Over the last several months, multiple media stories have noted the high costs and rapid increase in charges by for-profit emergency air ambulance helicopter services across the country. Most recently, the May issue of Consumer Reports highlighted the problems with for-profit air ambulance companies’ business practices in an article titled, Air Ambulances: Taking Patients for a Ride.
Luckily for the people and visitors to Maine, LifeFlight is very different from the national experience, with significantly lower charges and highly ethical business practices.
LifeFlight, the state’s emergency medical helicopter service, is truly of Maine. It is a private nonprofit established to serve the people of Maine, and is in turn supported by the charitable LifeFlight Foundation. In a geographically large but sparsely populated state like Maine, the most efficient way to deliver critical care across the entire landscape is by helicopter. LifeFlight’s three helicopters and airplane are not “air taxis” but rather flying critical care units which bring the resources of our state’s largest medical centers directly to the side of a patient.
Here’s a look at the major issues highlighted in the recent Consumer Reports article:
COST
“Consumers seem to have plenty to complain about. For one thing, the bills are expensive, averaging more than $30,000, research shows.”
Actually, while the average bill nationally is more than $30,000, the more typical bill from the for-profit air ambulance companies is between $50,000 and $75,000. LifeFlight works hard to maintain some of the lowest costs and charges in the country. A recent study found that LifeFlight’s average charge per transport was about $12,000, compared to the national average of nearly $33,000 which includes both for-profit and nonprofit organizations. Without question, the cost of maintaining 24/365 availability of an air medical system is substantial, with the costs spread across the number of patients served. LifeFlight is able to maintain its low costs and charges because the organization uses a shared staffing model, it has a lean administrative structure, and it’s a private nonprofit.
INSURANCE
“It turns out that medical-emergency helicopters are often “out of network” and not fully covered by insurance.”
LifeFlight cares for all patients, and provides services to all in need regardless of insurance status or the ability to cover the costs of care. LifeFlight works closely with all of the insurance companies that operate in Maine. The organization maintains contracts with the leading insurance carriers that have agreed rates and limited patient responsibilities for co-pays. Insurance companies support the important use of helicopters for critically ill and injured patients, but also work to make sure costs are reasonable.
While LifeFlight’s charges are among the lowest in the country, the organization is also recognized as one of the top programs in North America. We recognize the impact of sudden unplanned bills from a medical emergency, and work carefully and transparently with patients and their insurance providers. For those without insurance, LifeFlight works to help patients and their families through established and transparent charity care guidelines and ethical business practices.
DEREGULATION
“And consumers have little recourse. Deregulation of the airline industry in the late 1970s left states unable to regulate air-ambulance services or to protect consumers from predatory practices.”
From the very beginning of operations in 1998, LifeFlight has worked with state regulators to establish policies that put the patient first. States oversee healthcare providers. An anomaly in Federal law, the 1978 Airline Deregulation Act, prevents states from overseeing air ambulances in the same manner they oversee ground ambulances. This allows air ambulances to operate without regard to state insurance and health regulations. The Airline Deregulation Act never anticipated an “air ambulance” becoming conflated with an “air carrier.” LifeFlight of Maine has worked for many years to right this anomaly, testifying to Congress and working closely with our Washington delegation.
MEDICAL NECESSITY
“The most frustrating part, according to industry experts we spoke with, is that many people taken by air ambulance could have been safely transported by ground ambulance.”
Judging the seriousness of a person’s illness or injury by what can be seen with the naked eye is an easy trap for a non-clinical observer to fall into. More than 85% of LifeFlight of Maine transports are for critically ill or injured patients who are already in a hospital but need rapid ICU-level transport to a major medical center in Maine or beyond. All of these cases require a direct physician order for the LifeFlight critical care team and the mode of transport—ground or air. For calls directly to the scene of an accident, Maine’s Board of EMS recognizes the challenges in determining when it’s appropriate to call for LifeFlight, especially in a rural, sparsely populated state like ours. In order to ensure the majority of patients transported by LifeFlight really need that level of care, Maine EMS has developed protocols to guide scene responders in making those decisions, and Maine has some of the strictest medical necessity guidelines in the country.
OVERUSE
“Why the overuse? Many air transports occur when patients are transferred between hospitals, and some doctors, fearful of lawsuits due to a delay in care, resort to that option too often…. Physicians and first responders need clearer guidelines on when an air ambulance is warranted, he says.”
LifeFlight is fully integrated into Maine’s emergency care, EMS, and healthcare systems. LifeFlight works closely with physicians at Maine’s network of community hospitals and specialists at Maine’s major medical centers to assure propriety of use. A Clinical Practice Committee, comprised of 27 emergency and specialist physicians from across the state, oversees LifeFlight’s clinical and use protocols. As noted above, use of LifeFlight’s services is guided by physicians making sure the patients they care for are served by the best resource. In addition, LifeFlight continually monitors resource use for appropriateness and outcomes.
SAFETY
“Being taken by air ambulance may actually increase the risk of something else going wrong. They crash more often than other air taxis, research shows. That’s partly because of poor decisions pilots may sometimes make when they feel pressure to transport patients quickly…. But Consumer Reports’ analysis of data from the National Transportation Safety Board on air-ambulance accidents between 2010 and 2016 suggests another reason. We found safety differences between for-profit operators and nonprofits.”
LifeFlight was built on a culture of safety, committing from the beginning to create an organizational culture that put the safety of the crew above all else, which, in turn, creates the safest environment possible for the patient. LifeFlight has been recognized nationally and internationally for our safety practices and innovations. We are among the small group of medical programs in the country that operate twin engine, instrument flight aircraft, incorporating all of the recommendations of the National Transportation Safety Board. LifeFlight is in the process of building a complete “next gen” aviation system for safety and reliability.
As a nonprofit organization, the pilots and medical crew are not included in financial discussions and can therefore make decisions without feeling pressured by the bottom line. The nonprofit status also allows the organization to raise private funding to purchase the safest and most reliable aircraft and aviation equipment. LifeFlight isn’t trying to turn a profit; the organization exists to take care of Mainers. We’re a nonprofit organization dedicated to supporting a public good.
SOLUTIONS
There’s also bipartisan support in Congress to investigate the problem and to give states more power to regulate the industry.
LifeFlight’s Executive Director, Thomas Judge, has testified in Congress and is one of the leading experts in the country on air medical policy and the design of air medical systems. He has worked extensively on the interface of the Airline Deregulation Act and air medical systems, and the design of high quality and efficient air medical systems. He recently completed a fifth appointment to the National EMS Advisory Council which supports policy at the Department of Homeland Security, the Department of Health and Human Services, the Department of Transportation, and the National Highway Safety Traffic Administration. He has served as a subject matter expert for Congress and federal agencies such as the Government Accountability Office as well as state, regional, and professional medical organizations.
LifeFlight is committed to continue working closely with industry leaders and our congressional representatives to build better policy around air ambulance regulation to protect patients and their families.
LifeFlight of Maine is an independent 501(c)(3) non-profit air medical and critical care transport organization. LifeFlight brings lifesaving critical care staff and equipment directly to the patient by helicopter, airplane and ground ambulance. It also provides advanced emergency medical training to Maine’s hospitals, emergency medical services (EMS) and public safety agencies. LifeFlight cared for nearly 1,800 critically ill and injured patients last year. Since its inception in 1998, LifeFlight has transported more than 22,000 patients. To learn more, please visit www.lifeflightmaine.org or call 207-230-7092.