Uncompensated Care
HEMS responds when requested by hospitals, law enforcement and ground EMS services, whether the patient has the ability to pay or not. Depending on where the HEMS agency is located, that percentage of population can require a significant amount of care that will have to be written off as bad debt or charity, depending on the agency. According to the U.S. Congressional Budget Office, newly approved legislation called the Big Beautiful Bill will create an additional 17 million uninsured citizens over the next 10 years. Some states have the ability to pick up a portion of uncompensated care, but not 100% of the costs. This will add to the burden of the industry. – Steve Soliz, Bell Flight
Insufficient Weather Reporting
One of the hurdles for HAA operations is the large gaps in weather reporting, particularly in remote areas. HAA often operates into unimproved landing zones (LZs) where official weather stations are nonexistent. This lack of precise, real-time weather data can lead to no-go decisions that delay critical patient transport, or worse, increase risk if crews push limits.
Solution: NEMSPA is actively pursuing a crucial solution in expanding the FAA Weather Camera network. This includes not only includes the FAA’s own deployments, but also integrates third-party cameras from hospitals, state DOTs, and even private companies. NEMSPA advocates for policy changes to allow these camera views to be used for “go” decisions, not just no-go ones. We support robust training for pilots and dispatchers to interpret visual weather conditions effectively. This would provide invaluable situational awareness, enhancing safety and enabling more timely flights.
– Brett Reeder, NEMSPA Financial Sustainability
When reimbursement covers less than half of operating costs and payment delays extend beyond 100 days, programs must make trade-offs that affect service quality and their ability to meet demand. This involves everything from base placement
Photo: Bell Flight
to aircraft choice to staffing configuration. Making changes to the chronically underfunded system
without adding
pressure on patients, through mechanisms like the No Surprises Act, is a positive step forward. We can and should do more to ensure the sustainability of air medical services. Despite these funding gaps, forward-thinking operators are finding ways to specialize their services for the patients who benefit most from air medical care.
– Kyle Danielson, Flightline Strategy No Surprises Act
The No Surprises Act (NSA) was enacted in 2022 to prevent insured patients from being balance-billed for out-of-network air ambulance services beyond the in- network cost, and to prohibit high charges and public payer rates (like Medicare) when determining payment through an independent dispute resolution (IDR) process.
This is a shift towards a market-based approach to promote negotiations between insurers and providers that create fair in- network agreements. The goal is for the insurance company and the HEMS agency to enter an IDR process to settle payment disputes between out-of-network providers and health plans when they can’t agree on a payment amount for certain services. This process involves a government- certified third-party entity that acts as an arbiter and chooses between the payment offers submitted by the provider and the health plan.
Although HEMS agencies are winning approximately 80% of these denial appeals, payment is not occurring. It is
being reported that denials by insurance companies have increased by over 20% since the NSA has gone into effect. – Steve Soliz, Bell Flight
The Rise of Drones and Airspace Integration
The increase in drones poses a growing threat of near misses or strikes with HAA aircraft. A lack of standardized reporting makes quantifying this risk and developing mitigation strategies difficult. NEMSPA is actively seeking to address this by pushing for improved drone incident reporting and data collaboration.
As
highlighted by NEMSPA’s recent inquiries to organizations like ASRS, the goal is to create a centralized, easily searchable database for drone near misses and strikes. This accurate data is essential for informing regulatory bodies, developing effective airspace management strategies, and creating public awareness campaigns regarding safe drone operation around HAA flight paths and LZs. – Brett Reeder, NEMSPA
Effect of Tariffs
The new U.S. tariffs on replacement parts are unprecedented and have been reported as high as $300,000 for an engine rebuilt in Europe. These unplanned expenses prolong out-of-service times (AOG) and impact patient response, as some multi-aircraft companies have to move around assets to cover areas that are short an aircraft. One of our legislative discussions is the idea of advocating the re-implementation of the 1979 Agreement on Trade in Civil Aircraft, which made aviation parts duty-free. – Steve Soliz, Bell Flight
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