AAMS Public Policy / Public Affairs Blog Latest News

Association of Air Medical Services (AAMS) Testimony on “No More Surprises: Protecting Patients from Surprise Medical Bills.” United States House of Representatives Committee on Energy and Commerce Subcommittee on Health June 12, 2019

The next is Congressional Testimony of Rick Sherlock, President & CEO, Association of Air Medical Services (AAMS) Listening to on “No More Surprises: Protecting Patients from Surprise Medical Bills.” United States House of Representatives Committee on Energy and Commerce Subcommittee on Health June 12, 2019

The Association of Air Medical Services (AAMS) is the leading worldwide organization representing the air medical industry and over 250 air ambulance providers throughout the United States, offering emergency helicopter and fastened wing air medical providers. Our imaginative and prescient is to guarantee that each individual has entry to high-quality air medical and essential care transport of their time of crisis. Our members are actively working to deal with stability billing points related to their providers by way of patient advocacy packages and dramatic will increase in their in-network agreements, which take patients out of the middle and hold them harmless. AAMS helps options that take patients out of the middle while preserving access to our essential life-saving providers. Over the past Congress, AAMS supported the bipartisan, bicameral language in the FAA Reauthorization Act that mandated the Air Ambulance Patient Billing Advisory Committee determine applicable solutions to deal with billing and value issues and advocate greatest practices and steps that may be taken to guard shoppers. We request that Congress do no harm and shield entry to the important, life-saving medical interventions and the entry to crucial care levels of health care that our providers provide. In time-sensitive, life-threatening sicknesses and accidents, when seconds matter, we need to proceed to keep these patients alive.

In summary, AAMS recommends that Congress take the following steps:

• Help and encourage fast implementation of the Department Of Transportation’s Advisory Committee On Air Ambulance And Patient Billing (AAPB) which is to determine actions to “protect consumers from balance billing” as directed by Congress in the 2018 FAA Reauthorization Act. • Enact laws that may require all air medical suppliers to submit value and high quality knowledge to the Centers for Medicare and Medicaid Services (CMS) and give CMS the authority to replace the reimbursement payment schedule. This enables the Federal authorities, along with different stakeholders and the general public, to raised perceive the true costs of emergency air medical providers and how the industry operates to offer these providers. Moreover, this can allow CMS to replace the outdated Medicare reimbursement price to accurately mirror true industry costs. Requiring all air medical suppliers to report this knowledge and CMS to reimburse emergency air medical providers based mostly on the precise costs of transport will assist scale back value shifting to the personal market and improve the quantity of in-network agreements, which might get rid of the stability billing challenge. • Encourage the Division of Transportation to make use of its present authority to research costs of sure non-emergency, on-demand personal airplane transports which will exceed normal industry expenses for comparable providers, including investigating how such providers are arranged.

AAMS gives the next written testimony in help of these suggestions.

Background on Emergency Air Medical Services

AAMS represents each helicopter and fixed-wing air medical suppliers and operators who ship lifesaving emergency transports day by day. AAMS members transport approximately 360,000 critically sick and injured sufferers per yr by way of emergency helicopter transport and a further 100,000 per yr by way of fixed-wing airplanes, some of that are also emergency transports. Emergency air medical providers (EAMS) transcend typical ambulance providers, as they are primarily flying emergency rooms and essential care models, capable of a degree of care past most ground ambulance providers. They’re highlyeffective medical interventions, however they’re an costly service that ought to only be used based on pre-existing protocols developed by local medical and emergency response authorities.

It’s essential to notice that emergency air medical providers do not determine which patients are transported by air medical or floor ambulance providers. They by no means self-dispatch; they solely reply to requests from medically-trained first-responders or physicians. Medically-trained first responders or physicians decide whether or not patients want emergency air medical providers based mostly on a spread of elements, including however not limited to, the higher degree of care provided by an air medical crew (e.g., airway stabilization, blood transfusions, and so forth.); the need for extra speedy transport than a floor transport would permit based mostly on the patient’s condition; or the geography in remote or rural areas and the space to travel to tertiary care. Emergency air medical providers are referred to as to answer each on-scene requests from first responders and emergency inter-facility requests from physicians.

Emergency air medical crews respond to these requests within minutes, day or night time; they are prepared to answer probably the most critically unwell or injured patients on a 24 hours-per-day 7 days-per-week foundation. Air medical crews are devoted essential care providers, with larger levels of coaching, gear, and expertise than most ground ambulance providers. Air medical pilots are some of probably the most skilled in aviation. By way of each voluntary industry commitments and industry-supported laws, air medical helicopters operate at a better degree of aviation safety than the remaining of the on-demand aviation segments, with several laws designed solely to deal with the distinctive dangers associated with the emergency air medical setting. AAMS would ask the Committee to acknowledge the super commitment that these individuals make to ensure crucial emergency medical response is all the time obtainable to the communities they serve.

Roughly 90% of the sufferers transported by emergency air medical helicopters are for stroke, cardiac, and trauma circumstances; the remaining 10% embody specialty pediatric care, burns, neonatal, high-risk obstetrics, neurological, and different circumstances. Because these age-related circumstances are extra prevalent in Medicare and Medicaid populations, our members’ transport volume instantly impacts that patient mix.

The Growing Want for Emergency Air Medical Services

EAMS is a essential element of the health care delivery system in the United States, making certain that critically injured sufferers are capable of shortly and safely access trauma care and other essential tertiary care. Almost 85 million People can only entry a Degree I or Degree II trauma middle within 60 minutes by way of helicopter. One other 30 million People should not have entry to these facilities inside this time sensitive window – typically referred to as the “golden hour – even by air. Nonetheless, EAMS serves as a crucial lifeline to those individuals who typically stay in rural areas.

On March 20, 2019, the Government Accountability Office (GAO) revealed its report, “Air Ambulance: Available Data Show Privately-Insured Patients Are at Financial Risk.” Congress required the GAO to supply the report within the “Explanatory Statement” for Division H of the “Consolidated Appropriations Act, 2017” (H.R. 244). That language directed the GAO “to submit a report to the Committees on Appropriations of the House of Representatives and the Senate on fixed-wing and helicopter air ambulance services, operational costs, and, as available, payment structures no later than 18 months after the enactment of this Act.” GAO reported that “there were 752 bases in the 2012 data and 868 bases in the 2017 data.” The report additionally notes that the added bases: • “increased the total area served by helicopter bases by 23 percent.” “About 60 percent of the new helicopter bases and about half of the new fixed-wing bases…were in rural areas.” “For just under half of the new helicopter bases…the area served overlapped with existing air ambulance coverage by more than 50 percent.” Added bases “increased the total area served by helicopter bases by 23 percent.”

EAMS enlargement in rural areas helped fill the hole in rural health care created by closing rural hospitals. As current media stories from Fort Scott, KS2; Fairfax, OK3; and Port Arthur, TX4 present, rural communities are devastated by the loss of their hospital amenities and the nervousness over who will provide access for emergency health care wants. These closures comply with the closing of 64 rural hospitals in 20132017, in accordance with the GAO. Most closures have been in southern states, with Texas experiencing 14 closures, however the Midwest, West and Northeast regions additionally misplaced hospitals. Furthermore, Navigant just lately revealed an analysis that indicates as many as 21 % of rural hospitals could possibly be in danger for closing on account of modifications in payer reimbursements.

The power of EAMS to fill the hole in access to health care in rural America, is diminishing. On account of mounting financial strain, since January 1, 2019, 31 helicopter air ambulance bases have closed and the third largest helicopter air ambulance supplier in the United States is just now on the path for emergence from voluntary chapter protection filing in March, 2019. Many of the closed bases have been situated in rural areas where they did not endure from lack of transport demand however suffered economically as a result of a bigger portion of Medicare, Medicaid, and uninsured sufferers.

The mixture of fewer air medical bases and fewer rural hospitals must be of nice concern to Congress. At a time when rural hospitals are closing, it’s crucial to take care of, and even to increase entry to emergency transportation for rural and underserved People. A rise in the time required to move a critically sick or injured affected person from an incident scene to the suitable facility brings with it the risks of life-altering problems and even demise. Sadly, with the closure of air medical bases and the continued closure of rural hospitals, it seems inevitable that transportation occasions will improve.

AAMS’ members additionally serve an important position in our homeland security infrastructure. Notably, our members reply to disasters working in partnership with FEMA and different Federal and State businesses. If federal coverage to treatment financial points effecting emergency air medical providers aren’t carried out, the present capacity of EAMS to surge to help strong participation in catastrophe response may additionally be in danger.

The Economics of Air Medical Transport

As of 2017, over 70% of air medical flights are under-reimbursed as they transport Medicare, Medicaid or uninsured sufferers. EAMS are not often publicly funded; less than 10% of EAMS nationwide are by way of a publicly funded agency. This leads to an ongoing imbalance between precise prices and government reimbursement and is a big change from simply 10 years ago, when the Medicare and Medicaid populations have been considerably smaller. As these populations elevated as a proportion of the general quantity of transports carried out, the uncompensated value of those transports multiplied, growing the fee for all transports. As we speak, the only largest factor growing value is the Medicare reimbursement gap. In accordance with a research carried out by Xcenda in 20176:

• $10,199.00: Median value of providing one helicopter transport o $5,998.00: Median Medicare reimbursement (base price plus mileage) per transport o $3,463.00: Median Medicaid reimbursement per transport o $354.00 Median self-pay (uninsured) reimbursement

Seven out of ten of patients transported by EAMS are both Medicare, Medicaid, or uninsured; the remaining three out of ten patients should subsidize the remaining value. This is unsustainable, and drives a big cost-shift to non-public insurance-compensated transports.

Of the roughly 360,000 sufferers transported by EAMS per yr:

• ~133,200 are Medicare patients (37%);

• ~86,400 are Medicaid sufferers (24%);

• ~36,000 are uninsured patients (10%);

• ~93,600 are commercially insured (26%) (roughly 40% of these patients can be in-network);

• ~10,800 are coated by “other” insurance (three%).

The research additional discovered that uncompensated care incurred by serving Medicare, Medicaid, and uninsured patients creates value deficits that require personal payers to cowl more than $26,00zero per transport to allow providers to only break even. Resolving the Medicare value gap would scale back the pressures that drive greater pricing, in addition to to limit a patient’s potential publicity to a stability bill.

These numbers- both the high fastened value of providing the service and the combination of patients transported- develop into significantly worse in rural areas. Rural areas carry the very best demand (principally because of hospital closures), in addition to a significantly greater ratio of Medicare, Medicaid, and uninsured sufferers. Because the current EAMS base closures present, we are much less more likely to have the power to serve the areas where emergency air ambulance transports are wanted most.

AAMS strongly supports legislation that may reform the broken Medicare reimbursement system for EAMS, which is a main driver of stability billing. Laws launched within the 115th Congress, the “Ensuring Access to Air Ambulance Services Act” (H.R. 3378), would rebase the Medicare charges for emergency air medical transports using complete value knowledge collected from suppliers. This rebasing would tackle the growing hole between Medicare reimbursements and the actual prices of providing the service.

Air Medical Services and the Airline Deregulation Act

EAMS are unique within the well being care system. Air ambulance medical providers offered in flight are executed so in a singular surroundings and with considerations for aviation and patient safety that only exist in the air. The service is heavily regulated by the states for the purposes of health care (as ambulances) and the federal government for aviation security and providers (as air carriers). Emergency air medical providers are ambulances in that they transport critically unwell and injured patients, however it is their standing as air carriers that permits speedy transport of these patients over longer distances; over 33% of EAMS flights cross state strains daily and almost all of them will cross a county or municipal boundary.

The Airline Deregulation Act’s (ADA) uniform authority over the national airspace is important to the supply of this life-saving service. Air medical providers have been all the time meant to be included as air carriers underneath the ADA; a Senate flooring colloquy instantly discussed “the need for air ambulance services” during debate on the ADA on April 19, 1978.

Exempting air medical providers from the ADA would permit states to manage a wide range of points in relationship to the aviation features of a licensed air-carrier, together with the place and when they’re able to fly, creating borders within the sky and limiting entry to crucial care. Fee regulation is just the newest argument in an extended history of attempts by some states to manage the following issues:

• Competitors in air medical transport;

• Aviation security laws;

• The dimensions of the aircraft;

• The areas by which the plane can function;

• The distances an plane can journey; and

• The connection to hospitals or present medical providers.

Emergency air medical providers are already closely regulated by states; they’re licensed ambulance suppliers overseen by state-licensed medical directors. States have full and unfettered authority to manage each facet of the supply of medical care inside the aircraft. Additional, states and native communities typically regulate the triage protocols for requesting an emergency air medical service, and whether or not that affected person must be taken by air or floor.

Ought to there be a change to the 40-year-old federal primacy over aviation and air service regulation, there can be monumental penalties for air medical operations, together with:

• Unfavourable Impression on Safety: Allowing states to manage prices or billing would scale back monetary compensation wanted to spend money on both required and voluntary security enhancements. EAMS operators help enhanced safety regulation and stand absolutely dedicated to further safety enhancements past regulation (night time imaginative and prescient goggles, Crash Resistance Gasoline Techniques, and strong flight operational high quality assurance techniques). All of these security enhancements can be severely hampered by state fee regulation that reduces the power to make these investments.

• Borders within the Sky: The ADA protects airlines from state regulation on air service routes. By exempting EAMS from the ADA, state authorities can be allowed to manage the place air medical providers fly, often in makes an attempt to restrict competition. For example, an aircraft in South Carolina transported a critically injured youngster to a North Carolina hospital. The hospital, appearing underneath the state’s then-existing Certificate of Need (CON) regulation, attempted to bar the plane from the helipad, going so far as to threaten the impoundment of the plane and the arrest of its crew. A federal courtroom affirmed the ADA’s protection of that aircraft’s capacity to cross borders and be sure that the closest applicable aircraft can transport a patient to the closest applicable hospital or trauma facility for his or her time-sensitive medical condition.

• Decrease in Entry to Important Air Medical Transport, particularly in Rural Areas: Limiting the number of air medical providers in an space (together with by way of CON legal guidelines) will cause a big decrease in access, particularly in rural areas, in instances the place state-regulated methods arbitrarily determine a scarcity of adequate “need.”

• Restrict Affected person Care Selections by Referring Physicians: Within the case of inter-facility transports, physicians are presently capable of make a transport willpower based mostly on their expertise and the condition of the patient. Altering the ADA would limit that decision-making potential.

• Prohibit entry to choose: A state might prohibit the power of a health care entity to decide on to possess their own Half 135 certificates, or to freely choose the Part 135 operator that meets their needs. Restrictions on the power of an air service to function the place wanted signifies that a state might choose to not permit an operator to offer providers within its boundaries.

Present Efforts to Tackle Stability Payments: Patient Advocacy and Network Participation

AAMS’ members are addressing stability billing in a quantity of ways, including by way of patient advocacy packages and elevated insurance community participation. AAMS is worried that current insurance industry conduct toward emergency air medical transport has solely worsened issues of stability billing and air medical program stability, particularly in the rural surroundings.

States possess the power to manage insurance policy provided within their borders, with the exception of federally-regulated Employee Retirement Revenue Security Act (ERISA) plans. Together, both the state or the federal government has the authority to compel insurers to offer insurance coverage merchandise that present truthful compensation for emergency air medical providers. Yet, personal insurance coverage has responded by increasingly setting rates arbitrarily or denying funds by means of medical necessity denials, underpayments, and different techniques. For instance, almost half of all claims are initially denied reimbursement by the well being plan. Virtually 40% of these denials are for medical necessity – a choice made by the attending doctor or first responder based mostly on medical protocols and state EMS protocols, not the air medical program. If insurance coverage corporations are allowed to disregard selections made in emergency conditions, by a medical skilled which are in the perfect curiosity of the insured patient, then what’s the function of medical insurance? Health care providers, particularly in emergency conditions, cannot be involved with their selections being second-guessed after-the-fact by insurers, whose intent may be extra targeted on monetary considerations than affected person wants.

Our members are actively negotiating with insurance coverage corporations to safe in-network contracts where such negotiations can be found. Despite that willingness to barter in-network charges, some insurers, citing low volumes and infrequent want for transports, have outright refused to even talk about an in-network settlement with emergency air medical providers. AAMS finds that refusal simply unconscionable; while it might make sense to the insurer, it hurts both the patients they’re insuring and the well being care providers. Despite this, our members have managed to increase network participation significantly; one member alone has elevated their general network participation from 2% to virtually 30% in the final three years. Insurance corporations should acknowledge the need for this service and restrict questions of medical necessity, enter into community negotiations with emergency air medical suppliers, and stop the apply of sluggish funds or payments on to the patient (which solely places patients within the middle).

It is very important notice that emergency air medical transports usually are not a price driver for medical insurance corporations – in reality, this life-saving service is less than one % of all well being care costs. Based on testimony before the Montana Legislature Joint Financial Affairs Subcommittee in 2016, and supported by national medical insurance knowledge, masking air medical providers in full represents about $1.70 of the typical monthly premium. Whereas these providers are costly to function and expensive per transport because of the nature of the service, the maths exhibits that they can be coated easily by well being insurers for a tiny fraction of a monthly insurance premium. Emergency air ambulance transport is a particularly uncommon service and a really small half of the whole well being care delivery system. In line with the 2018 Milliman Medical Index Research on well being care prices, emergency air ambulance providers characterize a tiny fraction of the “other” four% of premium prices (“other” prices also consists of floor ambulance, sturdy medical gear (DME), house well being, and all medical provides)8. To interrupt it down even additional, air ambulance transports account for lower than 1% of all ambulance transports.

Many of AAMS’ members have patient advocacy packages that permit dedicated affected person advocates to work side-by-side with patients to assist them and their households navigate the complicated world of insurance claims. If, and when, the insurance coverage firm underpays or rejects a first responder or physician’s determination, our members’ patient advocacy packages intervene by advocating on the patients’ behalf to attraction these selections and guarantee they’re coated pretty by the well being plan for which they pay their premiums. Our members are dedicated to helping our patients from the beginning of their medical emergency until their claim is resolved. For one of our largest members, by way of their growing in community relationships, affected person advocacy and strong financial help program, the typical out of pocket for their patients including copays and deductibles is less than $400.

Emergency Air Medical Services vs. Non-Emergent Medical Transport

EAMS provide emergency medical response 24 hours-per-day, seven days-per-week to ensure that patients have access to, and obtain, the perfect care and transport potential, regardless of when or the place an emergency happens. Providers transport a affected person only when a physician or medically-trained first responder has deemed air medical transport medically vital. Whether these transports are from the precise scene of an accident or damage (such as the aspect of the street or a football subject) or inter-facility (from a smaller less-equipped hospital to more superior care at a tertiary well being care middle), they are all deemed emergency situations by the requesting physician or first responder. After figuring out whether the flight circumstances permit for a protected flight, EAMS respond to every request inside minutes and with out information or regard for a affected person’s potential to pay.

Emergency air medical providers embrace all helicopter transports. In some instances of excessive distances fixed-wing airplanes are used in emergency affected person response; while these flights are much less frequent, they’re certainly not less important.

There are also providers that provide non-emergency personal fixed-wing airplane medical transport by air. These providers aren’t all the time requested by physicians; they are often requested by anybody with a capability to pay, and are most often organized by means of hospital case managers or by sufferers’ families using web directories. Historically, and like all pre-arranged personal air-taxi service, the fees for private airplane medical transportation can be paid up-front by the individual arranging the flight; these flights would not often be coated by Medicare, Medicaid, or personal insurance.

AAMS is aware of several corporations at present offering totally different choices to rearrange and finance these varieties of flights; AAMS has also acquired questions relating to these varieties of privately arranged airplane transports. It ought to be famous that these flights are not any totally different of their association than some other ondemand personal plane transport. These flights also needs to by no means be confused with emergency air medical providers or the economic issues confronted by emergency air medical providers or providers.

AAMS refers all questions and considerations relating to billing to the Department of Transportation’s Shopper Safety Division (DOT CPD). DOT CPD has full authority to manage the economic facet of these providers and AAMS strongly recommends that DOT train this authority wherever essential to ensure that sufferers and their insurers are informed of the complete value estimate of the providers earlier than the non-emergent flight and usually are not excessively charged following the flight.

Legislative Actions Already Taken to Tackle Air Medical Stability Billing

To be able to handle potential billing considerations, and because EAMS is both ambulance and air-carrier, Congress took vital action on emergency air medical stability billing in 2018. Within the “FAA Reauthorization Act of 2018” (H.R. 302):

• Congress established the “Advisory Committee on Air Ambulance and Patient Billing”, which is composed of all stakeholders in air medical providers and is directed to determine actions to “protect consumers from balance billing.” The Committee consists of the Secretary of Health and Human Services and is additional required to make suggestions for “consumer protection…and the prevention of balance billing,” together with “options, best practices, and identified standards to prevent instances of balance billing.” The supply requires the Committee to deliver its remaining report to Congress, and additional directs the Secretary of Transportation to challenge any vital laws or steerage to reinforce the transparency and knowledge reporting of emergency air medical suppliers and establish “consumer protections for customers of air ambulance providers.”

• Another provision of the FAA Reauthorization Act requires the Secretary of Transportation to offer a separate report to Congress on plans for extra “oversight of air ambulance providers.”

• A 3rd part of the legislation establishes further requirements for emergency air medical providers, including offering contact info for the Department of Transportation’s Aviation Shopper Advocate.

We might urge both the Committee and Congress to permit the Advisory Committee to carry out its mandate, which is particularly required to determine options to EAMS stability billing points. Congress structured the Advisory Committee to deliver collectively insurers, insurance coverage regulators, shopper teams, physicians, and air medical providers to carry out a comprehensive evaluation and to advocate actions to offer aid for patients whereas making an allowance for the unique operational, regulatory, and financial elements of emergency air medical providers.

Even earlier than enactment of the FAA Reauthorization Act, the Department of Transportation took action, using its present authority, as described in the 2017 Authorities Accountability Workplace (GAO) report on air medical billing and value issues. The Department’s Aviation Shopper Safety Division established a portal for addressing air ambulance shopper complaints, and is responding to those complaints. In 2018, of over 350,000 air medical transports, DOT has acquired 24 complaints, which represents roughly .007% of all affected person transports. Thus far in 2019, 6 complaints have been reported to DOT.

In Conclusion: Improve Transparency, Preserve the Service, and Do No Harm

AAMS also supports efforts to extend transparency relating to emergency air medical providers, costs, and costs. The FAA Reauthorization Act tasks the Advisory Committee with creating recommendations for the federal collection of further knowledge on prices, costs and funds, operations, and competitors.

The “Ensuring Access to Air Ambulance Services Act” would also improve transparency, not solely by amassing complete value knowledge, but in addition by directing the GAO to compile this knowledge right into a report back to Congress. The laws would additionally set up a knowledge assortment program for reporting of quality metrics for well being care offered by emergency air medical providers. As rural hospitals proceed to shut, air medical transports provide a vital, life-saving service for rural patients. The continued and growing shortfall in Medicare and government payments for the service is undermining the power of providers to proceed to serve patients-in-need. It’s subsequently very important for Congress to both reform Medicare reimbursements and keep away from taking any action that may accelerate the closure of bases and additional restrict access to crucial levels of health look after hundreds of thousands of People.

We consider that some present concepts to unravel for stability billing for patients are misguided, comparable to a proposal to require air medical providers to separate “aviation” prices from “health care” prices in payments. Emergency medical care offered in flight is completed so in a singular setting and with considerations for aviation and patient security that solely exist in the air. Health care and aviation providers are inextricably linked and inconceivable to separate in any meaningful approach. For instance, many plane are fitted with exterior oxygen tanks to lower the danger of cabin hearth, thus changing the character of delivering oxygen to patients. The prices for that service are increased by its use in an airborne setting, and shouldn’t be in comparison with comparable providers on the ground. Most significantly, the separation of bills in this method would offer no discernable profit for sufferers, and does nothing to scale back the costs of emergency air medical providers or shield patients from receiving stability payments brought on by extraordinarily low payments made by insurers or insurer’s refusal to discuss in-network agreements with air medical suppliers.

Moreover, proposals to restrict air ambulance expenses through the use of Medicare as a metric can be devasting to EAMS. As we’ve shown, and as unbiased research have clearly indicated, the current Medicare charge schedule was developed and not using a research of costs and since its implementation CMS has by no means collected a single value knowledge point nor undertaken an evaluation of the price of providing the providers. By capping rates at 125% of Medicare as some suggest, EAMS would primarily gather the next:

• $10,199.00: Median value of offering one helicopter transport o $7,497.50 Proposed Median Business Insurance coverage reimbursement per transport o $5,998.00: Median Medicare reimbursement (base fee plus mileage) per transport o $three,463.00: Median Medicaid reimbursement per transport o $354.00 Median Self-Pay Reimbursement

This proposal would finish emergency air medical transport in the United States, limiting providers only to those communities who choose to offer them as a public service or hospitals prepared to subsidize the bulk of the fee.

Lastly, we consider that the complete dialogue of stability and surprise billing, no less than as it has utilized to emergency air medical providers, appears to disregard a easy but essential precept: “do no harm.” Do no hurt to sufferers who might obtain these bills, but in addition do no hurt to the caregivers who’ve devoted their life’s work to serving others, both in the back of helicopter, a ground ambulance, an emergency room, or at a patient’s bedside. AAMS believes in protecting sufferers; our members shield them every single day. AAMS believes in protecting them from the devastating incapacity of strokes and coronary heart attacks, protecting their lives from horrible accidents brought on by accidents, and protecting them from worsening accidents sustained during floods, storms, mass shootings, and different pure disasters.

AAMS thanks the Committee for the opportunity to supply this testimony and welcomes continued dialogue on this necessary matter. Again, we ask the Committee to acknowledge the distinctive and distinct regulatory, economic and operational points of this important service and to take care that any legislation does not inadvertently curtail access to EAMS for patients-in-need.