Rugged. Rural. Remote. The geographic characteristics that define our state and foster industries that generate billions of dollars in annual revenue are unfortunately the same characteristics that pose serious challenges when it comes to providing accessible health care to all our residents.
Since 2010, over 110 rural hospitals throughout the country have shuttered. It is expected that one hospital will close per month across the US. To date, these closures have resulted in approximately 85 million Americans who now live more than an hour drive from the nearest Level-1 or Level-2 trauma center. According to a report by the Robert Wood Johnson Foundation and the Harvard School of Public Health, 26% of rural Americans say there was a time in the past few years when they have not been able to receive health care when they needed it.
In medical emergencies when distance can be deadly, air ambulances fill the gap and provide the critical care and speedy transport patients need to survive.
A recent study conducted by Rush University Medical Center in Chicago found that stroke patients who were transported by air entered into surgery faster than those transported on the ground. In these cases, speedier access to medical care led directly to better patient outcomes.
Unfortunately, access to air ambulance services is at risk; 35 air medical bases across the country have already closed this year. Air ambulances can only be requested by the first responders on the scene — trained professionals who usually only have minutes to make the decision. Despite the clear benefits to patients, and the fact that air ambulances never self-deploy, insurance companies routinely deny coverage to patients by claiming a lack of medical necessity. On top of this, insurers continue dragging their feet to bring this life-saving service in network. Some insurance companies only bring one provider in network; others refuse to bring any.
This intentional denial of claims by insurance companies leads to surprise medical bills and puts patients in the middle. Legislation currently being discussed in the U.S. Senate, S. 1895 — Lower Health Care Costs Act, and specifically section 105, would inflict even more damages on providers and patients.
Section 105 would allow private insurance companies to pay air ambulances a “median network rate”, also known as a benchmark rate. But because insurance companies allow so few providers in network, sometimes refusing to include any air medical providers, no real benchmark rate exists. Section 105 will line the pockets of the insurance companies at the expense of rural residents and lead to even more closures of air medical bases.
The best way to address balance bills, while still protecting patient access to these life-saving services, is to take aim at the underlying cause — chronic under-reimbursement by government programs and increasing denials by private insurers. Seventy percent of air medical transports are for patients with Medicare, Medicaid or who have no insurance. These programs reimburse only a portion of the cost of transport.
Last year, Colorado’s Sen. Cory Gardner took meaningful action to ensure air medical services remain available to those living in the state’s most secluded regions when he co-sponsored legislation (S. 2121 — Ensuring Access to Air Ambulance Service Act of 2017) — along with Colorado’s senior Sen. Michael Bennet — that would have created a more accurate payment system by requiring all air medical providers to submit cost data to the Department of Health and Human Services (HSS). This year, the House is considering an amendment to the “No Surprises Act” proposed by Rep. Ben Ray Lujan (D-N.M.), which requires data collection from both air ambulance providers and insurers, a real step in the right direction.
I urge Sen. Gardner and his colleagues to continue to fight to preserve access to air ambulance services by opposing Section 105 of S. 1895 so that patients in rural communities can continue to rely on these life-saving services in an emergency.
Dr. Shay Krier is an emergency medicine physician in Pueblo, Colorado. He received his medical degree from the University of Colorado Denver School of Medicine.