CHAMP

Champions in Safety.  Champions in Care.

Medical Necessity is NOT Physician or HEMS Operator Opinion.

In its review of documents associated with the 26 deadly medevac crashes in the United States since 2003, the Baltimore Sun claimed that the helicopters were sometimes used in situations that were not immediate or life-threatening. “At least eight involved patients who waited longer for a helicopter than a ground ambulance might have needed to drive them to a hospital. And at least six were for patients discharged soon after a helicopter dropped them off at a hospital, or who survived a lengthy ambulance ride after the helicopter sent to get them went down,” according to the Sun.

HEMS transport is a dangerous, expensive, and stressful medical procedure, and is only appropriate when medically necessary.  Medical ethics do not permit the performance of unnecessary hazardous procedures.

The Centers for Medicare and Medicare Services (CMS) of the US Department of Health and Human Services (DHHS), through negotiated rulemaking with providers, has established standards for medical necessity of various modes of medical transportation, including HEMS.  

HEMS participating Medicare providers agree to:

– bill the government only for services provided in accordance with CMS medical necessity standards,

– inform patients and provide an estimate of charges in advance when services may not be covered,

– submit only factual statements of medical necessity.

The essential components of HEMS medical necessity are threefold:

1. The patient cannot safely remain where they are.  

 Scene calls nearly always pass this test.

2. The patient can only appropriately be transported by HEMS, as no alternative method is reasonable.

HEMS missions frequently fail this test, with little or no prospective utilization review, or meaningful application of medical necessity standards.  

3. The patient is being transported to the closest appropriate facility.

Again, HEMS missions frequently fail this test, charging patients, taxpayers, and insurers for transport beyond the closest appropriate facility, most commonly to fly patients to hospitals affiliated with the referring facility.

If a medical transport fails to meet any of these standards, it is not medically necessary.  As any HEMS mission is inherently dangerous, expensive, and stressful, it is unethical to provide unnecessary HEMS.  

And unnecessary HEMS is often unlawful.  It is a federal felony for a participating Medicare provider to submit a claim for reimbursement for unnecessary services, or to make any false representation to promote payment, such as an inaccurate or false physician statement of medical necessity, or inaccurate or false patient care report.  These prohibitions apply regardless of whether the claim is approved, or any payment is made.  

And it is unlawful to bill a Medicare beneficiary for services not covered by Medicare, unless the patient’s informed consent is secured in advance of service through execution of an Advance Beneficiary Notice.

Are you involved in unethical provision of needless HEMS?  

Do you know what your HEMS operator charges?  Do your patients?  

CHAMP expects HEMS operators to adhere to CMS standards of medical necessity.