It’s hard to believe, but fall is now in full swing, and I’ll soon be seeing you in Fort Worth, Texas for the 2017 Air Medical Transport Conference. Thanks to your continued involvement and support, I’m pleased to provide you with an update on AAMS and MedEvac Foundation activities since our last membership meeting this past December in Charlotte.
With a new administration in the White House, AAMS’ Government Relations efforts have been very busy throughout 2017. AAMS worked hard to stay on top of the ever changing climate in Washington, while still working to advocate on behalf of the entire industry this past year:
Throughout the year, AAMS Govt. Relations efforts were focused on Republicans efforts to repeal and replace the Affordable Health Care Act. We covered several of these topics for our members including: Tax Credits and HSAs, and CMS Releases ACA Market Stabilization; the original House Bill and the final bill that was passed; U.S. Senate’s reveal of their “Better Care Reconciliation Act” (BCRA) and the drama as it played out on Capitol Hill throughout this past summer. While the Healthcare Repeal and Replace efforts stalled this summer on Capitol Hill, AAMS continued to keep an eye out for our members on this vital topic, and are staying on top of the new movement on Healthcare Reform front that has begun again on Capitol Hill. We will continue to keep you informed as those efforts continue.
Returning to AAMS this year is our brand new Vice President of Government Relations Christopher Eastlee (formerly the President of the Air Medical Operators Association). At AMOA Chris focused on issues of aviation safety in the air medical industry. As AAMS Vice President of Government Relations, Chris will focus on legislative affairs and regulatory issues related to healthcare, aviation, and other policy areas that affect the air medical and critical care ground medical transport industry and support AAMS’ mission to represent the entire industry and preserve access to safe, effective air medical and critical care ground transport throughout the United States.
Another topic that AAMS Government Relations efforts have had to stay on top of throughout the entire year is the “21st Century Aviation Innovation, Reform, and Reauthorization Act” (H.R. 2997). AAMS opposes two provisions of H.R. 2997:
- ATC Privatization: While there are numerous provisions in the House bill that AAMS supports, such as provisions to expedite the equipment installation and certification process, AAMS joins multiple general aviation organizations, including HAI, GAMA, NBAA, AOPA, and NATA in opposing the privatization of the ATC.
- Air Medical Billing Regulations: AAMS and HAI also oppose Section 512 of the bill, which would require the separation of air medical service billing into aviation and “non-aviation” related services. The Provision: (1) Mandates a far-reaching, open-ended, burdensome, and duplicative new regulatory regime; (2) Would pierce the Airline Deregulation Act’s (ADA) preemption provision, inhibiting the delivery of life saving emergency transportation services across state lines; (3) Did not have the benefit of the report and findings of the pending AAMS-supported Government Accountability Office (GAO) study on air medical cost, billing, and reimbursement issues when it was introduced; and (4) Introduces the concept of separating the charges of an air carrier into what could and could not be regulated by states.
On the Senate side the FAA Reauthorization bill became S. 1405. Since neither the House nor the Senate debated their respective committee-passed FAA bills (H.R. 2997 and S. 1405) during September, Congress needed to enact a short-term extension for the FAA and aviation programs before the expiration of their authorization on September 30th.
In April, AAMS was pleased to announce the publication of the Air Medical Services Cost Study Report, conducted by the independent research firm Xcenda LLC. AAMS commissioned the study in response to an evident need for reputable, independent research, specific to air medical transport, to quantify the costs associated with providing emergent air medical transports. Further, the study examined the appropriateness of the 2002 Medicare rate-setting methodology for air medical services and current payment adequacy. The resulting report provides independent substantiation of actual costs to the Centers for Medicare and Medicaid Services (CMS) and Members of Congress. Through various forms of communication (industry conferences, newsletters, and other means), Xcenda targeted recruitment from air medical providers billing Medicare in 2014, the most current billing information publicly available at the time of this study. A detailed cost data collection tool was distributed to providers who volunteered to participate. The study group included fixed-wing, rotor-wing, for-profit, non-profit, independent and hospital-based providers. Cost data were aggregated and analyzed at a per-transport and per-base level. Differences between program types, tax status, size, and geographic location were also examined. The study’s respondents represent 51% of all air medical bases nationwide and captured 46% of air medical services billed to Medicare.
Highlights of the findings include:
- The median reported cost of an emergent air medical transport is $10,199;
- Medicare payment rates cover only 59% of actual costs on average;
- Over 1/3 of respondents reported negative margins for emergent air medical services;
- The percentage of the U.S. population covered by air medical services, within a 15-to-20-minute response area, has grown from 71.2% in 2003 to 86.4% in 2016; and
- Air medical services improve access to level 1 trauma centers for 87 million Americans who would not be able to receive emergent care in a timely manner otherwise.
Also this past spring, while all of Washington was wrapped up in the Healthcare Debate, AAMS continued to keep an eye on important various healthcare issues, including important insurance programs for our Children’s Transport Teams such as the funding for The Medicare Access and CHIP Reauthorization Act (MACRA) reauthorized the Children’s Health Insurance Program (CHIP). Today, AAMS continues to watch Capitol Hill’s efforts on funding of insurance programs for CHIP and ACA.
During the month of January, AAMS’ Region VI Director Susan Smith and the AAMS Public Relations Team put together and released a video aimed at informing the public about the dangers posed to HEMS providers by UAVs/drones in low altitude airspace. The film, which was recorded in December, 2016 at AMTC v2.0, features safety advocates including Stacy Fiscus, Chair of Vision Zero. It encourages drone owners to visit ‘www.knowbeforeyoufly.org’ for more safety advice. Back on May 22 this year, the FAA Drone Rule was overturned by the courts. A federal appeals court threw out the FAA’s registration rule for drones flown recreationally; stating it directly contradicts current law forbidding such a requirement. The 2012 law reauthorizing the agency precluded it from putting forward “any rule or regulation regarding a model aircraft.” A three-judge panel of the U.S. Court of Appeals for the D.C. Circuit said the regulation couldn’t be clearer that it applies to hobby drones as defined by the law. AAMS continues to be an advocate for the air medical community and industry around Drone Safety, recently the AAMS Vision Zero Campaign published a letter by Erik Bratton, Hospital Wing’s Director of Safety, calling on Congress to enact legislation to promote drone education and to require registration.
Back in 2015, AAMS, and other air medical organizations, came out in support of Crash Resistant Fuel Systems (CRFS). In July this year, Rep. Perlmutter and Rep. Polis introduce the Helicopter Fuel System Safety Act. The act requires all newly manufactured helicopters be built with safer fuel systems and, within 18 months of enactment, all newly manufactured helicopters comply with the recommendations from the Rotorcraft Occupant Protection Working Group, which will significantly reduce the risk of post-crash fires.
At the end of July, the Government Accountability Office (GAO) released its report, titled “Air Ambulance: Data Collection and Transparency Needed to Enhance DOT Oversight,” which affirmed the Department of Transportation has the authority, under current law, to address industry data collection and consumer issues. AAMS Supports the GAO Report Recommendations:
- “Communicate a method to receive air ambulance-related complaints, including those regarding balance billing, such as through a dedicated web page that contains instructions on how to submit air ambulance complaints and includes information on how DOT uses the complaints.”
- “Take steps, once complaints are collected, to make pertinent aggregated complaint information publicly available for stakeholders, such as the number of complaints received by provider, on a monthly basis.”
- “Assess available federal and industry data and determine what further information could assist in the evaluation of future complaints or concerns regarding unfair or deceptive practices.”
- “Consider consumer disclosure requirements for air ambulance providers, which could include information such as established prices charged, business model and entity that establishes prices, and extent of contracting with insurance.”
AAMS fully supports additional transparency and consumer protection actions on the part of the DOT along the lines of the report’s recommendations and is working to improve the industry’s transparency with regard to both costs and quality-of-care. AAMS and its member companies were pleased to work with the GAO in developing this report and appreciate their efforts in reviewing these issues and providing specific recommendations for addressing them.
At the beginning of August this year, AAMS announced its support of the bi-partisan legislation, H.R. 3378: Ensuring Access to Air Ambulance Services Act, introduced by Rep. Jackie Walorski (R-IN), Rep. Suzan Delbene (D-WA), Rep. Bill Johnson (R-OH), and Rep. Raul Ruiz (D-CA). AAMS applauds Rep. Walorski, Rep. DelBene, Rep. Ruiz, and Rep. Johnson for their efforts to understand the significant challenges that face air medical providers across the country and actively work towards a solution. AAMS also praises the continued efforts of Chairman Pete Sessions (R-TX), a longtime champion of the need for Medicare payment reform in air medical transport. This legislation would establish cost and quality-of-care reporting requirements for the industry and implement a Value-Based Purchasing (VBP) Program beginning in 2024. It would also reform the Medicare fee schedule for air ambulance services, starting with temporary, noncumulative payment increases to providers followed by rebasing air medical reimbursements in 2021 based on the actual costs reported.
Member Reminder: AAMS fully supports this legislation, and encourages members to contact their Members of Congress to ask them to cosponsor H.R. 3378. The House of Representatives website provides a tool at the top of their homepage for identifying your Member of Congress by zip code. More Information on H.R. 3378: AAMS background on the legislation and the need to reform outdated Medicare rates and Cosponsors of H.R. 3378.
At the beginning of September this year, AAMS also signed on to a multi-association letter to the President’s Commission on Combating Drug Addiction and the Opioid Crisis to share our thoughts on how their report and recommendations could be improved. Our collective recommendations included addressing the stigma of opioid addiction, providing adequate funding, strengthening primary prevention efforts, expanding prescriber education efforts, and ensuring access to medication-assisted treatment for those suffering from addiction.
Other than our continuing focus on Capitol Hill, AAMS remains active in many other areas. Take a look at some notable accomplishments since our last membership meeting in Charlotte below.
- Airbus and the Ukrainian sign for 55 helicopters
- Sikorsky Delivers Black Hawk to San Diego Fire-Rescue Department
- Northrop Grumman Delivers Software for UH-60V
- LONGBOW Awarded $170 Million in Orders
- Sikorsky Honors UK Maritime & Coastguard Agency
- Netherlands signs combined Apache and Chinook sustainment contract with Boeing
- ASU Obtains EASA NVIS STC on AW139
- Indian state of Maharastra orders Sikorsky S76D
- First Helicopter Degree Graduates
- First ground test of Safran hybrid electric propulsion system
- Meggitt awarded five year fuel cell contract
- Boeing awarded $181M contract for Procurement of 156 CH-47F Chinook Helicopters
- Bell and SUBARU announce their collaboration
- First H160 pre-assembled rear fuselage is plug and play ready
- Safran renews Pattonair contract
- Japan Coast Guard signs HCare Smart for its H225 fleet
- Aeronautical Accessories Focused on Expanding Bell 505 Accessory Offerings
- CAAS, EASA and Airbus collaborate
- Boeing awarded $264M contract for MH-47 Support Services
- Magpas Air Ambulance selects AW169 to replace MD Explorer