Air medical services: What is the cost of a life?
Regardless of its cost, helicopter transport is a treatment choice and should not be chosen out of convenience
The cost of being transported by a helicopter air ambulance has been in the news for the several years. For reasons that I don't fully understand, these costs have never been fully negotiated between the service providers and the insurance companies. The result is that patients are often stuck with an air transport bill ranging in the tens of thousands of dollars.
Given that it costs about $30,000 to be treated for a heart attack, I scratch my head at the $50,000 bill for a short helicopter transport. Sure, it's expensive to run an air ambulance. Providers shift costs to patients to cover the cost of operations and we forgive patients on paying parts of the bill. But that doesn't soften the blow of the overall cost, which can send many patients into bankruptcy.
The Montana legislature has been looking into the cost of providing air medical transport for a couple of years. A predominantly rural state, air transport of critically ill or injured patients is a real possibility for the citizens living there. It appears that insurance companies and provider agencies have been unable to negotiate fee rates that both sides can agree to. The age-old argument is there — the insurance companies say they can't pay what the transport agencies charge; the transport agencies say that they won't survive on what insurance is willing to pay.
And the patient is stuck with a truck payment that's due all at once.
Montana State Senator Gordon Vance and Representative Ryan Lynch have sponsored bills that would essentially stop balance-billing practices for air medical transport for out-of-network providers. It appears that it has had the desired effect of helping to bring concerned stakeholders to the negotiating table. It will be great if the two sides can come to some sort of compromise. But I'm not holding my breath.
Why this matters to ground-based EMS
Most of us are ground-based field providers. Why should we care about this situation? Because we have an obligation to provide our patients with care that is appropriate to their condition. Having a patient transported by helicopter is a treatment choice, not a convenience one.
It used to be that a response area was covered by one, maybe two air providers. That's no longer the case in an increasingly large area of the country. That lowers the number of transports per agency per day, which increases the per trip operating cost. Given that the cost is so high, a field provider has to make transport decisions that are ethical and arguably reduce the chance of morbidity. Simply using air transport to avoid an extended ground transport is potentially harmful to the patient.
It's also time to consider the idea of exclusive operating areas for air medical services. Ground agencies have been subject to EOAs for many years. Limiting the number of agencies in a response zone increases the number of runs per unit, which lowers the operating cost per call.
Government overreach? Only if you think it's OK to charge fifty large for a short distance transfer.
It will be interesting to see how the Montana legislative effort plays out. In the end, air transport is often a necessity in that large rural state. It just can't be so expensive that folks would be unwilling to use the service even when the justification is right. That would be a terrible situation to be in.