{"id":30363,"date":"2018-06-28T16:48:30","date_gmt":"2018-06-28T21:48:30","guid":{"rendered":"http:\/\/stateimpact.npr.org\/oklahoma\/?p=30363"},"modified":"2018-06-28T18:14:02","modified_gmt":"2018-06-28T23:14:02","slug":"congress-considers-protections-from-sky-high-air-ambulance-bills-but-companies-say-regulations-could-limit-critical-care","status":"publish","type":"post","link":"https:\/\/stateimpact.npr.org\/oklahoma\/2018\/06\/28\/congress-considers-protections-from-sky-high-air-ambulance-bills-but-companies-say-regulations-could-limit-critical-care\/","title":{"rendered":"Regulations may cap sky-high air ambulance bills, but companies say they could limit critical care"},"content":{"rendered":"<div id=\"attachment_30365\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-30365\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-1920x1130.jpg\" alt=\"\" width=\"1920\" height=\"1130\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-1920x1130.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-500x294.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-768x452.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-150x88.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-300x177.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-620x365.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR-1835x1080.jpg 1835w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Chris-Glascow_HR.jpg 2000w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact<\/p>\n<p class=\"wp-caption-text\">Pilot Chris Glascow is a 20 year Army veteran. Most of Air Methods&#8217; pilots are ex-military.<\/p>\n<\/div><p>The air medical field has grown tremendously since the 1980s. Air ambulances take patients to the nearest hospital, which often means crossing state lines. But a legal quirk means paying for a life-saving flight can lead to financial ruin. Congress is mulling a fix, but some air ambulance companies say it could have unintended consequences.<br \/>\n<iframe loading=\"lazy\" src=\"https:\/\/w.soundcloud.com\/player\/?url=https%3A\/\/api.soundcloud.com\/tracks\/464814828&color=%23ff5500&auto_play=false&hide_related=true&show_comments=false&show_user=true&show_reposts=false&show_teaser=false&visual=false\" width=\"100%\" height=\"150\" frameborder=\"no\" scrolling=\"no\"><span data-mce-type=\"bookmark\" style=\"display: inline-block; width: 0px; overflow: hidden; line-height: 0;\" class=\"mce_SELRES_start\">\ufeff<\/span><\/iframe><!--more--><\/p><p>Pilot Chris Glascow flicks metal switches above his head and recites the wind direction and fuel-supply from the cockpit of an Air Methods helicopter on a pad near Pocola, Okla. The routine is a habit of a pre-flight rundown he picked up from 20 years flying Black Hawk helicopters in the Army.<\/p><p>He points to a small black screen that blinks on with what looks like green crosshairs in the middle.<\/p><p>\u201cProbably within a minute or so, we\u2019ll be in Arkansas,\u201d Glascow said. \u201cWe\u2019re right on the edge.\u201d<\/p>\n<h4>Crossing state lines<\/h4><p>It\u2019s a familiar flight path. Fifty-six percent of the flights from the Air Methods\u2019 Pocola base bring patients across state lines for treatment at the nearest hospitals in Arkansas, or Arkansas patients headed to hospitals in Tulsa or Oklahoma City. Hospitals specialize in certain fields, so the best care for a patient could be hours away.<\/p><p><a href=\"https:\/\/www.airmethods.com\/\">Air Methods<\/a> is the largest air ambulance company in the country. The outfit owns five other Oklahoma bases under Tulsa Life Flight brand it bought in 2009.<\/p><p>In under a minute, the Arkansas River slips underneath the shadow of the helicopter, and Mercy Hospital in Fort Smith comes into view. It\u2019s one of the hospitals Air Methods owners are afraid could be inaccessible, if <a href=\"https:\/\/shuster.house.gov\/press-releases\/shusters-faa-bill-overwhelmingly-passes-house\/\">proposed changes<\/a> in the latest Federal Aviation Administration Reauthorization Act are approved.<\/p>\n<div id=\"attachment_30368\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-30368\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR-1620x1080.jpg 1620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/GPS-closeup_HR.jpg 2000w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact<\/p>\n<p class=\"wp-caption-text\">The helicopter&#8217;s GPS shows the Arkansas River on the right.<\/p>\n<\/div><p>If I had been a patient, that minute-long flight could have cost thousands of dollars. That\u2019s because air ambulances are exempt from most health care billing regulations. Federal law prevents states from restricting prices because air ambulance companies are considered air carriers like Southwest or American Airlines.<\/p><p>If an air ambulance is out of a patient\u2019s insurance network, air ambulance companies are allowed to balance bill the remainder of the bill that the insurance company won\u2019t cover \u2014 meaning the patient is on the hook for the undiscounted rack rate that the air carrier decides to charge.<\/p><p>\u201cThere\u2019s nothing really they can turn to because of this regulatory blind spot essentially that air ambulances fall into,\u201d said Erin Fuse Brown, a <a href=\"http:\/\/law.gsu.edu\/profile\/erin-fuse-brown\/\">law professor at Georgia State University<\/a> and expert in health care billing. \u201cThere\u2019s nothing that would protect them, that would allow them to push back on the extraordinary charges that they are billed when they get home from the hospital.\u201d<\/p><p>Fuse Brown said many states have tried to regulate air ambulances, but they\u2019ve all lost in court.<\/p><p>\u201cThe federal Airline Deregulation Act broadly preempts any state effort to regulate the rates, or the prices or even the insurance requirements, and that makes air ambulances, sort of immune from a lot of these state attempts to get air ambulance coverage more broadly accessible to people,\u201d she said.<\/p>\n<h4>\u2018Borders in the sky\u2019<\/h4><p>Fuse Brown said the FAA reauthorization bill <a href=\"https:\/\/www.congress.gov\/bill\/115th-congress\/house-bill\/4\/cosponsors?q=%7B%22search%22%3A%5B%22hr+4%22%5D%7D&r=1\">recently passed<\/a> by the U.S. House of Representatives includes some important consumer protections. Right now, patients get one big bill for services. The legislation under consideration would require itemized bills that separate out transportation and medical charges. It would also allow states to regulate the medical side of air ambulance billing, which has people like Doug Flanders, director of government affairs for Air Methods, worried.<\/p><p>\u201cWhat some people are calling \u2018just a little provision\u2019 could have large impacts to patients, not just in Pocola, Oklahoma, but all over the country,\u201d he said.<\/p>\n<div id=\"attachment_30366\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-30366\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-1920x1692.jpg\" alt=\"\" width=\"1920\" height=\"1692\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-1920x1692.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-500x441.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-768x677.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-150x132.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-300x264.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-620x546.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR-1226x1080.jpg 1226w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Doug-Flanders_HR.jpg 2000w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact<\/p>\n<p class=\"wp-caption-text\">Doug Flanders, director of government affairs for Air Methods at their base in Pocola, Okla. explaining where the helicopters fly to.<\/p>\n<\/div><p>Breaking out aviation costs from medical costs for a bill is more complicated than people think, Flanders said.<\/p><p>\u201cAll of our helicopters are integrated. Our training for clinicians is integrated,\u201d he said. \u201c How is it, when you\u2019re flying from Pocola to Arkansas, will we know which one is aviation and which one is medical? \u00a0Because it\u2019s all integrated together, that\u2019s how the system is.\u201d<\/p><p>Flanders said giving states authority to regulate the medical side of air ambulance service could lead to an inconsistent patchwork of regulations.<\/p><p>\u201cWhat if the state of Arkansas decides that it will only accept Arkansas helicopters because now they have the authority to be able to regulate that medical cost? Those are life and death decisions that borders should not make a difference,\u201d he said. \u201chis kind of legislation that creates borders in the sky would do that.\u201d<\/p><p>Not everyone in the industry agrees, however.<\/p><p>\u201cI cannot imagine that a state would do anything to inhibit the ability of a physician to send a patient to the most appropriate medical facility,\u201d said Greg Hildenbrand, executive director of Life Star of Kansas, a non-profit air ambulance service and board member of the <a href=\"https:\/\/www.acctforpatients.org\/\">Association of Critical Care Transport<\/a>. With the Senate now considering its own version of the FAA Reauthorization Act, the organization is urging lawmakers to give states more oversight, and retain the <a href=\"https:\/\/transportation.house.gov\/faa\/\">House language<\/a>.<\/p><p>\u201cGround services do this every day,\u201d he said. \u201cI don\u2019t see that that\u2019s going to create a problem in our ability to care for patients appropriately or take them where they need to go.\u201d<\/p>\n<div id=\"attachment_30364\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-30364\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-1920x1280.jpg\" alt=\"\" width=\"1920\" height=\"1280\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-1920x1280.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-500x333.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-768x512.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-150x100.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-300x200.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-620x413.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR-1620x1080.jpg 1620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Blood_HR.jpg 2000w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact<\/p>\n<p class=\"wp-caption-text\">Blood and other emergency medications are kept in a refrigerator at the Pocola Okla. base in case a patient needs a transfusion.<\/p>\n<\/div>\n<h4>Deregulation game<\/h4><p>Air ambulances were in their infancy when air travel was <a href=\"https:\/\/www.gpo.gov\/fdsys\/pkg\/STATUTE-92\/pdf\/STATUTE-92-Pg1705.pdf\">deregulated<\/a> in the 1970s. Since then, the industry has had little oversight on where bases are located. That\u2019s lead to vast deserts of coverage and other areas, like on the Oklahoma border, with a saturated market that has multiple carriers.<\/p><p>With no cap on pricing and high fixed costs like helicopters and trained personnel ready to fly at a moments notice, Hildenbrand says increased competition has driven prices up, instead of down.<\/p><p>\u201cThe numbers of patients per helicopter has dropped significantly, but we still have to spread the same costs per base over fewer numbers of patients and so that has driven costs up considerably,\u201d he said.<\/p><p>The rise in price is dramatic. A <a href=\"https:\/\/www.gao.gov\/products\/GAO-17-637\">Government Accountability report<\/a> found that between 2007 and 2016, Air Methods\u2019 average helicopter transport costs increased from $13,000 to $49,800. Since it owns two-thirds of the air ambulances in the country, the company\u2019s pricing greatly influences the market.<\/p>\n<div id=\"attachment_30376\"  class=\"wp-caption module image aligncenter\" style=\"max-width: 1920px;\"><img decoding=\"async\" loading=\"lazy\" class=\"size-large wp-image-30376\" src=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed-1920x1019.jpg\" alt=\"\" width=\"1920\" height=\"1019\" srcset=\"https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed-1920x1019.jpg 1920w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed-500x265.jpg 500w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed-768x408.jpg 768w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed-150x80.jpg 150w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed-300x159.jpg 300w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed-620x329.jpg 620w, https:\/\/stateimpact.npr.org\/oklahoma\/files\/2018\/06\/Sparks-Hospital-Fixed.jpg 2035w\" sizes=\"(max-width: 1920px) 100vw, 1920px\" \/><\/p>\n<p class=\"wp-media-credit\">Jackie Fortier \/ StateImpact<\/p>\n<p class=\"wp-caption-text\">A view of Sparks Regional Medical Center in Fort Smith, Ark. from the helicopter. It&#8217;s one of the hospitals that Air Methods says they may not be able to fly to if states regulate air ambulances.<\/p>\n<\/div><p>Because air ambulance providers accept much lower reimbursement rates from Medicare and Medicaid patients \u2014 and may not receive any payment at all from uninsured patients \u2014 the impact of these rate hikes has fallen almost entirely on private healthcare insurers and their members.<\/p><p>Hildenbrand, a 20-twenty year veteran of the industry, said insurance companies are fed up.<\/p><p>\u201cI think we\u2019ve reached a tipping point in the industry where insurance companies are saying, \u2018No, we\u2019re not going to continue to pay these rates,\u2019 and so then patients get balance billed $40,000 or something after their insurance has paid. I don\u2019t think it\u2019s a sustainable system,\u201d he said.<\/p><p>As billed charges have soared, more insurers have started limiting their reimbursements to air medical providers. Air Methods has responded by hiring \u2018patient advocates\u2019 who go through the appeals process with the insurance company. Ultimately, if the insurance company won\u2019t pay, the patient is on the hook.<\/p><p>The House version of the FAA reauthorization bill would also set up a council of industry representatives, lead by the Department of Transportation, which oversees air ambulances. The group would include air ambulance providers and insurance company representatives, among others, and would write and reevaluate consumer protections. The legislation also establishes a complaint hotline for patients, similar to one available for commercial airline passengers.<\/p><p>Fuse Brown with Georgia State University thinks it\u2019s a step in the right direction, but said the regulatory council might not go far enough.<\/p><p>\u201cThe task of the committee would be to come up with additional consumer protections that haven\u2019t been specified in the bill,\u201d she said. \u201cIt\u2019s unclear at this point, whether the committee would come up with protections that would substantively provide consumer protections.\u201d<\/p><p>Congressional\u00a0<a href=\"https:\/\/www.heller.senate.gov\/public\/index.cfm\/2017\/11\/senators-introduce-bill-to-ensure-rural-communities-have-continued-access-to-emergency-air-medical-services\">Republicans<\/a> and <a href=\"https:\/\/www.mccaskill.senate.gov\/media-center\/news-releases\/aiming-to-crack-down-on-exorbitant-air-ambulance-costs-for-missourians-mccaskill-introduces-legislation\">Democrats<\/a> are backing other bills to give consumers more protections in the event air medical reforms are stripped from the FAA legislation. Whether these efforts lead to lower air ambulance costs for patients is up in the air.<\/p>\n","protected":false},"excerpt":{"rendered":"<p>The air medical field has grown tremendously since the 1980s. Air ambulances take patients to the nearest hospital, which often means crossing state lines. But a legal quirk means paying for a life-saving flight can lead to financial ruin. Congress is mulling a fix, but some air ambulance companies say it could have unintended consequences. [&hellip;]<\/p>\n","protected":false},"author":199,"featured_media":30367,"comment_status":"open","ping_status":"closed","sticky":false,"template":"","format":"standard","meta":[],"categories":[23],"tags":[897,35,898,443],"acf":[],"_links":{"self":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30363"}],"collection":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts"}],"about":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/types\/post"}],"author":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/users\/199"}],"replies":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/comments?post=30363"}],"version-history":[{"count":8,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30363\/revisions"}],"predecessor-version":[{"id":30381,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/posts\/30363\/revisions\/30381"}],"wp:featuredmedia":[{"embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media\/30367"}],"wp:attachment":[{"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/media?parent=30363"}],"wp:term":[{"taxonomy":"category","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/categories?post=30363"},{"taxonomy":"post_tag","embeddable":true,"href":"https:\/\/stateimpact.npr.org\/oklahoma\/wp-json\/wp\/v2\/tags?post=30363"}],"curies":[{"name":"wp","href":"https:\/\/api.w.org\/{rel}","templated":true}]}}