The already-delicate rural healthcare system is severely off-kilter with no indication of returning to pre-COVID normalcy. For rural hospitals, which generally exist on thin margins even in the best of times, the situation has only grown more dire.

Just this year, at least 14 rural hospitals have closed in the U.S. This has incredibly adverse effects on population health and patient outcomes, as a 2019 study found that “death rates in the communities increase by nearly 6% after a rural hospital closes.” As we move towards recovery, it’s imperative that the 60 million people living in rural areas of the U.S. have timely access to care and that this care is adequately covered by payers.

Looking at ways we can restructure the healthcare landscape to be prepared for the next pandemic, air medical services have continued to make a difference for rural populations in several ways, including shortening time and distance to care, enabling safer transfers between trauma and specialty centers, and extending the capabilities of rural hospitals.

Shortening time and distance to care: Not only are rural hospitals disappearing, those that remain are often underfunded and understaffed, leaving them poorly equipped to treat certain patients. The lack of healthcare access due to geographic location is only exacerbated by this lack of capacity and resources.

In these scenarios, which are becoming more and more common, patients must be transported to more advanced facilities, such as trauma centers that are better equipped to treat their conditions. A major barrier to those facilities is distance: a ground ambulance may require hours of driving to reach the rural hospital, while an air ambulance may cover the same distance in under an hour.

Enabling safer transfer between trauma and specialty centers: Approximately 85 million Americans live more than an hour from a Level I or Level II trauma center if driven by a conventional ground ambulance. Without air medical transport service, these people, who represent 25% of the U.S. population, cannot access lifesaving trauma services in a timely manner.

Air ambulances are staffed with paramedics and nurses who can perform important care for trauma patients, which a rural hospital staff may not be familiar with delivering. Air medical service extends the reach of hospitals and specialty centers, preserving access to these lifesaving facilities for millions of Americans in rural areas.

Extending the capabilities of rural hospitals: Given the rapid closures and widespread vulnerabilities experienced by rural hospitals, air ambulances effectively serve as flying emergency rooms with lifesaving equipment and highly trained staff who treat patients in the air during critical moments helping rural hospitals improve outcomes.

Ensuring Adequate Coverage: Emergency air medical services are a low-volume yet integral component of the healthcare system, serving approximately one out of every 1,000 Americans annually. It is crucial that the healthcare industry remains focused on delivering access to care for the 60 million rural Americans. Rest assured that air medical services will continue to represent an essential lifeline for rural communities.

The COVID-19 pandemic disrupted everyday life in the U.S., and it wreaked havoc on our healthcare system. Hospitals lost revenue and were forced to lay off workers, a consequence of fewer visits to the emergency department and the postponement of non-urgent procedures.

The American Hospital Association has estimated that U.S. hospitals are seeing a $50 billion-per-month negative impact from COVID-19 as costs rise and revenues plummet. Hospital operating margins, already ultra-thin at an average of 2% prior to the pandemic, have also taken a hit. According to a report from Kaufman Hall, hospital operating margins fell 96% in the first seven months of 2020 compared to the same period in 2019.

For rural hospitals, which generally exist on thin margins even in the best of times, the situation has only grown more dire. Just last year, at least 14 rural hospitals have closed in the U.S. This has incredibly adverse effects on population health and patient outcomes, as a 2019 study found that “death rates in the communities increase by nearly 6% after a rural hospital closes.”

Since 2010, 133 rural hospitals across 34 states have closed, and 21% of the nation’s 430 rural hospitals were already at high-risk of closure prior to the pandemic without improvements to their financial situations, according to Navigant Health. And just since the start of the pandemic, these safety net hospitals have reported a 20-30% loss in revenue, according to America’s Essential Hospitals.

Often the first point of contact in the health care system for Americans, many rural hospitals provided the necessary critical care close to home, even as their limited resources were taxed further as some urban hospitals sought help to transfer COVID-19 patients to rural facilities where beds were available. While providing quality healthcare to rural areas has never been easy, the challenges have increased over the last few years and the pandemic only exacerbated these problems.

Approximately 60 million people – about one in five Americans – rely on rural healthcare, and the challenges for these hospitals have intensified to the point that it must be addressed. So, in 2019, the American Hospital Association (AHA) gathered rural hospital and healthcare leaders to create the Future of Rural Health Care Task Force, which released its recommendations last month for addressing this crisis.

One of the Task Force’s recommendations is for rural hospitals to form strategic partnerships and affiliations. Several members of the Task Force noted that forming strategic alliances, “helped their organizations respond more effectively and efficiently to the pandemic.”

For example, many rural hospitals remain unequipped to treat certain patients. A partnership with an urban facility could provide access to technology and expanded services. However, in these scenarios, which are becoming more and more common, patients generally must be transported to more advanced facilities, such as trauma centers, that are better equipped to treat their conditions.

In that case, rural hospitals can serve as an entry point for larger hospital systems, which the Task Force suggests can result in “synergies that benefit both entities and the populations they serve.”

To make these synergies possible air ambulances often serve as flying emergency rooms with lifesaving equipment and highly trained staff treating critical patients in the air while transporting them to facilities offering more advanced care. Air Methods is proud to be part of rural communities throughout the U.S. and partner with both rural and urban hospitals to provide that connection point and extend access to more advanced healthcare in rural America.

The State of Rural Healthcare in the U.S.

In rural America, small medical centers are seeing an influx of patients due to the COVID-19 pandemic, and many patients are being turned away because there is simply not enough room. In New Mexico, Air Methods air medical crews are answering the call to ensure patients can receive proper care.

Crews at Air Methods’ Native Air bases in New Mexico have been spreading the word about what it’s like transporting patients from rural areas to larger hospitals in major cities for treatment.

Members of the crew at Native Air’s Las Cruces base were recently featured in the Las Cruces Sun-News’ Healers and Builders series that recognizes citizens who heal, safeguard, and improve the greater Las Cruces area. The crew gave reporters a look at how they are tackling their new reality transporting COVID patients throughout the region.

In Carlsbad, Air Methods crews are transporting patients across state-lines to receive care due to staffing shortages. Since the pandemic, these crews are transporting more than 60 patients per month, which grew from 40 per month pre-pandemic.

Marnie Hill, an air ambulance pilot for Native Air’s Carlsbad base, said it best: “People are suffering. It’s our job to get them the best care possible. Sometimes the weather gets in the way, but we do the best we can for them. It’s our job. We put ourselves at risk. It’s as controlled a risk as we can make it.”

Check out recent coverage of the selfless work Air Methods’ Native Air crews are doing in Las Cruces and Carlsbad.

We’re happy to announce that we have entered an in-network agreement with HealthPartners, a consumer-governed, nonprofit healthcare organization based in Bloomington, Minnesota. The agreement enables Air Methods to provide HealthPartners plan members – totaling 1.8 million people across Minnesota, Wisconsin, Iowa, Illinois, North Dakota, and South Dakota – with critical air medical services at discounted in-network rates. The agreement includes commercial insurance, state public programs (SPP) and Medicare Cost.

“As many states in the Midwest see spikes in COVID-19 cases, air medical services are more important than ever,” according to Chris Myers, our executive vice president of reimbursement. “Air ambulances are crucial for interfacility transports during hospital surges and are also key in quickly reaching patients in rural areas. We are proud to enter this agreement with HealthPartners, which will ensure those who need air medical transport will receive it at affordable rates. We encourage all health insurance companies to negotiate similar agreements with Air Methods.”

Air Methods is now in-network with more than 100 health plans in more than 40 states. The latest agreement with HealthPartners continues Air Methods’ focus on expanding its in-network partnerships to 100 percent of plans in the country.

Expanding high-quality care access to rural regions

As hospitals across the country continue to be shuttered, access to care is a growing necessity for many, especially those in rural areas. However, even in highly populated states, nearby emergency and specialty care are not always available.

Today, more than one-quarter of the American population, 85 million residents, can only access a Level I or II trauma center within an hour if they are flown by air medical transportation. Nationally, 15 rural hospitals have closed in the U.S. this year. According to the National Rural Health Association, rural residents have greater transportation difficulties reaching health care providers, often traveling great distances to reach a doctor or hospital.

Air Methods eliminates those geographic obstacles while providing life-saving interventions during missions, such as clot-busting medications that must be given shortly after a major stroke to significantly improve outcomes and trauma care after an accident. Air ambulances are considered “flying ICUs” and the clinical teams flying on these missions have the highest first-attempt success rates in the nation among their peers at performing prehospital intubations, which is an emergency medical procedure to open a patient’s airway when breathing is obstructed. Developed exclusively by Air Methods’ clinicians, this emergency process was recently published in the leading textbook for emergency medicine continuing education, Prehospital Trauma Life Support (PHTLS) (9th Edition).

During this national healthcare crisis, Air Methods continues to provide lifesaving emergency air medical services for patients. The safety of our teammates, partners, and patients, remains our top priority and our vital services will continue, without disruption as long as we can do so in a safe manner, in accordance with proper medical protocol.

Emergency air medical providers are a critical link in ensuring rural medical access. As COVID-19 spreads from more urban areas to our rural communities, we stand ready to care for those critically ill patients who are facing respiratory failure, among other conditions. Strokes, heart attacks, and scene accidents don’t stop because of this pandemic, and if the outbreak worsens, we will see greater need for air medical services to transport patients to the appropriate care environment. Moreover, if the outbreak worsens, ICUs may become overwhelmed and patients will need to be transported to other hospitals.

To that end, Air Methods has formed a COVID-19 task force to evaluate all care challenges, recommend appropriate actions, and implement new protocols. We will continue to monitor and evaluate evolving national, state, and local guidance via the Centers for Disease Control (CDC), local health officials, and our teammates.

Air Methods has equipped our clinical and operations teams with procedures and safeguards for care of patients during the pandemic, including patients symptomatic for COVID-19. These include the use of personal protective equipment (PPE), which is critical for the health and safety of our teams, their loved ones, and the communities and patients we serve. We are following CDC recommendations regarding disinfection of the transport vehicle after transporting a patient with a potential or confirmed case of COVID-19. Office-based staff who can do their job remotely are working from home to reduce unnecessary risk.

It has been brought to our attention that some air medical companies have made the decision to stop transporting COVID-19 patients. The safety of our pilots and clinicians is our top priority. Air Methods is flying, and will continue to fly, positive/suspected COVID-19 patients only when the proper PPE is available for our crew. We are called to transport patients due to the critical nature of their condition – as long as we have the appropriate PPE for the safety of our crew, we will respond.

Air Methods is working closely with our local, state, and federal officials, as well as our local partners to ensure that the medical supplies and equipment supply chain is not disrupted. It is critical that air medical providers have access to additional supply chains for PPEs in the short term to ensure continued operations.

As our partners see their patient load increase, we are working with them to assist with surge capacity. We are identifying resources, collaborating with local EMS and fire, and assistance planning for EMS/HEMS vehicle control/staging. Additionally, we are coordinating communication through our AirCom office with national emergency communications center, fielding calls, providing flight coordination, logistical support, and use of our AirCom app to save time, improve accuracy, and simplifying the process resulting in better outcomes.

We are also taking every measure to protect the financial wellbeing of patients affected by COVID-19. We have implemented a patient advocacy process for these patients and are actively working with all payers in-network and out-of-network payers to form productive partnerships. We will work closely with our patients to ensure their emergency air medical service is covered.

During this challenging time, the safety of our employees and patients is our top priority. We recognize this is an ever-changing situation, and as new information arises, we will continue to update policies and procedures as needed. We are committed to continue providing the best care in the air to the communities that rely on us.