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Air medical transport has been facing challenges in recent years, with a few emerging trends currently at the forefront. We are seeing changes in the industry emerge, from staffing shortages and increased specialty transports, to feeling the effects of the No Surprises Act. As we approach the end of 2023, we want to share the top three trends that we have observed here at Air Methods.
The industry, including medical transportation and healthcare facilities, is being heavily impacted by staff shortages affecting roles such as pilots, healthcare workers, and maintenance technicians. The presence of skilled personnel is crucial for providing high-quality care. However, it’s not just the medical transportation industry that’s grappling with these challenges. Hospitals and health centers are also struggling to maintain adequate staffing levels. Many rural communities are facing the decision of closing beds or units due to insufficient staffing. In some cases, specialty services like Labor and Delivery are being cut back. These shortages are placing enormous pressure on local ground transport and air services to ensure patients receive the necessary level of care.
Key insights into the reasons behind staff shortages:
A critical factor behind the shortage of medical professionals in the air medical industry is the high demand for their services. As the population grows older and medical emergencies become more frequent, the need for skilled practitioners and pilots in air transportation is rising. Becoming a qualified medical professional in this field requires rigorous training and extensive financial investment, which can put off some individuals from pursuing careers in healthcare. Furthermore, the competitive job market for healthcare and aviation sectors makes it challenging for the air medical industry to attract and retain top talent. Meeting strict safety and regulatory requirements also presents challenges for professionals working in air medical transport. The aviation and healthcare industries are both highly regulated to ensure the safety of patients and crew. This demonstrates the need for constant training and certification in addition to experience, which adds even more pressure to an already high-stress environment. Workload and stress are other significant factors associated with the air medical shortage crisis. Air medical professionals frequently face demanding work schedules and high-stress situations, which can lead to burnout and affect employee retention rates. Overall, these challenges contribute to a shortage of medical professionals in the air medical industry, a crucial component in transporting critically ill or injured patients quickly and efficiently. Read more about pilot staffing shortages here. Read more about clinical staff shortages here. Read more about AMT staff shortages here.
Specialized transport is on the rise, particularly in the fields of pediatrics and cardiovascular care. This includes transporting pediatric patients and newborns in the neonatal intensive care unit (NICU). We have also seen an increase in cardiovascular assist device transports for patients that require specialized interventions like IABP (intra-aortic balloon pump), Impella and ECMO (extracorporeal membrane oxygenation).
Key insights into reasons for increase in specialty transport:
The number of patients being transported by air has grown in recent years due to several factors. One of them is the regionalization of care as healthcare systems concentrate specialized services in specific hospitals. This often means that patients need to be transported from one facility to another, and air transport is crucial for ensuring they have access to these specialized centers. In addition, advances in neonatal and pediatric care have expanded the range of conditions that can be successfully treated in pediatric patients, making air transport an even more viable option for critically ill children.
Another factor driving the increase in air medical transport for patients is the growing awareness and utilization of this service. Healthcare providers, emergency medical services, and the public are becoming more aware of the benefits of air medical transport. Increased awareness and utilization of air transport services can provide a critical link in the chain of care, helping ensure that patients receive the specialized care they need in a timely manner.
Population growth is also contributing to the rise in air transport. With more and more people living in urban areas, traffic congestion on the ground is often a factor that can hinder the safe transport of critically ill patients. This increases the need for air transport, which can bypass ground traffic and quickly bring patients to the medical facility they need.
Read more about the increase in pediatric specialty transport here. Read more about the increase in cardiovascular specialty transports here.
The No Surprises Act went into effect in 2022 for the air medical industry. This is a law that Air Methods strongly supports as it removes patients from the middle of any billing dispute between medical providers and insurers, thereby protecting patients from “balance bills.” Now, when an out-of-network insurance company refuses to cover or under-reimburses for an emergency air transport of one of its customers, the air medical provider and insurer can enter an independent dispute resolution (IDR) process to resolve the billing dispute. This new system eliminates the possibility that a patient could receive a bill for unpaid transport. Unfortunately, the IDR process has been structured to favor insurance companies rather than air providers, particularly those in rural areas, and these remaining out of network health plans have pursued tactics of delaying payment or underpaying for critical services. While Air Methods has been a leader in the industry going in network and today is 76% percent in network with health plans, we have had to pursue the IDR process for the remaining out-of-network transports. We win these cases 87% of the time but it has delayed payments by months. States are looking at similar NSA-style initiatives for ground transportation, which may result in similar cost pressures for ground transport. We will have to wait and see if these changes result in loss of access to ground transport for patients leading to further demand on the air transport industry to fill the gap left by ground transportation, especially in rural America.
Read more about the No Surprises Act and its impacts here.
On Monday, December 21, 2020, the U.S. Congress passed, with the President signing on Sunday, December 27, the Consolidated Appropriations Act (HR 133), which included the No Surprises Act. The No Surprises Act takes the patient out of the middle of the billing process between their health care provider and health insurance company – by prohibiting balance billing and establishing an independent arbitration process to resolve any billing disputes.
The following is a statement from Air Methods on the passage of the legislation:
Air Methods has long supported policies that take patients out of the middle of the emergency healthcare billing process, and we have worked to develop such solutions through innovations like our robust Patient Advocacy program and our efforts to go in-network with payers around the country. In addition, we have been active members of the congressionally created Department of Transportation Air Ambulance and Patient Billing (DOT AAPB) Advisory Committee to work toward fair and equitable solutions to surprise billing.
To that end, we appreciate and welcome efforts by Congress to address surprise billing by passing the No Surprises Act. Along with collaborating with stakeholders through the rulemaking process, we look forward to our continued work with the DOT AAPB Advisory Committee and hope the final recommendations from that group provide additional guidance for regulators in their decision-making process.
We are prepared to work with lawmakers on a variety of solutions addressing claims that are denied by insurers. One key concern for Air Methods is the possibility of tying reimbursements to a median in-network rate that uses inaccurate benchmarks and does not adequately compensate emergency air medical companies for their services. It is also important that this legislation does not nullify the great gains we have made in reaching in-network agreements with many payers around the country, which has made a huge impact on taking patients out of the middle of the billing process. We also strongly support policies that promote more robust data collection, which will allow for fair in-network reimbursement rates.
Air Methods still believes going in-network is the best solution to balance bills. As we have for the past 18 months, we will continue to partner with any insurance company willing to negotiate in good faith. We encourage the largest national insurance companies – UnitedHealthcare, Cigna, and Aetna – to come back to the table to resume negotiations with Air Methods to secure in-network partnerships. If they agree to fair reimbursement rates, then Air Methods will be nearly 100% in-network for all our commercially insured patients.
This legislation also eliminates once and for all the need for air medical memberships. In the past, air medical memberships were sold under the guise as a way to protect consumers from large air medical bills. However, this new legislation and continued progress reaching in-network agreements show there is no need for any consumer to buy – or for any provider to sell – memberships. We encourage all providers that have membership programs to end them and adopt more effective practices. The surprise billing legislation passed today illustrates the need for the air medical industry to evolve.
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What the Legislation Does:
• Prohibition on balance billing patients. • Open negotiation process between insurer and provider. • Independent Dispute Resolution (IDR) process – a “baseball-style” arbitration. Data collection on the costs of providing air ambulance services as well as on air ambulance quality and claims data submitted by insurers. • The establishment of an air ambulance advisory committee through the Department of Health and Human Services and the Department of Transportation to examine issues related to air ambulance clinical capabilities, vehicle types, and triage criteria
What IDR Arbiter “Shall Consider”:
• The qualifying payment amount defined as – the median of the contracted rates recognized by the plan…(determined with respect to all such plans of such sponsor or all such coverage offered by such issuer that are offered within the same insurance market) as the total maximum payment (including cost share amount) for the same or similar service that is provided by a provider in the same geographic region.• Quality & outcomes measurements of the provider• Acuity level of the patient• Training, experience, and quality of the medical personnel• Aircraft type, including the clinical capability level of the aircraft• Population density of the pick up location (urban, sub-urban, rural, or frontier)• Demonstrations of good faith or lack of good faith efforts to go in network by payer provider• If applicable, contracted rates between the provider and plan during the previous 4 years.