How Air Ambulances don't work

Discussion in 'Flight Following' started by Mtns2Skies, Jan 26, 2021.

  1. PlasticCigar

    PlasticCigar Pre-takeoff checklist

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    Plastic Cigar
    Having been both on the sending and receiving end of air ambulance transports for a couple of decades I can assure you that the transferring physician is usually quite aware of the acuity of the situation and the potential for deterioration. Just because something bad didn’t happen during the transport doesn’t mean the potential wasn’t there. I don’t think that’s “defensive” I think it’s smart.

    Again, having been involved in hundreds of transfers (on both ends) air ambulance is often slower than ground except in special circumstances and no one wants to put the air crew in danger (especially in the middle of the night or bad weather) when ground is a viable alternative.

    There have been some cost/benefit studies and in some cases air ambulance is clearly justified when the harm from delay in treatment is significant (trauma, stroke).

    Defensive medicine certainly exists but most people are trying to do the right thing. I have written letters (often multiple) to get air ambulance paid for by insurance who retrospectively decided it wasn’t “medically necessary.” So far, I have been quite successful making the case that with the information available at the time and the potential for deterioration air ambulance actually was the most appropriate choice.

    As many of you know, any money insurance companies “waste” on medical payments is profit they don’t get to keep (“medical loss ratio”) so every incentive is for them to deny as many claims as possible, knowing that <100% will be appealed and among those that are appealed (sometimes multiple times) many will go unpaid. Essentially, there is no disincentive to denying a claim.

    I’ve been involved in quite a few air ambulance transports and while the flights out were stressful the flights back were usually quite fun. Hard to find a better group of people who knowingly risk their lives to help others, or as one group here likes to say “You gotta be sick to fly with us!”

     
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  2. YooperMooney

    YooperMooney Pre-takeoff checklist

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    CapellaXS
    Paramedic/FF here. Worked volly fire for 17 years and ten years for one of the largest non profit EMS firms in the nation. I’ve seen first hand how certain types request a chopper at the sight of a horrific crash without even triaging the patient(s). It happens. I wish they’d put more physicians (“notarzt”) on the ambulances like in Germany. Might actually save healthcare costs. I’ve seen this first-hand while working ALS shifts
    with an orthopaedic surgeon who oddly enjoyed working as an EMS peon on his days away from the OR.
     
  3. Cervieres

    Cervieres Pre-takeoff checklist

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    Antione
    Congratulations on your decades of experience and thank you for your assurance. In my experience, I have accepted numerous hospital transfers by air that were not justified and the family often receives a bill that they cannot afford to pay.
     
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  4. Velocity173

    Velocity173 Touchdown! Greaser!

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  5. PlasticCigar

    PlasticCigar Pre-takeoff checklist

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    I’m curious then if you knew beforehand how inappropriate the air ambulance was why you didn’t have a conversation about sending them by ground? In every transfer I have sent or accepted we discussed how the patient was getting there. I guess I just haven’t seen this rampant abuse of the air ambulance system that you’re describing.


     
  6. Bell206

    Bell206 En-Route

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    Unfortunately, abuse exists and it became very prevalent after the shift from traditional programs to community based programs. Instead of it being a patient priority system it became a numbers game mostly based on flight volumes. However, the dynamics are changing on several levels and it will be interesting what operators remain independent. My guess is within 5 years there will be 2 maybe 3 primary air providers and the current level of overlap/competition will drop dramatically just in time for the current state level legal actions come to a head on the billing issues.