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November 23, 2010

Ohio critics: Competition between medical helicopters puts patients at risk

By Hagit Limor

CINCINNATI — The skies above the Tri-State are getting crowded these days. While the number of flights into the local Cincinnati Northern Kentucky International Airport have dropped precipitously, the number of medical helicopters circling the skies has grown exponentially.

No less than seven medical helicopter companies and hospitals now serve the counties in this region of Ohio, Kentucky and Indiana. Critics said competition has led to unnecessary flights at a great cost to patients and their insurance companies.

"I think we're flying a lot of people who don't need to fly, that aren't serious enough to fly," said one local emergency worker.

The worker, fearing job loss, wouldn't let us share his or her identity, but the I-Team spent weeks talking to doctors, medics, hospital administrators and representatives of several medical helicopter services to put together a picture of this increasingly competitive industry.

The granddaddy of all local services is University Hospital's Air Care, one of the nation's most established programs. Unlike 96 percent of other medical helicopter services, it staffs every flight with an emergency doctor and a specialized nurse. It also carries advanced drugs and blood and can carry two patients or a patient and relative due to its dual engines.

"We can bring the hospital to you instead of getting you to the hospital," said flight doctor Jason McMullan.

Competitors said none of that matters if it takes Air Care up to 30 minutes to arrive to their rural destinations.

"The quicker that you can start treatment the better the outcomes are," said Brown County General Hospital CEO Mike Patterson.

Patterson said Air Care is great, but service to patients in his region has improved since Air Evac Lifeteam landed its chopper on his hospital grounds in Georgetown, Ohio. Air Evac is one of several private, for-profit medical transport businesses that have come into the region, expanding service to outlying counties.

The competition ramped up after the federal government changed rules this decade that made it more profitable for private companies to get into the business. The base manager for PHI, another service that's based in Morehead, Ky., between Cincinnati and Louisville, said there are fewer rules regarding medical requirements than exist to fly the choppers.

"It's not impossible for anybody that has the money to go get a helicopter, to get themselves certified, get the certified pilots and to start up a service," said Darren Graham.

Selling memberships
Air Care's clinical director, Teri Grau, said the company's mission makes a difference. "I can tell you our mission is all about saving lives, and we have completely focused all of our efforts and energy on providing the highest quality care for our patients."

Private companies said that's their mission too. But they've added a few nuances to their business model. Unlike University's Air Care, several of the for-profits sell memberships in the community.

We found Air Evac's local representative, Kathy Lewis, flanked by a crew from the Georgetown Fire Department, selling memberships at the Brown County Fair. Her sales pitch: For $60 a year, a family can make sure they'll get no bills should emergency strike and Air Evac flies them to a hospital.

But competitors said what Air Evac's Lewis calls "peace of mind" in reality represents a waste of money. There's no guarantee in case of emergency, medics would call the helicopter company a patient has joined. It could be any of half a dozen nearby. Further, the vast majority of people will never need this service.

"I think that the odds of you needing a helicopter, really needing a helicopter in any given year, are about the odds of you winning the Powerball," said Dr. McMullen.

Regardless, all medical helicopter services fly patients whether or not they're members. The flights are their bread and butter. They charge $17,000 and up, billing insurance companies first, but the uninsured or underinsured must pay any balance. University Hospital's not-for-profit Air Care said it soft bills patients who can't pay, forgiving their debt. Most private companies work out payment plans of some sort.

Conflict of interest?
It's the business model that worries critics like the emergency worker who talked with us without identification. The worker said there's a conflict of interest because Lewis doesn't just represent and sell memberships for Air Evac, she also serves on the Georgetown Life Squad. The worker said Lewis' friendships with surrounding EMS crews have led them to call Air Evac for cases that could transport much cheaper by ambulance. "It's coming down to where they're flying everything."

We tried to talk to Lewis but she refused. Her corporate overseers also would not not talk to us on camera or on a recorded conversation. The company's director of base operations, Andy Arthurs, said the company forbids even the appearance of a conflict of interest, but he didn't directly address why the situation with Lewis didn't raise any flags.

Air Care's Dr. McMullen said there's a difference between a not-for-profit hospital and a corporation like Air Evac. "When motivation is from the corporate side, which is profit, as opposed to medical care and safety, which is what comes from Air Care, you can get some conflicts there."

The CEO of Brown County General Hospital disagrees. Mike Patterson said he's noticed no shortcuts on Air Evac's flights. "I have not observed that or has anyone come to me with any complaints."

Patterson said the service has cut the time his patients can get to advanced medical help in the city. "It has enhanced the level of care."

That's a point we heard from the president of the Brown County Life Squad and Rescue Association. Chris Hauke serves as a paramedic on the nearby Ripley squad. "It's all about getting the patient where they need to be the quickest. That means better outcomes for the patient."

Air Care's Dr. McMullen said those outcomes begin in the field, that a few extra minutes may be worthwhile to get advance expertise and equipment. "Do you want your vehicle to get to you fastest or do you want the highest quality medical care to get to you the fastest?"

Hauke said his squad and others make decisions based on what is best for the patient. He believes the closest helicopter should always get the call. He defends Lewis, whom he knows professionally, and said that while medics may sometimes err on the side of caution, they're not making calls to increase profits for anyone.

"I don't see any conflict with Kathy (Lewis) being an employee of Air Evac and being a volunteer on the life squad," said Hauke.

Again, Lewis wouldn't talk to us or allow us to shoot at Air Evac's building. Arthurs defended his company's practices and level of care.

Republished with permission from