Under the proposed new waiver, which comes following the industry’s balance billing problem, patient response decisions would be taken away from the air medical provider’s first responders and physicians. Instead, a call centre would process each case and authorise the type of response based on a system of cost containment, which Air Methods believes will put profitability above patient needs.
“Rather than consider common sense reforms … the State is now proposing an untested model that relies entirely on reducing patient access to critical care services in order to ‘manage’ costs,” the air medical provider wrote. “Not only does the State plan to deliver diminished levels of service by cutting the number of bases that will be allowed to serve the State and setting quota levels for transports under the public utility model, but the State does not have a contingency plan if it finds the programme insolvent due to inadequate state appropriations. It seems that such a situation will force the State to further cut levels of service in Wyoming, resulting in even greater risk to Wyoming patients.”
Air Methods noted that the waiver included ‘missteps’ that would both make it ‘unworkable to deliver cost savings to the healthcare system’ and ‘an irresponsible risk for the State to take against the interests of the very patients it serves’. Air Methods argued that the waiver fails on three main accounts: firstly, it ignores that air medical resources are already largely distributed to the needs of the community they serve; secondly, it ignores that trained medical professionals treating the patient alone have the expertise, information and authority at the time of transport to be able to determine whether a patient must be flown; and finally, it ignores that interfacility transports are no less emergent than scene transports.
As such, Air Methods argues that the waiver ‘poses a direct risk to all Wyoming patients’. It proposes an alternate solution to limit the cost of air medical care to that suggested by the waiver, asserting that it is actively negotiating with many insurance companies to secure in-network contracts, aiming to have 40 per cent of its services in-network and covered by insurers by the end of the calendar year. And for instances where the provider is out-of-network, it has also implemented a Patient Advocacy department (established two years ago), in which dedicated Patient Advocates work side-by-side with each patient to help them or their representative navigate the ‘complex world of insurance claims’.
“Due to the nature of the legal conflicts, budgetary burden and operational shortcomings of the Waiver Application, Air Methods recommends that the Department should act in the best interest of patients and taxpayers and abandon the Waiver Application,” Air Methods writes. In its commentary, the air medical provider lists an alternate course of action that carefully considers patient access to care, without overstepping state authority, or overreaching or bending federal authority.
“We welcome the opportunity to continue to work with the Wyoming Department of Health and the Wyoming State Legislature on future policy that benefits the safety, health and wellbeing of our patients and all Wyomingites,” Air Methods concludes.
Read Air Methods’ full document of public comments here.