Cantwell, Snowe Introduce Bipartisan Bill to Set National Air Ambulance Safety Standards

Bill would extend same high safety standards WA currently meets to rest of nation, make interstate transport of patients safer

WASHINGTON, D.C. – Today, U.S. Senators Maria Cantwell (D-WA) and Olympia J. Snowe (R-ME) introduced a bipartisan bill to establish national safety standards for air ambulances that incorporate high safety standards previously implemented by Washington state and Maine.

The Air Ambulance Medicare Accreditation and Accountability Act (S. 1407) would, for the first time, tie Medicare reimbursements to national air ambulance safety standards, and restructure the reimbursement system to more accurately reflect investments in safety, ensure there is a strong incentive in place for safety improvements nationwide, and help Washington state air ambulances maintain their high standard of care.

In Washington state, residents of rural and underserved areas, such as Eastern Washington, the San Juan Islands or the Olympic Peninsula, depend on air ambulance transportation to access emergency medical services. For Washington, Idaho, Montana, and Alaska, the Seattle-based Harborview Medical Center is the only Level 1 Adult and Pediatric Trauma Center in the region, and patients are routinely transferred between these surrounding states. This legislation will make the interstate transport of patients safer by having all states meet the same high safety standards as Washington. 

“This legislation will ensure safer interstate transport of patients by extending to all 50 states the same high safety standards Washington currently meets,” said Senator Cantwell. “Many parts of Washington and the surrounding Pacific Northwest depend upon air ambulance services to safely transport patients to Harborview Medical Center in Seattle – the only Level 1 Trauma Center in Washington, Idaho, Montana, and Alaska. Washington has long been an innovative leader in health care, and this bill ensures that our air ambulance services are able to continue both their commitment to and investment in high safety standards. Revising Medicare reimbursements for air ambulances to better reflect investments in safety ensures there’s a strong incentive in place for safety improvements nationwide.”

Every day, approximately 400,000 patients and transplant organs are safely transported by helicopter. While Medicare reimbursement has recognized the substantial costs of those air ambulance providers that voluntarily meet the highest standards of medical care for patients, Medicare does not require adherence to those standards. Other regions of the country are witnessing inappropriate over-utilization of air ambulance services, which leaves patients stuck with thousands of dollars in bills. The Cantwell-Snowe bill seeks to correct Medicare policies that have resulted in a significant geographic variability in air ambulance medical capability, patient safety and quality.   

“One size does not fit all when it comes to lifesaving services provided to Medicare beneficiaries,” said Senator Snowe. “Unfortunately, current reimbursement rates have encouraged a race to the bottom among some air ambulance service providers. In one recent case, the lack of air conditioning in an air ambulance might have contributed to the death of an apparent heat stroke victim. Medicare has an opportunity and an obligation to improve the quality and value in our health care system, and reimbursement rates should recognize stronger performers. Air medical providers that fly safer aircraft and provide the highest quality care are struggling to survive on the current fee schedule. At the same time, air medical providers that skimp on those same quality and safety investments are making considerable profits at the expense of patients and taxpayers.”

From 2003 to 2008, there were 85 air ambulance accidents and 77 fatalities nationwide, and 2008 was the deadliest year with 29 fatalities. In 2010, there were 12 crashes nationwide with 7 fatalities. The last fatal air ambulance crash to occur in Washington state was in September 2006, when an Airlift Northwest helicopter crashed into Puget Sound, killing the pilot and two nurses aboard. In 2009, the National Transportation Safety Board (NTSB) examined the alarming number of air ambulance crashes and the underlying economics of air ambulance services, and provided 21 recommendations including the establishment of Medicare accreditation of air ambulances, consistent with Medicare mandatory accreditation of other health providers. 

Under S. 1407, the Secretary of Health and Human Services (HHS) is directed to set safety standards within one year of enactment and will reimburse only to accredited air services within two years of enactment. The legislation also establishes “never events” for which Medicare reimbursement will not be provided, including patient death or serious disability caused by medical transport vehicle failure or crash, or responding without a formal request. Air ambulances will continue to be licensed by the state in which they are based.