The following column is the opinion and analysis of the writer.
Access to health care in rural America is disappearing. One hundred and two rural hospitals closed across the country in the last nine years. Arizona was not spared, where three rural hospitals have closed in the last nine years. When access to emergency health care shrinks, air medical providers fill the gap by transporting thousands of patients to the closest, most appropriate health-care facility when time is critical for their treatment. But what happens if access to air medical transport also disappears? For people living in rural areas, it could mean the difference between life and death.
Unfortunately, according to the Association of Air Medical Services, 35 air medical bases have closed in America since the beginning of this year, including three in the Arizona communities of Springerville, Willcox and Globe.
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What is driving these closures is a combination of chronic under-reimbursement for the 70% of patients with Medicare, Medicaid or who have no insurance, and increasing denials by private insurers to cover these life-saving services. Government programs reimburse only a fraction of the cost of providing care. For patients with no insurance, providers typically must absorb those costs. For the other 30% of patients, private insurers are increasingly denying claims based on medical necessity or network status, despite the fact that 100% of all air medical transports are deployed by EMTs or doctors. Placed in a serious financial squeeze, providers simply cannot sustain bases where they must be ready to deploy 24/7/365. In fact, one large air medical provider, PHI Inc., filed for Chapter 11 bankruptcy protection to reorganize and solve its debts, in part due to a significant loss of revenue from air medical services.
To add to the list of threats facing air medical providers, language being considered in legislation before Congress would put insurance companies ahead of patients by letting insurers decide what they want to pay for this service, potentially decimating essential air medical services. Section 105 of the Lower Health Care Costs Act (S. 1895) would allow insurers to pay a median in-network rate. The problem is some insurers refuse to go in-network with any air medical provider while others have only one in-network provider. This makes it impossible to even determine a median rate.
Americans know this is bad for patients. A recent survey by the American College of Emergency Physicians found that 81% of Americans believe their insurance companies should pay for surprise medical bills and more than half — 54% — of survey respondents said they received a surprise bill because their insurance did not cover the medical treatment they received.
In order to preserve access to emergency air medical services for Arizonans and all Americans, and address the problem of surprise billing, there is a better way. Congress is also considering the No Surprises Act (HR 3630), out of the House Energy and Commerce Committee, which would require that data be collected to determine the actual cost of providing emergency air medical transports. An amendment offered by Congressman Ben Ray Luján (D-N.M.) would require that this data be collected from both providers and insurers to inform a workable solution to surprise medical bills.
Until we look at the data, update reimbursement rates accordingly, and require that private insurers cover the cost of transports, patients will continue to lose access to critical emergency care and receive surprise medical bills. We urge Sen. Martha McSally to support HR 3630 and protect Arizonans’ access to life-saving air medical services.
Dr. TK Kelly, M.D., FACEP, is an emergency medicine physician and associate clinical professor in Phoenix.
