The Trump administration reversed its decision to deny air ambulance companies access to coronavirus relief money over the weekend, a move the industry says is needed as it experiences a drop in air medical transports.
The Health Services and Resources Administration in the Department of Health and Human Services updated sometime between April 24 and Monday its website on Covid-19 claims reimbursement for testing and treatment to health-care providers and facilities serving the uninsured.
As recently as April 24, a previous version had put air and water ambulances on a list services excluded from the $100 billion in relief funds for hospitals and health-care providers on the front lines of the Covid-19 response. But as of this week, they’re no longer on the exclusion list.
A HRSA spokesman declined to shed any light on the reasoning behind the change, but it comes as air ambulances have experienced a 40% drop in volume as more people stay off roads and away from activities that are more likely to require emergency care. It also reflects an overall drop in health services outside of Covid-19, according to the Association of Air Medical Services
The HRSA spokesman, who spoke on condition on anonymity in order to comment on official agency business, said the agency first determined that air and water services should be excluded from getting the federal funds, but after “further review and with the launch of the COVID-19 Uninsured Program Portal” decided to permit the industry to access the money.
The spokesman didn’t clarify why HRSA reversed its decision or why the industries were excluded in the first place.
JaeLynn Williams, CEO of Air Methods, one of the country’s largest air medical service companies, said her company was told incorrectly it didn’t have the unique code given to health-care providers to bill Medicare that was needed to get the federal funds.
She said the company does service Medicare beneficiaries and offered not to send “surprise” bills to Covid-19 patients in return for getting the federal funds, a mandatory condition for providers accepting certain federal funds.
The HRSA spokesman denied the lack of the code, known as a National Provider Identifier, was why air ambulances were previously ineligible for the money.
Williams said her company, like others, has seen at least a 20% drop in transports and needs the federal funds to offset the added cost of outfitting air crews with the protective equipment needed to fend off infection by Covid-19 patients they’re transporting.
Shawn Gremminger, director of health policy for the Pacific Business Group on Health, said the move to direct federal funds to air ambulance companies, which have come under fire in recent years from Congress for issuing surprise bills, makes little sense.
“I have a hard time thinking that in general air ambulance is the best use of these marginal federal dollars,” he said. The group’s 41 member organizations together spend $100 billion a year on health coverage for more than 15 million employees.
Gremminger pointed out that private equity companies in recent years have started or bought many air medical services, expanding the number of air ambulance sites in the U.S. while the number of primary care practices hasn’t grown in proportion to the population.
The Coronavirus Aid, Relief, and Economic Security (CARES) Act provided the $100 billion to hospitals and other providers as part of a $2.2 trillion stimulus relief package (Pub. L. 116-136).
Air ambulance companies received some of that money based on the number of Medicare patients that they had transported in 2019, Christopher Eastlee, vice president of government relations for the air ambulance trade group, explained. This is the same formula that applies to across providers, he said. That money came around mid-April.
However, Eastlee said the 40% drop in volume means they’ll likely need more funds.
$815 Million Sought in Next Relief Bill
“We made an initial request of HHS for approximately $365 million in the $100 billion HHS fund. In the ensuing weeks, we actually increased our ask in regards to the next piece of legislation to $815 million,” he said, adding that money also accounts for an anticipated increase of uninsured patients “just due to the rapidly increasing unemployment levels.”
The association is building support on Capitol Hill and working with other emergency medical groups “so we can be aligned with their asks in terms of making sure we’re basing our estimates on similar aspects of providing care,” Eastlee said.
Without that funding, association President Cameron Curtis and Eastlee said the companies’ air bases could be forced to close, compounding an existing problem of lack of access to care in sparsely populated areas.
Angela Hewlett, associate medical director of infection control and epidemiology at the University of Nebraska Medical Center, said her hospital uses air transport, especially for very sick patients who can live up to eight hours away in the western rural part of the state.
But air transport during the pandemic is different than a typical trauma case, she said at an Infectious Diseases Society of America press briefing.
“When those beds are full—which is occurring as of today—they are needing to ship those sick patients out to other hospitals. And so finding ways to do that has been difficult,” she said.
“We’ve been accomplishing it thus far,” Hewlett said. “But if we see big spikes in in sick patients out in the small communities, it’s going to be difficult to give them the care that they need.”
Protecting Air Crews
Another challenge has been protecting the air crews, Andrew T. Pavia, chief of the division of pediatric infectious diseases for the University of Utah, said on the same briefing as Hewlett.
“These folks take risks every day. They fly in snow storms to pick up trauma victims. But it’s a different kind of risk to transport somebody with a respiratory disease in a small aircraft,” he said, adding that some of those flights can take several hours.
Curtis and Eastlee of the Association of Air Medical Services said their crew members have been trained on how to transport patients with infectious diseases.
“They flew during the HIV crisis, they flew during SARS,” Curtis said. “It’s not that they aren’t worried about it. It’s just that they’ve been trained to fly into those situations and to prepare.”