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Helicopters in EMS (HEMS)

Jennifer Farah, MD and Stuart Swadron, MD, FRCPC
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Nurses Edition Commentary

Kathy Garvin, RN and Lisa Chavez, RN

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EM:RAP 2019 September Written Summary 465 KB - PDF

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Clay S. -

I think the vast majority of air transport could be done safely by ground. I work in a relatively remote location in WY. If one does the math on ground transport vs air, transport times are typically not much different. A review of the actual amount of time saved with flight would be helpful as I suspect it is much less than people would guess.

Jenny Farah, MD -

Absolutely - EM providers should be vigilant of the time-critical nature of the patient's illness (if it exists), and weight the pros and cons of air versus ground transport. This episode was limited to discussing the cost of an individual mission, but indeed, so many other topics related to HEMS are relevant to our practice - more episodes to come, perhaps!

Chuck S., M.D. -

I love that you are discussing this but have a couple of problems with your presentation (in addition to the 2 previous comments) First the for profit companies in general fly less expensive aircraft and yet charge 30-50% more for the same flights. 2 the vast over abundance of aircraft dramatically decreases the "utilization" and hence increases the cost (not to mention the skill set of providers). 3. Most importantly the states (thanks to the airline deregulation act) have no control over air ambulances in their states so talking about a "cap" by the states is simply not true. Yes insurance companies like to not pay for anything so there needs to be some pressure on them as well as the providers. But by federal law states can't set charges again handicaping the solution. I would love to send you a map of the air ambulance services in Missouri.4. Finally I think it would be most useful for ED docs and EMS medical directors to be familiar with the charges in their area as it might be worth waiting 5-10 min to save a patient about $30,000 to $50,000 dollars by getting a less expensive aircraft.
Thanks and would be glad to provide more information and discuss. Also suggest reaching out to Dr. Mike Abernathy for his take.

Jenny Farah, MD -

Thanks for the comments! Much appreciated! Agreed - this is one of the few markets, where less competition means better prices for the consumer (please refer to 13:15 of the episode where me and Stu discuss just that!). As for the issue of billing, a few clarifications...The Airline Deregulation Act, although significantly limiting state oversight of the airline industry, did not necessarily translate to all air-transport billing matters. Medicaid is a joint federal/state program. It is federally mandated but state implemented. The program allows states to set a Medicaid fee schedule, which is then matched by federal dollars. Thus, states are afforded some flexibility to determine covered populations, covered services, health care delivery models, etc. Because of this flexibility, there is variation across state Medicaid programs, and thus covered cost for individual patients.
As for your last point, about making each carriers’ charges more readily accessible, so that EM providers can review them on shift... Although good in theory, I think it may be challenging to factor in possible in-network status/insurance coverage (and thus left over co-pay) for each patient. We’d simply be looking at a list of generic charges that don't directly translate to the ultimate payer cost. But it is a good reminder that all EM physicians should be vigilant of their patients’ options for this very costly transport service. Thanks again for your input!

Chuck S., M.D. -

Agree with your points and the feds can (and do) set fee schedules but those are essentially federal programs hence outside the ADA. I also totally agree that excessive competition drives up the cost (not down as one would expect). I also agree that (just like all of medicine) the final charge is probably not related to what the patient may ultimately pay. That said the starting charge is certainly an indication of what the final bill is going to be. My point was to your stating that equipment is a major cost (which is true) but often the for profit companies use less expensive equipment (single engine non IFR etc etc) yet have much higher fees (again in my area 30-50% higher). If the states were allowed to regulate the number of aircraft that alone would dramatically both decrease the cost and improve service (more procedures more flights etc lead to better skills). If you have an email I would love to send you the map of Missouri helicopter services to show you what I mean.
Thanks for this important work

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EM:RAP 2019 September Full episode audio for MD edition 228:36 min - 247 MB - M4AEM:RAP 2019 September German Edition Deutsche 113:47 min - 156 MB - MP3EM:RAP 2019 September Farsi Edition Farsi 199:37 min - 274 MB - MP3EM:RAP 2019 September Spanish Edition Español 81:07 min - 111 MB - MP3EM:RAP 2019 September Canadian Edition Canadian 19:03 min - 26 MB - MP3EM:RAP 2019 September French Edition Français 20:28 min - 28 MB - MP3EMRAP 2019 September Board Review Answers 135 KB - PDFEMRAP 2019 September Board Review Questions 710 KB - PDFEM:RAP 2019 September MP3 Files 295 MB - ZIPEM:RAP 2019 September Written Summary 465 KB - PDF

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