting the Coronavirus infection which has enveloped the world in a dreadful storm. While the usual precautions that are taken by the general public apply to the air ambulance professionals too, there are additional precautions that are expected to be taken by these frontline workers. Washing hands, keeping alcohol-based sanitizers, and face masks apart from protective bodysuits are just a few of the obvious ones. We take a look at other precautions that must be taken by the medical flight workers.
CPR is a Risk for Air Ambulance Professionals
A lot of the emergency calls that air ambulance professionals receive are related to drug overdoses and cardiovascular problems. Both of these conditions can necessitate cardiopulmonary resuscitation or CPR. However, in the face of the Coronavirus infection, this can pose a real, life-threatening problem to the healthcare workers. The constant compression of the chest can release salivary particles that can enter the system of a healthy individual through the air or simply settle down on the clothing. If the CPR is being conducted in a closed environment, the risk can compound itself greatly.
Only the Very Serious Emergencies Must be Attended
Even hospitals today are considering only tending to the very serious cases that need hospital attention. The emergency department professionals are donning full protective gear when taking a look at emergency cases. The reason for this is obvious: they have no idea whether the symptoms are because of COVID-19.
Hospital emergency departments are asking the frontline on-the-field healthcare workers to wait for a while and try to revive them before even considering bringing them to the hospital for further care.
Frequent travelers – especially those who go to various countries for business – usually make sure that they have an emergency air ambulance evacuation membership. These memberships are in addition to the travel insurance coverage that is usually bought.
Today, COVID-19 has thrown up new problems when it comes to evacuation utilizing air ambulance services across borders. The million-dollar question, therefore, is this – “are air ambulance evacuation memberships useless in the current scenario?”
International Air Ambulance Evacuation Memberships are Currently of No Use
One thing that most countries have in common during this COVID-19 pandemic is the lockdown. Almost all countries have locked their borders to international flights. No one can get in or out of a country any longer unless it is a rescue mission that is conducted by the governments at the highest diplomatic levels. What use is an air ambulance evacuation membership in this scenario? The answer to this question is obvious. There is no much that a medical flight company can do in a situation like this. However, the efficacy of this emergency transport remains for domestic transfers. They are all the more important in the face of the Coronavirus epidemic that has gripped the United States today.
Air Ambulance Membership and Domestic Emergency Evacuation
The United States is preparing to face the pandemic on a war footing. However, the risk of spread to the rural areas still looms large. If there is an outbreak in the rural areas, air ambulance memberships are going to come quite handy. Reaching the urban medical facilities on time will be crucial for those who are severely infected by Coronavirus.
In this context, people must note that it is only the most severe of the cases that are admitted to hospitals for critical care and ventilator support. However, most of the infections are mild, and experts say that some are even asymptomatic.