The Advocate - The Association of Critical Care Transport's Official Newsletter

Beginning nearly three years ago, Survival Flight, the University of Michigan’s medical transport programs flight nursing staff, embarked on a journey to provide point of care ultrasound for patients during transport.

Since designing and implementing their program, they have increased their knowledge base, usage, skill sets and education in relation to Point of Care Ultrasound. Their team recently presented a paper at the American College of Emergency Physicians’ meeting regarding the educational aspect of their training, and recently submitted a scientific paper for review and possible inclusion in the AirMed Journal. Their team is also presenting at the SAEM conference in Las Vegas in May of 2019.

But how did they get started down their journey to POCUS?

Read more to learn about how they began.

Jeremy Benson, BS, MS-CCP, FP-C, CMTE, was named the 2018 ACCT Patient Advocate Award winner during ACCT’s Fall Leadership Meeting. 

The ACCT Patient Advocate Award, sponsored by SevenBar Aviation, is given annually to recognize an outstanding ACCT member employee for his or her tireless and often unrecognized efforts to fulfill our promise to critical care transport patients.

Jeremy serves as a clinical base manager for University of Mississippi AirCare. He also extends his commitment to clinical excellence by volunteering to chair the standardization committee aimed at improving efficiency and delivery of medical care across the State of Mississippi.

Jeremy has been instrumental in developing a critical care orientation program that has doubled in size over the past two years. This growth led to the development of a critical care team that can provide advanced critical care medicine to any patient of any age for up to 12 hours in any vehicle or environment. With Jeremy’s involvement, this team has changed the way the State of Mississippi responds to disasters, high-risk events and mass gatherings.

Jeremy’s focus is intense, directed and visionary. He goes beyond his regular job duties in many ways. Team members refer to Jeremy as “the solver” and that is how he is designed, from solving small issues like trash pick-up to more complex issues with opening new bases.

The ACCT Patient Advocate Award is Sponsored by SevenBar Aviation.

ACCTSponsorLogo 7bar 300px

 

 

This article is republished from the June 2018 edition of NIOA News, the official newsletter of the National Information Officers Association

This is the story written by and about my good friend Betsy Randolph’s journey through PTSD. It was brought on by the accumulation of years of trauma on top of trauma until Betsy reached the “tipping point” that nearly sent her to the place of no return.

The encouraging part of Betsy’s story is that she finally realized that reaching out for help was not a weakness but rather a sign of strength.

Thanks to Dr. Tania Glenn and her use of Eye Movement Desensitization and Reprocessing (EMDR), a technique that has been extensively researched and proven effective for the treatment of trauma, she found her way back to a normal life from the PTSD that nearly destroyed her.

Read the full article here

View the full NIOA newsletter here. 

 

The FAA Reauthorization Act of 2018 (H.R. 302 Division B) was passed by the House by a vote of 398 to 23 on September 26. The bill will authorize FAA funding and programs until 2023. The version that House passed incorporated several compromises that legislators believed would allow it to pass both the House and Senate.

Notably, the language would reauthorize the National Transportation Safety Board and the Transportation Security Administration and would expand oversight of the Next Generation (NextGen) technology upgrade program.
During these House and Senate negotiations, ACCT strongly urged Senate committee leadership to include Sections 412 and 413 of the House-passed FAA Reauthorization Act (H.R. 4), which, among other things, included crucial language that would remove non-air transportation services of air ambulance operators from oversight under the Airline Deregulation Act (ADA), introducing an important consumer protection that would help prevent high consumer costs, or “balance billing,” by allowing states to regulate the rates and services of air ambulance providers.

While this specific language was not ultimately included in the final negotiated package, slightly modified language from Sections 412 and 413 was added to the final compromise package, including the authorization of an Advisory Committee on Air Ambulance and Patient Billing that would make recommendations with respect to disclosing charges and fees for air ambulance services and the prevention of balance billing. A report by the Advisory Committee would also inform future rulemaking to discuss data reporting, transparency, and the development of further protections for air ambulance customers. These provisions, while altered, represent a significant first step toward greater transparency and patient protections in the air ambulance industry. In addition, the FAA reauthorization bill also includes provisions for the submission of complaints by air ambulance customers as well as a report to Congress on air ambulance oversight.

The Senate gave final approval to the reauthorization bill on October 3 by a 93-6 vote. The President signed the bill on October 5, marking the first long-term reauthorization for the agency since late 2015 and its longest since 1982.

This fall CMS released a proposed rule entitled “Regulatory Provisions to Promote Program Efficiency, Transparency, and Burden Reduction.” The proposed rule was developed in response to President Trump’s executive order that instructed agencies to look for ways to reduce regulatory burden. The agency also notes that the rule was informed by stakeholder feedback submitted in response to CMS requests for information (RFIs). If finalized, CMS estimates the policy would save $1.12 billion annually.

Broadly, the rule proposes policies that CMS believes will reduce regulatory burden on providers and suppliers through changing, removing, or streamlining current regulations believed to be excessively burdensome. Many of the proposals involve conditions of participation (CoP), conditions for coverage, and other participation requirements.

On October 3rd, the United States Senate passed a bipartisan opioids package with a sweeping vote of 98 to 1, after the U.S. House of Representatives passed the final version of the bill with a vote of 393 to 8. The President signed the bill into law on October 24. The 660-page bill encompasses over 75 pieces of legislation from both the House and Senate and includes several provisions that would expand access to addiction treatment, including a proposal to allow Medicaid reimbursement for additional inpatient addiction treatment facilities by partially lifting the decades-old Institutions for Mental Diseases (IMD) exclusion rule. However, the bill did not address one of the most significant issues that arose during the development of the legislation: Part 2 privacy for substance abuse records.

Other policies focus broadly on prevention, research and data collection, payment and reimbursement, support for local communities, target patient populations, law enforcement, and prescribing processes and practices. While there appear to be many policy changes, some argue that the efforts are low-hanging fruit and that the bill does not include enough federal investment.

Click here for a section-by-section summary.

On September 25, the House passed by voice vote the Pandemic and All-Hazards Preparedness and Advancing Innovation Act (PAHPAI) of 2018. The bill updates the PAHPA framework to address 21st century public health threats including the spread of infectious diseases or chemical, biological, radiological or nuclear attacks. The bill would authorize $7.1 billion for the period from fiscal 2019 through 2028 for the Project BioShield special reserve fund used to purchase medical countermeasures.

The bill also would reauthorize the following amounts annually through fiscal year (FY) 2023:

  • $685 million for Public Health Emergency Preparedness cooperative agreements with states.
  • $611.7 million for ASPR’s Biomedical Advanced Research and Development Authority (BARDA).
  • $610 million for the strategic national stockpile of medical countermeasures.
  • $385 million for the Hospital Preparedness Program.
  • $161.8 million to support CDC biosurveillance and situational awareness activities.
  • $100 million for CDC grants to states to prevent and control mosquito-borne diseases.
  • $57.4 million for the National Disaster Medical System.
  • $40 million for the CDC’s Epidemiology and Laboratory Capacity grant program, the same amount it receives in fiscal 2018.
  • $30.8 million for CDC vaccine tracking and distribution activities.
  • $11.2 million for the Volunteer Medical Reserve Corps.
  • $5 million for an emergency system for advance registration of health professional volunteers.

The Senate passed a similar bill (S. 2852) out of committee in June, but with authorities expiring September 30, 2018, there is a sense of urgency. The House and Senate are expected to reconvene in Washington following the election for a lame duck session around November 13th.

The President signed an appropriations package that included five spending bills – 75-percent of the government funding – and the rest funded through Dec. 7th. The appropriations “minibus” funding bill includes the Department of Defense (DOD), the Labor, Health and Human Services (HHS) and Education Appropriations bills for the fiscal year 2019, as well as a short-term Continuing Resolution (CR) to temporarily fund remaining government programs until December 7, 2018. The bill includes $90.5 billion for HHS – $2.3 billion increase from fiscal 2018 – increased funding to combat the opioid epidemic and gives Substance Abuse and Mental Health Services Administration (SAMHSA) an increase of $500+ million.

As noted above, there are a few agencies operating under a CR through December 7, 2018. One of these is the Food and Drug Administration (FDA). With the FDA at the center of some of the Administration’s prescription drug proposals and the election outcome unclear, FDA funding could become a sticking point in Congress. Congress will address funding for the remainder of the year when they reconvene in Washington following the election for a lame duck session around November 13th.

A few weeks ago, we shared a Holland & Knight memo regarding the Trump Administration’s proposed rule regarding “Public Charge” provisions of immigration law.

Here is a link to a new Kaiser Family Foundation analysis of the potential effects of the proposed public charge rule that was officially published on October 10.

Among other things, the study shows that nearly all noncitizens who entered the United States without legal permanent resident status have at least one characteristic that would be weighed negatively in a public charge determination, and that potentially over 2 million Medicaid/CHIP enrollees living in a family with at least one noncitizen would disenroll from these programs.

Jonathan “JR” Roebuck

Jonathan “JR” Roebuck, remote access project manager for LifeFlight of Maine and MedComm, was honored at the Helicopter Association International’s Salute to Excellence Awards Dinner at HAI Heli-Expo 2018 in Las Vegas, Nevada. He received the 2018 Airbus Helicopters Golden Hour Award.

Roebuck was honored for his work in the creation of the Remote Access Project.

LifeFlight Eagle is expanding its service and adding its first ground critical-care ambulance in the Kansas City region.

The ambulance will conduct only interfacility transports, and will initially be used only when the program’s aircraft are unable to fly because of inclement weather.

“Creating a ground transport option helps us fill a critical gap in the service we provide,” said Jeff Willhite, LifeFlight Eagle’s vice president of program operations. “Our rural hospitals have extremely sick patients they need to get to the city, regardless of what weather conditions might be. Now we can still serve those hospitals and their patients’ need for critical care, even if we aren’t able to provide the speed of an aircraft.”

“It’s a win for local EMS, too. It reduces the burden on 911 services, who have to pull an emergency response ambulance off the street to conduct these long transports out of their communities.”

The House Energy and Commerce Committee will hold the first of two markup sessions to vote on opioid legislation on Wednesday, May 9. This follows the marathon session that the Health Subcommittee held prior to going to recess when they advanced 57 bills attempting to combat the opioid crisis, 48 of which passed by voice vote. The bills include policies to improve patient safety, enforcement, and prevention as well as coverage and payment issues with Medicare and Medicaid. The second markup will held on May 17th.

Click here for more of the two markups from the Committee.

Research shows laser eye damage possible at extended ranges

By Tammy Chatman, Flight For Life

A Coast Guard helicopter crew member suffered eye damage when he was stuck by green laser lights while training in Coast Guard Air Station/Sector Field Office Port Angeles, in Washington State, on March 21, 2018.

He and two other members of the MH-65 Dolphin helicopter crew landed safely after being hit by a laser several times that evening.

The aircrew was immediately examined by the duty corpsman. After consultation with the flight surgeon, two of the three aircrew members were medically grounded until they were seen by an optometrist.

One of the crew members was found to have suffered eye damage and was grounded for seven days. The other crew member was grounded for two hours but has since returned to duty.

Because members of the crew were medically grounded, Naval Air Station Whidbey Island and Sector Columbia River in Warrenton, Ore., became responsible for covering the Port Angeles station’s area of until Port Angeles aircrews were medically cleared. This of course created a delay for any emergent situations due to the distance the backup teams had to travel.

ACCT members gathered in Washington on April 17th and 18th to build support for the “Air Ambulance Quality and Accountability Act” (H.R. 3780) and to discuss drug shortages affecting critical care transport (CCT) providers.

Capitol Hill Day participants received a warm reception from lawmakers regarding these priorities. ACCT participants held over 60 meetings and garnered a great deal of support for H.R. 3780, adding more cosponsors.

In addition to their meetings with their congressional representatives, Capitol Hill Day participants had the opportunity to hear from Preston Bell, Legislative Director for Congressman Richard Hudson (H.R 3780 sponsor) and Puja Patel of the American Heart Association (AHA) to learn about their credentialing program and their partnership with the Joint Commission. The discussion served as an opportunity for ACCT members to ask questions to learn about the benefits and challenges of such an approach in the CCT space. Finally, participants received a midterm election forecast from two former deputy chief of staffs.

We encourage all ACCT members to utilize the attached ACCT Advocacy Toolkit to reach out to your members of Congress to urge them to show their support for the air ambulance community by cosponsoring H.R. 3780. As we approach the 2018 election, the time is now to continue to make big steps towards getting this legislation enacted into law.

On April 27th, the U.S. House of Representatives passed a five-year Federal Aviation Administration (FAA) reauthorization bill, FAA Reauthorization Act of 2018 (H.R. 4). H.R. 4, which would reauthorize the aviation regulator through the 2023 fiscal year and included disaster-related provisions that would alter Federal Emergency Management Administration (FEMA) policy, but did not include controversial language to privatize air-traffic control systems, though it does include a requirement that the FAA report on NextGen ATC development. The FEMA rider aimed to give the agency more flexibility in providing grants for infrastructure construction used to mitigate future natural disasters, and was likely included in an attempt to garner Democrat votes for the package. 

The question now becomes what changes, if any, the Senate will require so that it too solicits the votes necessary for passage. Senator John Thune, R-S.D., said he hoped the Senate would now act on its own FAA reauthorization bill after the House measure passed. The Thune-sponsored bill would authorize the FAA through 2021 — two years shorter than the House version — and doesn’t include the disaster title. Current authority for the FAA expires Sept. 30.

The Trump Administration is pursuing a new policy that could jeopardize the status of dozens, if not hundreds, of Critical Access Hospital across the United States. The issue involves the location of designated Hospital Outpatient Departments within 35 miles of a CAH. CMS now says that an HOPD is an extension of a hospital and, therefore, a CAH within 35 miles of an HOPD is in violation of the rules. How this impacts existing CAHs that had been designated as Necessary Providers (prior to January 1, 2006) is unclear. In 2013, the Office of Inspector General audited all the critical access requirements and found a number of critical access hospitals didn’t comply.

On Friday, April 6, 2018, Health and Human Services Secretary Alex Azar named Adam Boehler, the founder and former CEO of Landmark Health, as the deputy administrator and director of the Centers for Medicare & Medicaid Services (CMS) Innovation Center. Created under the Obama Administration through the Affordable Care Act, the CMS Innovation Center supports the development and testing of new healthcare payment and service delivery models.

Member Spotlight: Ann & Robert H. Lurie Children's Hospital of Chicago Transport Team

Lurie Children's Hospital Transport Team Communication Center acts as the entry point for over 5,000 transfers annually into the free-standing Children's hospital in downtown Chicago. In addition to acting as the entry point for transfers, the Communication Center triage RN is the entry point for requests for telemedicine consults from physicians in the community. Emergency Care Connect, Lurie Children's Emergency Department (ED) based Telemedicine Program, provides a means to connect children in the community with the care they need, when they need it. It provides a means to connect with the expertise of top specialists at Lurie Children's.

The 2018 National EMS Memorial Service (NEMSMS), honoring 36 air medical and EMS providers will be held at National Harbor on 19 May during the Weekend of Honor which runs from 18-20 May. New this year will be the NEMSMS's first annual Line-of-Duty Death(LODD) Seminar as part of its 2018 Weekend of Honor. The seminar is Friday, May 18, 2018, from 10:00 a.m. until 4:00 p.m. and is open to all who serve in EMS, Air Medical, Fire Service, or Law Enforcement and is offered at no cost to participants. Chaplains and other support personnel are also invited to participate. 

For more information on the National EMS Memorial Service and the LODD Seminar see the links below:
http://www.national-ems-memorial.org/ 
http://www.national-ems-memorial.org/lodd-seminar-registration/ 

  • Also the dates for the National EMS Memorial Bike Ride have been announced.
    East Coast Route will be 12-18 May ending at National Harbor to kick off the Weekend of Honor.
    Southern Route will be 20-22 May.
    Midwest Route will be 25-30 of June.
    Colorado Route will be from 24-27 July.
    West Coast Route will be 25-29 of September.
    Details can be found on the website at www.muddyangels.org 

Last week a drone may have been involved in the crash of an Robinson R-22 being flown near Charleston, SC, by a private helicopter instructor and trainee. That comes on the heels of the first confirmed strike of an aircraft in the U.S. by a drone on 21 September 2017, when a UAV being flown illegally by a hobbyist pilot hit a UHM-60 Black Hawk helicopter over Midland Beach in Staten Island, New York.

Fortunately, no injuries were reported in either incident. It brings to question growing concerns about what will happen when -- not if -- more drone strikes on helicopters occur. 

It is projected that nearly 3 million drones will have been sold in 2017 though the final numbers are not yet in.

ACCT members have garnered a great deal of support for H.R. 3780, adding more and more cosponsors. This increase in support is due to the time and effort spent by ACCT members educating their members of Congress.
Our recent success has shown that we have the ability to make real movement happen on this bill and we need you to continue in your outreach. Please utilize the attached ACCT Advocacy Toolkit to reach out to your members of Congress to urge them to show their support for the air ambulance community by cosponsoring H.R. 3780. As we approach the 2018 election, the time is now to continue to make big steps towards getting this legislation enacted into law.

ACCT will hold a Capitol Hill Advocacy Day on Tuesday and Wednesday April 17th and 18th to build support for this important legislation. The Hill Day provides members the opportunities to share ideas and educate their legislators on how decisions made in Washington impact CCT patients across the country. We hope you will join us in Washington! If you would like to participate, please e-mail Roxanne Shanks at This email address is being protected from spambots. You need JavaScript enabled to view it. by March 16th.

Click here for a flyer and hotel information.

Following a brief partial government shutdown, the Senate passed the latest continuing resolution -- Bipartisan Budget Act of 2018 -- by a vote of 71-28 in the early hours of February 9 followed promptly by passage in the House of Representatives by a vote of 240-186, and ultimately signed by the President. The bill extends government funding at current levels through March 23, and lawmakers hope to use the interim time to negotiate a complete omnibus spending bill to fund the government through September 30, the remainder of fiscal year (FY) 2018.

Notably, the funding resolution includes Medicare add-on payments for ground ambulances that will be in effect for five years (December 31, 2022), including the 3 percent increase for ground ambulance trips originating in rural areas, the 2 percent increase for ground ambulance trips originating in urban areas, and a "super rural" add-on of 22.6 percent for ambulance services in the "lowest population density" areas.

The White House released President Trump's fiscal year (FY) 2019 budget proposal, which calls for significant cuts to Medicaid while increasing funding for efforts to combat opioid misuse. The budget is viewed as a blueprint for federal funding requests. Congress ultimately drafts and approves federal spending measures.

Notably, the Department of Health and Human Services (HHS) would receive $68.4 billion under the budget proposal, which represents nearly flat funding from last year's request but represents a $17.9 billion or 21 percent decrease from the 2017 enacted level.

The Centers for Medicare & Medicaid Services (CMS) extended for another six months its moratoria on new Part B non-emergency ground ambulance suppliers in New Jersey and Pennsylvania. The extended moratoria will run through July 29, 2018. The extension also applies to new non-emergency ground ambulance suppliers in Medicaid and the Children's Health Insurance Program (CHIP) in those states. CMS implemented the moratoria on newly enrolling Medicare providers and suppliers after it identified patterns of fraud, waste or abuse among these particular provider types and geographic locations.

In 2016, the ACCT Standards Committee released version one of its Critical Care Transport (CCT) Standards (available at www.ACCTforPatients.org). This first version included Always and Never Event as well as safety metrics adapted to CCT from the Joint Commission on the Accreditation of Hospital Organizations. The Standards Committee had wrestled with establishing clinical metrics for the standards as well. We began to evaluate the clinical metrics being submitted to the Ground and Air Medical qUality in Transport (GAMUT) database by some of our members. Recognizing that GAMUT was supported by the Air Medical Physician Association (AMPA) and the American Academy of Pediatrics (AAP) and that the Commission on the Accreditation of Transport Systems (CAMTS) was utilizing the GAMUT metrics for its accreditation process for all levels of transport, it was recommended that we evaluate how a relationship between ACCT and GAMUT could be mutually beneficial.

Last March, the NTSB concluded its accident analysis of the 2015 Flight for Life hard landing and subsequent fire in Frisco, CO. One of the recommendations was to improve the information on safety systems incorporated in aircraft. The goal is to help those who purchase, lease, or work in helicopters to have a deeper understanding of what specific standards an aircraft meets especially in regards to crash resistant fuel systems and seating. During the investigation, the NTSB found challenges in identifying even in new aircraft what specific supplemental type certificates were incorporated.

The NTSB then recommended that ACCT take a community lead working with AMOA and AAMS to develop a support matrix for aircraft acquisition. ACCT developed a steering committee comprised of Thomas. Judge (chair), Greg Hildenbrand, Robbie Tester, Chris Eastlee, and Ed Stockhausen. Ed Eroe and Chris Zalar support the project.

To date, we have made our first report to the NTSB and added a library section on the ACCT website. The library includes the Terms of Reference for the project, a white paper laying out the issues, and a number of back ground documents both from the accident report and other studies on aircraft survivability.

The Steering Committee has developed a draft outline for an interrogatory paper and a aircraft analysis matrix.

More recently we have incorporated two advisory committees for the project; a professional group representing NEMSPA, AMPA, ASTNA, and the IAFCCP and a technical panel comprised of the major OEMS’s; Airbus, Bell, Leonardo, and Sikorsky.

Members of the panels include:
AMPA: Ryan Wubben, MD, Craig Bates, MD ASTNA: Kelly Holdren, Sharon Purdom IAFCCP: Stacy Fiscus and NEMSPA Justin Laenen, Bill Winn

Airbus Helicopters: Jeff Trang, VP Technology and Flight Ops Bell Helicopters: Tony Randall, Mgr. Continued Operational Safety Leonardo Helicopters: Mike Bucari, Mgr. Business Development, Martin Cameron, Head Design Engineering Sikorsky Aircraft
Tim Fox, Senior Engineer, Commercial Products, Mike Cerneck, Director of Safety
Note we are continuing to recruit representation from MD Helicopters.

Our next step is to draft out the Interaggatory and complete the matrix with hopefully a final report by the end of the spring.

For more information, contact: Tom Judge: This email address is being protected from spambots. You need JavaScript enabled to view it. 

The Air Ambulance Quality and Accountability Act Introduced, ACCT Takes to the Hill

On September 13, 2017, Representatives Richard Hudson (R-NC), Ron Kind (D-WI), Lynn Jenkins (R-KS), and Joe Kennedy (D-MA) introduced a bipartisan bill, Air Ambulance Quality and Accountability Act (H.R. 3780). The bill ensures that all patients in need of air medical services throughout the nation have access to high quality care and patient safety regardless of which air ambulance agency transports them. Specifically, the bill would:

  • Establish conditions of participation for air ambulance agencies, including adherence to minimum standards and reporting on quality measures;
  • Establish cost reporting by air ambulance providers and suppliers; and
  • Require a MedPAC study based on that cost reporting.

ACCT applauds the introduction of H.R. 3780 and members of ACCT are working diligently to garner additional support for the bill. To aid in this effort, ACCT encourages all members to review the “toolkit” to learn more about the bill, to learn about the differences between H.R. 3780 and similar legislation moving through Congress, and how to best engage lawmakers to support the bill as a cosponsor.

In an effort bolster support to advance the bill through the House and to generate a companion bill in the Senate, several members of ACCT participated in a Hill Day in Washington, D.C. on November 14th and 15th. On their Hill visits, ACCT members urged Congress to support, through cosponsorship, H.R. 3780. Many offices indicated their support and we continue the amount of cosponsors continues to grow. During the Hill day, ACCT members also garnered interest by several key Senators to lead the effort in the Senate.

Advocacy Toolbox Links:

H.R. 3780 One-Pager

Air Ambulance Quality and Accountability Act Section-by-Section

Air Ambulance Bills Side-by-Side

Advocacy Toolbox Base Document

ACCT House Health Staff Contact List

ACCT Response to AAMS statements on H.R. 3780

ACCT Supported Protecting Patient Access to Emergency Medications Act Passed by Congress

Congress passed H.R. 304, the “Protecting Patient Access to Emergency Medications Act” that would clarify that emergency medical services (EMS) professionals are allowed to administer controlled substances pursuant to standing or verbal orders under certain conditions. The issue arose last year when the DEA said that legislative action would be needed to continue to allow “standing orders” for EMS workers administering controlled substances. The bill will streamline DEA registrations for emergency agencies and medical directors operating in counties and states nationwide. The bill was presented to the President on November 7th.

Department of Health and Human Services (HHS) Secretary Update

HHS Secretary Tom Price, M.D. resigned in late September following revelations of his considerable domestic and international air travel aboard privately chartered flights and military aircraft. There is also a belief that the President had lost some confidence in his Secretary as a consequence of the failed effort to repeal the Affordable Care Act.

Alex Azar, a former executive of Eli Lilly was nominated by President Trump to be Secretary of the (HHS). Azar would replace former Secretary Tom Price who resigned amid an ethics scandal.

Azar is an attorney and a pharmaceutical industry veteran. He has a reputation for being intelligent, practical, and non-ideological. He has industry and government experience from his work at Lilly where he ultimately became president of the company’s U.S. operations. Prior to that, he served as HHS general counsel and then deputy secretary during his six years with the Bush Administration.

Azar has close political ties with Republican lawmakers and observers believe that during his time with Lilly (and Indiana-based company), he developed a relationship with Vice President Pence.
As HHS Secretary, Azar will be leading the Administration’s efforts to repeal the Affordable Care Act and, among other things, address drug pricing and reimbursement. Those issues are potential political challenges for Azar and will, no doubt, be discussed during his confirmation hearings where Democrats can be expected to challenge, in particular, his ability or willingness to address drug prices or other pharmaceutical company issues.

The Senate Health, Education, Labor, & Pensions (HELP) Committee held the first hearing on the confirmation for Secretary of Health and Human Services (HHS) nominee Alex Azar on November 29. Notably, only the Senate Finance Committee has jurisdiction to vote on the nomination and advance it for consideration by the full Senate. Senate Finance has yet to schedule a confirmation hearing.

The Senate passed its version of tax reform, the Tax Cuts and Jobs Act (H.R. 1) by a vote of 51-49 in the early hours of Saturday, December 2 along a party-line vote. The vote followed two days of debate and amendments.

The bill would add $1 trillion to the national debt over 10 years. Republican leadership has offered assurances that a waiver of the PAYGO rules, if required, would be included in a must-pass vehicle before the end of the year in order to prevent a sequester-- in order to avoid a Medicare sequester.

The Senate bill would repeal the Affordable Care Act’s (ACA) individual mandate, which would result in $300 billion in savings but is criticized for potentially destabilizing the individual health insurance market. Because the Senate bill differs significantly from the version of tax reform passed by the House, the two chambers will now hold a conference to reconcile the differences before both voting on a revised bill. Their goal is to send a final package to the President by the end of the year for his signature. Republican leadership in the House have suggested that repeal of the individual mandate is likely to be included in the final conference committee bill. President Trump has said that he will sign whatever tax bill is passed by Congress.

CHIP and Medicare Extenders Bill Still a Work in Progress, including Ground Ambulance Add-Ons

Congress on December 7 passed a two week stop-gap spending bill that includes a temporary CHIP funding fix for states running low on money—but the bill does not authorize new funding for the program. The bill now goes to President Trump, who is expected to sign the measure. Trump yesterday also began negotiations with Republican and Democratic leaders on a new spending bill that Sen. Shelley Moore Capito (R-W.Va.) says is likely to include new funding for CHIP.

The House Ways & Means Committee and Senate Finance Committee have released separate outlines of bipartisan legislation to extend Medicare health programs and policies, including offsets, though the committees didn’t break out the cost of the so-called extenders or the sum of the offsets. Both bills extend the temporary increase in the ambulance fee schedule rates for all ground ambulance services (i.e., 2 percent urban add-on payment and 3 percent rural add-on payment) and the super-rural ambulance add-on payments for five years through December 31, 2022. The health extenders package is expected to be part of legislation to fund the Children’s Health Insurance Program, which in turn is expected to be part of a year-end omnibus bill.

On October 12th, the President issued an Executive Order instructing three cabinet departments to undertake regulatory efforts to make changes to Health Reimbursement Accounts (HRAs), short-term insurance policies, and so-called “Association Health Plans”. It is expected that, on this third issue, the Department of Labor will begin a regulatory process whereby the definition of an “employee organization” under the 1974 ERISA statue would be broadened to include not just labor organizations but also trade or other associations. This would allow such associations the opportunity to offer self-insured health insurance products to their members that would be exempt from state regulation. Certain federal regulations would still apply, such as non-discrimination requirements, prohibitions on health status underwriting and pre-existing condition exclusions, coverage of children up to age 26 and no lifetime or annual limits on essential health benefits. But some ACA requirements that otherwise apply to small group insurance – such as the essential benefits mandate – would not apply.

The Association Health Plan idea has been around for many years, and Congress has voted on it several times, but this is the first time an effort to implement it through a regulatory change has been undertaken. The idea has very broad support in the small business community and elsewhere based on the opportunity to create more robust risk pools and competitive options. But critics believe that it could lead to the creation of plans that would siphon off lower risk beneficiaries and leave higher risk individuals in state small group markets. Of course, whether these predictions might turn out to be accurate would depend in part of how any final regulation is structured. California Attorney General (and former Member of Congress) Xavier Becerra has filed a motion seeking an emergency injunction that would require the federal government to pay cost-sharing reduction (CSR) subsidies. The motion was signed by 18 states and Washington, D.C.

This week, Mississippi and Georgia signed bills adopting REPLICA. With the addition of the 9th and 10th states, the compact became effective. 

The Recognition of EMS Personnel Licensure Interstate CompAct (REPLICA) is the collective solution to cross border-licensing issues that have been managed by state EMS Offices in various ad hoc manners for years. With the implementation of an Interstate Compact, EMS will join the ranks of other professionals such as physicians, nurses and emergency managers. 

Alabama, Missouri and Delaware still have active bills in their respective state legislatures. 

To find out more about REPLICA and it's potential impact to your state and program, visit the REPLICA website, http://www.emsreplica.org/.

The National EMS Memorial Service Weekend of Honor begins Friday, May 19, in Washington, DC. 

For more information about Weekend of Honor, visit http://www.national-ems-memorial.org/ and its Facebook page, https://www.facebook.com/NEMSMS/

 

The National EMS Memorial's East Coast Bike Ride started Sunday, May 13.

The ride will culminate Friday in Washington, DC, as part of the National EMS Memorial Weekend of Honor. Keep up with the ride's progress and see photos on the organization's Facebook page, https://www.facebook.com/muddyangels/, and on its website, http://www.muddyangels.com/rides/east-coast/

 

The 2017 Air Medical Memorial Service will be held July 24 in Littleton, CO. More details will follow.

 

 

On March 28th, the National Transportation Safety Board adopted a final report on the crash of a medical helicopter at Summit Medical Center, Frisco, CO. Of the number of recommendations from the NTSB, ACCT was asked to take lead in developing a process to better inform purchasers of medical helicopters and the aviation and clinical crews staffing the helicopters of the safety engineering profiles of the aircraft.

The NTSB specifically identified in its findings the lack of clear information about which standards aircraft with long-established type certificates meet, as well as challenges among customers' and end-users' awareness and understanding of relevant and applicable safety engineering standards. As an example, the aircraft in the Frisco crash was relatively new -- built in 2013 -- the applicable standards the aircraft was required to meet for fuel tank and seating crashworthiness were circa 1977.

On April 25-26, ACCT held its annual Spring Hill Day Legislative Briefing and Capitol Hill Day in Washington, DC. ACCT members received updates from an excellent group of speakers as part of the briefing. First, the group heard from Rita Habib, a health staff member with the Office of Sen. Michael Bennet (D-Colo.), who discussed Senate movement on the ACCT-supported Protecting Patient Access to Emergency Medications Act (H.R. 304/S. 916). The bill, which passed the House of Representatives unanimously in January, would ensure that EMS personnel would be able to dispense lifesaving medication in the field. Given its strong support in the House, many are looking for the Senate to pass the legislation unanimously and send it to the President’s desk as soon as possible.

Update on ACA Repeal Efforts

On May 4, the House of Representatives passed the American Health Care Act (AHCA) (H.R. 1628) by a vote of 217 – 213, with all Democrats and 20 Republicans voting against the measure. The passage of the legislation comes over two months after it was originally introduced for consideration by the House and underwent several revisions before finally being passed.

Program slated to be honored with a Real Heroes award

LEWISTON—LifeFlight of Maine and the American Red Cross hosted a blood drive in December at Central Maine Medical Center in Lewiston. The event attracted more than 90 donors and collected 93 total units of blood, or 120% of the goal of 78 units.

Led by flight crew members, the blood drive honored one of LifeFlight’s young patients, Kinzie, who requires routine blood transfusions as part of her cancer treatment. LifeFlight is the only ambulance service in the state that carries blood on every transport, and has a unique understanding of the importance of blood donation. From cancer patients like Kinzie, to trauma patients who are losing blood at an alarming rate after a car or snowmobile accident, in a rural state like Maine, sometimes access to blood is a matter of life and death.

Things are changing in the airspace around us so how we operate should too!
Here are 4 Tips for Air Medical programs to enhance airspace safety and de-confliction when dealing with UAS (drones):

  1. Add a question to your PR sheet to identify whether a drone will be present, i.e. “Will there be a drone onsite during the event?”
  2. Include a discussion of drones in the shift briefing, i.e. “What actions should be done by flight crews if a drone is spotted or encountered etc...” Add drone related questions to your box of safety questions.
  3. When en route to a scene or hospital ask if there is a drone being utilized or observed onsite. For scenes, this can be done with both dispatch and when communicating with landing zone command. For interfacility flights, inquire via your dispatch, after giving patient report, or directly with security if possible.
  4. Prior to lift-off from a scene, PR or hospital, incorporate crew communication to confirm that the airspace is clear of drones.

The National EMS Memorial Service will be held on May 20, 2017, at the Hyatt Regency Crystal City in Arlington, VA. 

It will be preceded by the National EMS Memorial Bike Ride's east coast ride from Boston to Arlington. 

For more information and to learn how to participate or sponsor, visit http://www.muddyangels.com/

National EMS Memorial Bike Ride

May 13-19, 2017
Boston, MA to Arlington, VA
Registration open date= February 1, 2017.
Day 1 (May 13)- Boston, MA to Worcester, MA
Day 2 (May 14)- Worcester, MA to Hartford, CT
Day 3 (May 15)- Hartford, CT to Poughkeepsie, NY
Day 4 (May 16)- Poughkeepsie, NY to Tannersville, PA
Day 5 (May 17)- Tannersville, PA to Reading, PA
Day 6 (May 18)- Harrisburg, PA to Frederick, MD (Bus from Reading, PA in the morning)
Day 7 (May 19)- Frederick, MD to Arlington

House Advances Life-Saving EMS Bill

On Monday, January 9, the House of Representatives passed the Protecting Patient Access to Emergency Medications Act (H.R. 304) with overwhelming support, 404-0. H.R. 304 was re-introduced by Reps. Richard Hudson (R-NC) and G.K. Butterfield (D-NC).

The bill would amend the Controlled Substances Act (CSA) to enable paramedics and other emergency medical services (EMS) professionals to continue to administer controlled substances to patients pursuant to standing orders issued by their EMS agency’s medical director. In 2014, the Drug Enforcement Agency (DEA) announced that they would be creating DEA regulations to simplify EMS administration of controlled substances. However, the DEA later announced that the CSA only allowed for patient-specific orders for controlled substances and that the regulations would very specifically state that protocol-driven usage of controlled substances is not allowed.

Accordingly, H.R. 304 would amend the CSA to clarify that EMS are able to administer certain controlled substances, under standing orders issued by a EMS medical director physician. ACCT and our coalition partners worked diligently with our congressional champions to craft this legislation and gain support from additional Members of Congress.

Last year, U.S. Senators Bill Cassidy (LA) and Michael Bennet (CO) introduced similar legislation in the Senate. We anticipate re-introduction in the Senate shortly. With passage in the Senate, the legislation can be signed into law by the President.

ACA Strategy Continues to Evolve

Congressional Republicans are struggling to figure out how to best approach a “repeal and replace” strategy with regard to the ACA. Some are now talking about legislation to “repair” the ACA as an interim step. House Energy and Commerce Committee Chairman Greg Walden (R-Ore.) and Senate Health, Education, Labor, and Pensions (HELP) Committee Chairman Lamar Alexander (R-Tenn.) have both made recent statements indicating that some provisions of the ACA will be kept and modified if necessary.

Dr. Price Confirmed as HHS Secretary

Congressman Tom Price, M.D., was confirmed as Secretary of Health and Human Services on Feb. 10th. His nomination had become controversial as a result of some questions regarding certain investment transactions he was involved in and how he explained them in his testimony. 

House and Senate Committees Working to Stabilize Insurance Markets

Senate and House committees are now focusing on how to stabilize the individual markets created by the Affordable Care Act. Witnesses before two committees pressed repeatedly for certainty and transparency, as soon as possible because insurers must submit their 2018 rates for review by May. In a Finance Committee hearing witnesses blamed what they described as the ACA’s heavy-handed approach toward regulating what products can be sold and what benefits must be provided. A House committee reviewed several bills that would reform insurance plans, such as increasing the variation around the age rating for ACA plans and ensure protections for patients with pre-existing conditions. Click here to view the Finance Committee hearing and testimony, and here for the Energy & Commerce hearing.

New Details on ACO Track 1+ Model Announced

CMS has released a fact sheet containing critical implementation details for the new Track 1+ accountable care organization (ACO) Model. Track 1+ features less overall risk than Tracks 2 or 3 of the Medicare Shared Savings Program (MSSP), but unlike traditional Track 1, it will qualify as an advanced alternative payment model starting in 2018.

On July 15 2016, President Obama signed the FAA Extension, Safety, and Security Act of 2016. One of the provisions provides funding for the agency to report four times a year to Congress about the following:

  • the number of laser pointer incidents reported to FAA
  • the number of civil and criminal enforcement actions
  • the resolution of any incidents that did not result in a civil or criminal action
  • any actions taken to help deter laser pointer incidents

In addition, the maximum civil penalty that FAA can impose was raised to $25,000. It was formerly $11,000.

Provides clarifications on media use of drones and use of tethered drones by public safety agencies

On August 29, 2016 the new Part 107 rules for small UAS (drone) operation for commercial and government users went into effect. The current Section 333 Exemption with the blanket Certificate of Authorization (COA) will still be an option depending upon what the operator intends to do with their drone. The Part 107 will allow the operator to apply for waivers for many parts of the rule such as flying the drone within visual sight or flying no higher than 400 ft. Government/civil operators can apply for a Certificate of Authorization specific or meet the criteria of Part 107 based upon how they intend to use their drone.

During ACCT's annual meeting, officers for the 2016-2017 year were elected:

Officers elected by the Board:
Frank Erdman, Chair
Steve Haemmerle, Chair Elect
Edward Eroe, Treasurer
Greg Hildenbrand, Secretary
Denise Landis, Immediate Past President

2016-2017 ACCT Board, Affiliation, Term Expiration

Laura Neu, Ann & Robert H. Lurie Children’s Hospital, IL, 2017
Sherry McCool, Children’s Mercy, MO, 2017
Robbie Tester, Erlanger/Life Force, TN, 2017
Greg Hildenbrand, LifeStar, KS, , 2017
Mike Christianson, Sanford Medical Center Intensive Air, SD, 2018
Edward Eroe, LifeLink III, MN, 2018,
Steven Rockoff, DO, Superior Henry Ford Air Med 1, MI , 2018
Karen Arndt, OSF Aviation, IL, 2018
Mary Ahlers, UC Health-Air Care and Mobile Care, OH, 2018
Jeffrey Stearns, Mayo Clinic Medical Transport, MN, 2018
Jason Cohen, MD, Boston MedFlight, MA , 2019
Tom Judge, LifeFlight of Maine, ME, 2019
Frank Erdman, University of Wisconsin, WI, 2019
Steve Haemmerle, Carolina’s HealthCare System, NC, 2019
Denise Landis, Survival Flight, MI, 2019

Non-Voting Board Members:
Betsy Casanave, 7Bar Aviation, 2017
Krista Haugen, Survivor’s Network, 2017
James Perry, Patient representative , 2017

As the generation that created the specialty of critical care transport ages and is ready to start the next chapter of their lives, hundreds upon thousands of individual years of established knowledge and expertise go with them. The underlying challenge that remains is how to replace this with quality individuals that are becoming more difficult to find. While a virtual think tank is difficult to tap into, individual programs have become creative in their succession planning endeavors.

The purpose of the Mayo One Residency Program is to provide a formalized, ongoing development and support program for new crew members from completion of orientation through their first year of service. Our objectives are to continue to develop competence in the role, provide ongoing clinical, emotional, and social support for the new crew member just off orientation and to instill a teaching and learning culture for new and experienced crew members.

We identified two opportunities for improvement in our human resources processes – improving the pre-hire preparation of clinical team members and sustaining engagement in interested candidates who either were not quite ready to work for us or for whom we did not have a current vacancy. Our so-called ‘Mentor Program’ helps to address those opportunities.

President-elect Trump has staked out a vision for health care. The president-elect promises to repeal and replace the Affordable Care Act (ACA), hand over Medicaid reigns to state officials and allow individuals to deduct health insurance premiums from taxes, among others. Click here to read his one-pager. For further elaboration, click here for the Trump campaign’s 4-pager. Congressional Republicans have also provided their healthcare roadmap (click here for the 37-page report), which mirrors many of Trump’s priorities.

The scope of ACA replacement legislation is difficult to predict, but President-elect Trump’s high-level campaign proposals and more detailed proposals from House and Senate Republicans point to some common themes:

  • Providing tax-favorable treatment for individual-market health insurance premiums
  • Expanding Health Savings Accounts and Consumer Directed Health Plans
  • Continuing to prohibit pre-existing condition exclusions or rating based on health status
  • Creating high-risk pools for costly patients
  • Permitting the sale of health insurance across state lines
  • Funding Medicaid through per capita payments or block grants

Major changes to the health care sector are going to be considered and debated in the coming months. Given Republican control of the Congress and Presidency, we anticipate that some changes will be enacted affecting major segments of the health care industry. To learn more about these potential changes, please click here (link to H&K memo).

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