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Demand for Texas Air Transports Grow as Budgets Limit Rural Capabilities

EL PASO - Demand for air medical transport services - an expensive but often lifesaving option - is growing as an aging baby boomer population suffers increasingly serious health problems and budget cuts limit rural medical center capabilities, experts say.

Sierra Providence Health Network recently announced it will operate a helicopter designed as a flying intensive-care unit around the clock. Las Palmas Del Sol Healthcare opened a new helipad at Del Sol Medical Center. Del Sol also plans to contract helicopter services in the future. El Paso's University Medical Center, a "Level 1" trauma center, also has a helipad. Both private hospital networks tout the benefits of being able to quickly respond to health problems such as strokes, heart attacks and serious accidents that require immediate attention. Representatives from the hospitals could not be reached for comment.

Residents of rural far West Texas and southern New Mexico now will have access to specialists and high-tech equipment in the area's hospitals. With a range of about 150 miles, the service will reach Silver City, Ruidoso, Truth or Consequences and Van Horn.

By law, transport is provided regardless of ability to pay, said Dawn Mancuso, executive director and chief executive officer of the Virginia-based Association of Air Medical Services.

The flights are not cheap, and although the cost varies, Mancuso estimated an air transport would cost about $5,000 compared to $500 for an ambulance.

Getting paid can be a problem, she said. About a third of El Paso residents are without health insurance. Medicaid and Medicare use a fixed reimbursement schedule that does not cover the full price, she said.

And there are requirements, both for private and federal insurance, that must be met. The flightmust be "medically necessary" and the patient must be flown to the nearest appropriate medical facility, Mancuso said. If it's determined to not be medically necessary, an insurance company will downgrade the payment to ground ambulance rates, she said, "or they may deny paying the bill altogether."

"Maintaining it (a medical flight business) can be a challenge," Mancuso said. "You only get paid when you transport a patient. If you go out and you don't transport a patient, you don't get paid."

On top of that are the rising costs of fuel and accident insurance, she said.

Nonetheless, Sierra Medical Center now has its own air medical transport. It uses a traditional setup where the service is based at the hospital, Mancuso said. Omniflight Helicopters was contracted to operate the aircraft. Other business models include government operations that can tax to pay for the service, such as the state police in Maryland, she said, and private operators that fly out of the local airport or hospital.

If demand increases, then the service becomes more financially feasible, she said.

In 2002, about 400 dedicated emergency medical service helicopters operated nationwide, according to association data. By 2008, that number had grown to more than 800.

"Demand has grown for a lot of reasons," Mancuso said. Smaller community hospitals that do not handle the same patient loads often cannot afford to buy expensive equipment or keep medical specialists on staff.

"So hospitals with those resources are limited to certain areas, particularly urban areas where they have larger populations," Mancuso said. "In many rural and frontier areas ... air ambulances provide critical access to hospitals."

State budget cuts could affect services in Texas even further, said Denise Rose, the Texas Hospital Association' s senior director of government relations.

The Legislature is considering a budget that would cut uncompensated care funding by 23 percent, Rose said. Over the last two years, hospitals received $75 million each year, she said. The proposed budget would allocate $57.5 million for each of the next two years, she said.

Smaller hospitals could stop taking trauma cases, which traditionally are not profitable, she said. That likely would result in more calls for air transport, Mancuso said.


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