Reach C by Joshua E. Gilmore, MBA, gs In Missour ‘al Level ChiefExecutive Officer, Iron County Medical Center (NAPSA)—Ruralhealth care is in a nationwidecrisis, and it is no moreevident than right here in Missouri. Just last month, the Twin Rivers Regional Medical Center in Dunklin County closed for good,forcing many residents to drive more than an hourto the closest hospital. According to the NC Rural Health Research Program at the University of North Carolina at Chapel Hill, 86 rural hospitals have closed since 2010, and, according to iVantage’s The Hospital Vulnerability Index, 673 are at risk nationally. Besides TwinRivers, thestate of Missouri haslost the Southeast Health Center in Ellington (2016), the Parkland Health Center (formerly Mineral Area Regional Medical Center) in Farmington (2015) and the Sac-Osage Hospital in Osceola (2014). In addition,four other health care facilities outside the research program's definition ofhospital haveclosedaswell. Think about a pregnant woman who goes into premature laborin the mid- dle ofthe night, someoneinvolved in a life-threateningaccident or who has had a stroke where treatment is needed in minutes...and the closest medical care center is more than 50 miles away. “Medical help is growing danger- ously distant...in rural America, wrote Air ambulancesgetcritically ill Missourians to the medical help they need whenthey need (D-MO)hasintroduced billthat attempts to controlcosts, but it could have negative unintended consequences.Thisbill aims to change40 years of standardized, federal governmentregulation by allowing statesto individually oversee the medical portion offlights. “State regulation might soundlike a good idea, but to those of us wholive this every day we knowit isn’t?said Bill Patt, EMSdirectorfor Steelville Ambu- lance. “This patchwork quilt of regulations, coupled with Medicare reimbursementratesfalling way below the 50 percent range, will cause more harm than good,forcingair ambulance com- panies to close bases that are the only connection between our community and advanced medical care. We need solutions, not more red tape makingit harderforpatientsto get the critical care Jack Healy recently in The New York they need? Times.“Specialists are increasingly clusUnlike air ambulances, ground tered in bigger cities” ambulancesare regulated by individual In Missouri, nearly 2 million peo- ple live in ruralareas and for them air ambulances increasingly serve as a bridge to critical care. According to a 2017 report from the Association of Air Medical Services (AAMS), “75 percent of air medical Medicare transports are designated as rural” and an air ambulanceis often the difference betweenlife and death. Asvital as air medicaltransportis for millionsofruralresidents,the serviceis coming underincreasing pressure from Washington in reaction to reports of individuals being surprised by enor- mousbills, some more than $30,000. ‘Thereal problem with costisn’t gouging air ambulance companiesbutratherthat Medicaid and Medicare are still reim- bursing based onrates set 20 years ago that don’tline up with the cost of oper- ating flying ambulances in 2018. Addi- tionally, someprivate insurance companies use the governmentrate asthebasis for payments, which is often far below the cost of providing the service. Our own Senator Claire McCaskill states, and while one might assumethat states have agreementsin placeallowing forinterstate transport, many donot. More than 90 percent of air ambuJance transportsare with patients suffering from cardiacarrest,strokes or severe trauma,so getting them to theclosest, mostappropriate medicalfacility is crit- icalto savinglives. According to AAMS, nationally, 30 percentofall air ambulanceflights are rural, but thatfigure is more than 50 percent here in Missouri. Rural health care is in crisis as the epidemic ofhospital closings, like Twin Riversin Kennett, clearly shows. “Air ambulances are helping to fill the gap in getting critically ill, rural patients to the medical care they need? said Seth Myers, president of Missou- ri-based Air Evac Lifeteam. “Instead of trying to change the uniform system of national regulation that allows patients to be transported to the facility they need,regardless of where itis located, the governmentneedsto focus onthebigger issue, which is outdated Medicare and private insurer reimbursementrates.”
