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Business Models, Payment, and Government Guidance

Business Models, Payment, and Government Guidance. Dr. Robert Dodd Office of Research and Engineering D. Payment and Government Guidance. HEMS transport combines two complex activities: Helicopter operations 24/7 Advanced life support care for patients by highly trained clinicians.

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Business Models, Payment, and Government Guidance

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  1. Business Models, Payment, and Government Guidance Dr. Robert Dodd Office of Research and Engineering D

  2. Payment and Government Guidance HEMS transport combines two complex activities: • Helicopter operations 24/7 • Advanced life support care for patients by highly trained clinicians

  3. HEMS Business Models • Three variations: • Traditional hospital-based • Public service • Community-based • 88% increase in EMS helicopters during the last 10 years • Most of the increase associated with community based programs

  4. Payment • HEMS transport is very expensive • Health insurance pays HEMS providers • CMS (Medicare) • Medicaid • Private health insurance • “Self-pay” • Payment occurs only when patient is transported • Not all patients have insurance • HEMS locations are market driven

  5. Payment • CMS (Medicare) payment rates developed in 2002 • Fixed rate and mileage rate • Stratified by urban or rural transport • Private health insurers use different payment schedule • Economically marginal operators often: • Minimize capital expenditures • Strive for higher patient transport volume • Supplement operation with funds from external sources

  6. Payment • Payment practices may serve as disincentive for safety enhancements • Proposed recommendations to FAA will require HEMS operators to increase expenditures • Staff is proposing recommendations

  7. Government Guidance: HEMS Planning and Integration • Ground-based EMS systems are usually planned and developed by local and regional government agencies • Federal oversight or guidance is uncommon • HEMS helicopter use not always fully integrated into local or regional plans • HEMS operators can enter and leave a market at will

  8. EMS Helicopters: Missouri 1985 9 helicopters serving approximately 5 million population Source: Patient First Alliance

  9. EMS Helicopters: Missouri 2009 33 helicopters serving approximately 6 million population Source: Patient First Alliance

  10. Government Guidance: HEMS Use • Patients often transported who are not ill enough to justify HEMS transport • Many factors associated with “over-triage” • Competition for billable transports • Transport inflation to increase billable flights • Poor transport decision-making protocols • No national guidelines for patient transport mode • Increase of unnecessary transports increases patient and flight crew exposure to risk • Staff is proposing recommendation

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