A Huge Opportunity... Missed!

We got an update from the Association of Air Medical Services yesterday, concerning their efforts to maintain prior-level government funding for HEMS transports for persons covered by TRICARE, the medical insurance used by various classes of persons associated with the military - including retired service members like me. Here is what they had to say...

AAMS Member Alert - AAMS Provides TRICARE Update
March 25, 2014

This morning, AAMS President and CEO Rick Sherlock, AAMS Chairman Marty Arkus, and a number of top executives from AAMS’ member programs met with the Department of Defense Office of Health Affairs to discuss the sudden and unexpected drop of TRICARE reimbursement rates last October. As of October 1, 2013, TRICARE lowered its air medical transport reimbursement rates from to Medicare rates, resulting in an average 62% reduction in payment for TRICARE flights.

After working with AAMS for the past two months to identify the issues and the effects on the medical transport industry, the Defense Health Agency told AAMS, at this morning’s meeting, they will be reinstating the pre-October reimbursement levels retroactively, enabling programs to re-process medical transport bills from October 1, 2013 to now, and receive payments at the pre-October rates. They also said they will create a tri-service working group to work with AAMS to develop a reimbursement structure moving forward that recognizes the critical services air medical transport programs provide for military personnel, military retirees, and their families and create an action plan to implement that structure.

This morning’s outcomes will have an immediate and positive effect on the entire air medical transport industry and AAMS sincerely thanks the DOD Office of Health Affairs for their prompt actions to address our concerns. We look forward to an ongoing partnership with them in the future. AAMS will also continue to work with our friends on Capitol Hill to address the rapidly growing inadequacies of Medicare payments.

While the return to prior-level funding is good news for the HEMS companies, a chance to move HEMS in the right direction regarding safety has been missed, and if the people in charge of TRICARE did a little research, we might still create a win-win situation. 

Keep in mind, the TRICARE managers are supposed to do everything in their power to ensure that the best level of care - provided safely and cost-effectively  - is what folks covered by TRICARE receive. Against that we have the federal government looking to pay for expanded entitlement programs by cutting costs associated with military healthcare. That is rational if not appropriate. So they decided to reimburse TRICARE-covered HEMS flights the same way they do Medicare flights - Medicare pays "on average 62% less than TRICARE", but all HEMS companies participate in Medicare and accept "assignment." 

The return to prior level funding may have something to do with the AAMS choice for CEO, retired Major General (two stars) Rick Sherlock. The general was a great choice for communicating with the military on reimbursement issues as he speaks from decades of experience and may have even known some of the government folks involved. 

It's a shame though, that the Association of Air Medical Services (AAMS) doesn't live up to it's full mandate as the voice - not only of the HEMS industry where it is today - but also of where HEMS should be going in the future. AAMS could have sought to tie increased (or more properly "reinstated") reimbursements from TRICARE to improvements in the HEMS industry, the improvements called for by the NTSB and others familiar with our industry.

Click here to see what the NTSB has to say about the current state of affairs in HEMS

I suppose Mark Twain was right, It's difficult to get a man to understand something when his paycheck depends on his not understanding it. General Sherlock is influenced by the HEMS companies who get the same level of reimbursement from insurance companies (including Medicare and TRICARE) regardless of what features their aircraft don't have. But wouldn't it be tragic if some relative of General Sherlock's was flown in a single-engine, single-pilot helicopter with no autopilot that that suffered a mishap due to lack of these readily available features. (In case you haven't been paying attention, this happens fairly regularly - when it happens to someone you know and care about you see the issue differently). AAMS represents "Cadillac" flight programs who do everything right, as well as the other type of operator, and it is interesting that these first-class operators didn't sound off about getting something for the extra money they spend to be the best.

The only reason this is permitted today by the FAA is that safety requirements are predicated on how many people we will hurt if something goes wrong. If we are only going to hurt a few the rules are more lax. This ignores the fact that the person we fly usually isn't in any condition to comment on what we have or don't have regarding safety and redundancy. Australia recently dealt with this and mandated IFR twins for HEMS. ( IFR "instrument flight rules" capable - able to fly legally in the clouds which stops a pilot from getting progressively lower in bad weather until he finds the ground and, in the words of Ben Springer, takes a 40 g nap)  Imagine the U.S. being second to Australia! I remember when we were first in all things.

For Randy Mains' article on Australian HEMS click here...

SideBar: We miss you Ben Springer. You fly with angels now, for these last ten years. You showed us the way forward. We have goggles, and it is just as you said ten years back...Damn you were smart!

 Here's hoping that someday we will remember the "VFR-only" days and wonder why...

(from Flightweb, 10 years ago) We share the position: the right application of technology can reduce our accident rate.

Damn the barriers!

One reason I posted on this topic is I'm convinced one way to break through barriers is to stay stubbornly on message. I've decided to beat the drum on the issues I feel are most relevant, that is, can have the greatest impact on our accident rate. NVG & IFR or bust.

NVG is breakthrough technology. In 10 years, we'll be looking back wondering how we ever got along without them. Every year we delay, more people die--tragically stupid. I don't care how much they cost. The good news is the costs are in the ballpark of that $25-50K, "very affordable."

I'd like to see a collective unified outcry and see if we could break down the barriers on this one thing. There is other technology that can help too, but I don't want do diffuse the drumbeat. NVG-IFR-NVG-IFR. Stay focused--stay loud.
ALNW Pilot - Ben Springer

If you got a hundred HEMS pilots in a room and put this question to them, "should we operate twins with autopilots or the current crop of singles with no autopilots?" the answer would be unanimous, let's go for safety! But as we don't want to lose our jobs - us pilots -  we keep our mouths shut and hope that one motor doesn't quit.

How many commercial airplanes have you flown on in your life that had one engine?

Here is what TRICARE should do...

They should stand up for the safety of the current and former service members and family members they cover who might be transported by HEMS, and tie reimbursement to the capabilities and redundancies of the equipment used, and the skills of the persons employed.

I cover tiered reimbursement in greater detail here...

I don't agree with everything the NTSB puts out, but in this case they are spot-on...

safe flights.