Sep 10, 2019

How air ambulances got so expensive

Illustration: Rebecca Zisser/Axios

Air ambulances have become a lucrative business over the last few decades, at patients' expense, fueled by private equity and aided by the industry's relationships with providers, John Hopkins' Marty Makary writes in a new book out today.

Why it matters: The rise of the air ambulance industry has resulted in massive surprise medical bills and a spike in unnecessary use.

  • Congress has included air ambulances in its effort to crack down on surprise medical bills, and the industry is fighting to avoid this regulation.

Background: Air ambulances used to be owned and operated by hospitals, which sometimes took financial losses on their helicopter programs.

  • But that changed when investors saw a profit opportunity and began buying the ambulance services from hospitals. They then billed patients directly for rides.

By the numbers: Between 2007 and 2016, the average price charged by one air ambulance company for a transport rose from $13,000 to $50,000.

  • With this kind of money on the table, the number of air ambulance companies rose by 1,000% between the 1980s and 2017.

People in rural areas are hit the hardest. While some of these transports are necessary and life-saving, many others could be avoided, Makary writes.

  • Of the more than half a million ambulance flights a year, 80% aren't emergencies, but rather more like routine transfers.
  • To grow their business, companies began paying paramedics, nurses and doctors to become advisers with "informal agreements" to promote the company to emergency personnel and other providers.

The other side: Air ambulances say that they have to charge higher rates to commercially insured patients to make up for lower government rates.

The bottom line: "The air ambulance industry has become big business in America," Makary writes.

Go deeper: Air ambulances are expensive and most likely out of network

Go deeper

Air ambulances create memberships for patients

Photo: Don Kelsen/Los Angeles Times/Getty Images

Air ambulance companies are selling memberships as assurance that if a patient needs their services, they won't get slammed with massive bills. But these subscription services have drawn national skepticism, Kaiser Health News reports.

Between the lines: Air ambulances often aren't covered by private insurance, and they're becoming more expensive at the same time that they're becoming more necessary in rural areas without access to emergency care.

Go deeperArrowSep 17, 2019

Physician staffing groups are behind the surprise medical bills ad blitz

Physician staffing groups that generate large amounts of surprise medical bills are behind Doctor Patient Unity, the dark-money group running $28 million in ads against Congress' effort to crack down on surprise bills, the New York Times reports.

The two staffing groups, TeamHealth and Envision Healthcare, supply emergency room doctors, radiologists and anesthesiologists to hospitals — specialties that are among the most likely to be out-of-network for patients. Both groups are backed by private equity.

Go deeperArrowSep 16, 2019

Hospitals' dog in the surprise billing fight

Illustration: Rebecca Zisser/Axios

Although the surprise billing debate is often framed as a battle between insurers and doctors, hospitals also have a huge financial stake in the issue and are fighting tooth and nail to make sure they get their way.

Why it matters: Congress' effort to rein in surprise medical bills is on the rocks, thanks largely to industry opposition, and its failure would leave patients at risk.

Go deeperArrowSep 13, 2019