AAMS put letter to Membership in public domain

AAMS put letter to Membership in public domain

16-Mar-2022 Source: AAMS

Dear AAMS Members –

AAMS is working very hard to ensure every air medical program understands and supports our position regarding the AAMS lawsuit against the federal government’s rules implementing the No Surprises Act, a bill that AAMS largely supported and continues to support. We understand that questions still exist. As members of the AAMS Board, who voted on this position four times to ensure there was no ambiguity in our position, we feel it is our responsibility to further explain why this position is necessary and why every member and non-member benefits from this position.

AAMS’ position, in no way, harms hospital-based programs. This is false. The decision to put this argument before the court was made by an AAMS Board made up of mostly hospital-based programs. Nothing about our case is about “reimbursement”. Our case is about one thing only – a fair IDR process, where every member can make their case for fair payment from the insurer.

The AAMS case makes 4 arguments:

  1. QPA “Weighting” in IDR2 is not in statute; QPA should not, and was never intended to be, the presumptive factor. Every air medical transport service entering IDR should have all the factors considered – including the costs of providing the service, the type of aircraft, the quality of the care provided – without any prevalence or preference given. AAMS has consistently and clearly advocated for a fair and transparent IDR process.
  2. Inclusion of Single Case agreements, other insurance agreements, in the QPA Methodology as required in IFR 1. Air medical transport is unique among healthcare providers since single case agreements and other agreements with insurers are not to be included in the QPA calculation. The Departments indicated that this is specifically designed to lower the QPA.
  3. Calculating QPA by “Census Region” would lead to ridiculous results. IFR 1 rules require that if a sufficient number of in-network rates cannot be found in a given region, that the QPA must be calculated by “census region”, meaning that rates in Alaska would be compared to rates in southern California.
  4. Separation of air medical services that negotiate with insurers as part of a larger hospital negotiation, and those that do not, in the calculation of the QPA. Emergency Departments are similarly separated and for good reason; some hospitals choose to negotiate in-network rates based on the universe of services they offer. This is an excellent practice; however not every service has that ability, and those that do not should not be compared with those that do. The purpose of this position would in no way lead to “lower reimbursement” for any member – the QPA should be only one factor in the IDR decision. AAMS notes that this position is being deliberately misinterpreted by those that seek to increase division in the industry for their own purposes.

None of these positions should be considered stand-alone arguments. All the arguments serve one goal: to minimize the importance of the QPA in the IDR process. The QPA as a factor in the IDR process is the only provision of the No Surprises Act AAMS did not support. The legal strategy here must be viewed as a whole – to properly calculate the QPA to reflect actual network relationships between air ambulance providers and insurers, and to ensure that the QPA is just one factor in the larger IDR process.

AAMS firmly believes that every air ambulance provider benefits from these arguments. While it is extremely unlikely, let’s say for a moment the judge in the case decides in favor of only the separation of services argument, and there would be a separate QPA calculated by that insurer for that service in that region. In this case:

  • There is no data to show that an air medical service that negotiates an in-network rate as part of a larger hospital agreement would receive a lower QPA and therefore a lower payment.
  • If this was the case, that hospital service can choose to allow that service to negotiate an in-network agreement independent from the hospital; therefore, in any out-of-network situation the service would then be able to take advantage of the “independent” QPA. Only hospitals would have this ability; independent providers do not have the ability to switch to the “hospital” QPA if that QPA is higher.
  • Remember that this would only apply if that air ambulance service is out-of-network with that insurer. None of these rules apply to in-network agreements.

AAMS took this position for several reasons:

  • The ability for a hospital to negotiate with an insurer based on the universe of services it provides has a material effect on the rates it agrees to with insurers for individual services. It may choose to accept a higher payment for one service and a lower payment for another. It may not. Regardless, an “independent” provider does not have that ability.
  • It is important that – for the purposes of accuracy, transparency, and fairness – all the information provided to the IDRE’s as part of the IDR process recognize the reality of the healthcare environment.
  • This position in no way requires any air medical provider to accept a lower payment from an insurer; in fact, our lawsuit, if successful, allows all air medical providers an equal opportunity to receive fair payment for their services, regardless of their relationship to a hospital.
  • It also prevents a hospital from artificially lowering its in-network rates, and therefore the QPA for that service; this could have a material impact on services that may be half a state away.

The recent decision in the Texas Medical Association case regarding the “weighting” of the QPA in the IDR process – the most important part of the AAMS case, which is now consolidated with and fully supported by the American Hospital Association, the American Medical Association, and a host of other hospital and healthcare associations – bodes very well for a decision in AAMS’ favor. HHS’ recent decision to revise their guidance on the IDR process is also good news, and we hope this indicates that the government accepts that their interpretation was not consistent with the law. But this is not over, and our case – now the AAMS, AHA, and AMA case – is still moving forward. A favorable decision in that case benefits every air ambulance program and all of healthcare.

Please do not be swayed by arguments to the contrary. These arguments are false. Accusations against the AAMS legal team misleading the Board are similarly false. We stand united, regardless of the ownership model of our program, in our support of this position. We stand ready to further explain this position and answer any questions from the membership at any time.

Sincerely,
The AAMS Board of Directors


René Borghese
Administrative Director
Duke Life Flight

Kolby L. Kolbet
Chief Clinical Officer
LifeLink III

James Houser
CEO
STAT MedEvac

Deborah C. Boudreaux
Assistant VP, Nursing
Teddy Bear Transport
Cook Children’s

Ben Clayton
Interim CEO and COO
Life Flight Network

Chris Hall
Director, Government Affairs & Industry Relations
PHI Health

Rob Hamilton
President: Alliances
Global Medical Response

Mike Perkins
COO
MedFlight of Ohio
 
Stephanie Queen
Chief Nursing Officer
Air Methods Corporation

Jeff Richey
Executive Director
Airlift Northwest

Cindy Seidl
Chief Clinical Officer
STARS

, ,

Copyright © 2024 HeliHub

Website by Design Inc

Helihub logo

X