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

In a highly-anticipated ruling, the Supreme Court of the United States upheld the use of subsidies to individuals on federally-facilitated health insurance exchanges. The 6-3 ruling in the case, King v. Burwell, means that implementation of the Patient Protection and Affordable Care Act is not affected. Read the full opinion here. Currently, the federal government is operating insurance marketplaces in more than 30 states, and, as of February 2015, 7.5 million people receive premium subsidies in states with a federally-run marketplace. The ruling means that individuals will continue to receive subsidies to purchase health insurance through the federal marketplace.

Education meeting to feature outstanding presenters

The 2015 ACCT Annual Meeting is again being held in conjunction with the Pinnacle EMS Leadership Forum at the family-friendly Omni Ameila Island Plantation Resort near Jacksonville, FL.

ACCT's Education Meeting will be held Monday morning, Aug. 3. The afternoon session will be the Association's Annual Meeting.

Small Unmanned Aircraft Systems (UAS) or more commonly referred to as drones, present potential safety risks to air medical crews, aircraft, their patients and first responders at the scene as their numbers and use becomes more widespread.
A big selling point for the UAS hobbyist is the "fly it right out of the box" marketing done by the drone manufacturers. Sure there are instructions in the box but who takes the time to read them?

Case Western Reserve University is seeking people to participate in a survey to investigate challenges that new medical crew members experience in the critical care transport environment. Please see a copy of the invitation below, and consider participating in this project. This study will be very helpful to our industry as a whole.

Senator David Vitter (R-LA) introduced companion legislation, S. 1149, on April 30th to H.R. 822 introduced by Representatives Pete Sessions (R-TX), Gregory Meeks (D-NY), Todd Young (R-IN) and Bill Johnson (R-OH). The bill updates the Air Ambulance Medicare Fee Schedule. The legislation would also require the Department of Health and Human Services to create and implement a system for air medical Medicare providers to report their cost on specific cost drivers on a voluntary basis. Additionally, the Secretary of HHS and the GAO would issue a report, updated annually, on certain industry clinical quality measures taken from the Air Medical Physicians Association 2013 "Must Have" Consensus Metrics.

ACCT supports the concepts introduced in S. 1149/H.R. 822 related to cost reporting and the establishment of a quality program.

However, ACCT believes cost reporting should be mandatory to ensure accuracy and completeness across the industry. ACCT also recommends that any increase in reimbursement should be tied to participation in a quality reporting program. Further, ACCT endorses a MedPAC study around transforming payment for air ambulance services away form being a transport benefit to the provision of a medical service dictated by medical need.

ACCT is currently advocating our position before lawmakers in both chambers.

To see ACCT's Position Statement on Reimbursement and Accountability in Critical Care Transport, click here.

Please join us in welcoming ACCT's newest Gold Associate Member, Crystal & Company!

Crystal & Company is an independent, family-owned company that is a leading strategic risk and insurance advisor addressing clients' risk management, insurance brokerage, and employee benefits consulting needs. The company specializes in nearly 50 sectors, including aviation, healthcare and non-profits.

On May 21, the House Energy & Commerce Committee unanimously passed H.R. 6, the 21st Century Cures Act. The bill is intended to modernize the nation's biomedical innovation infrastructure and hasten the pace of cures, this bill comes after almost a year of fact-finding and will quickly be scheduled for consideration by the entire House.

The bill would alter the antibiotic process, create new disease research initiatives, establish new incentives for drug makers to study rare conditions and place a much greater focus on patient data to encourage more "personalized medicine."

Rep. Larry Bucshon, M.D. (R-IN-08) introduced "The Field EMS Modernization and Innovation Act" (H.R. 2366) in an effort to modernize our Emergency Medical Services System from a 20th century antiquated model based on transport to an innovative, patient-centered, efficient 21st century system. Senate companion legislation is anticipated to be introduced soon.

Air-Medical Programs must engage in UAS-related topics, education

March 2015

2015 has already been a busy year of news about drones. A drone crashing on the White House grounds, the capture of a drone over-laden with illicit drugs attempting to sneak over the border, and some high-profile near-misses with medical helicopters and airliners have begun to increase the awareness that drones present a problem that is almost certain to get worse before it gets better.
It is important that all air-medical programs increase their awareness of drone-related topics as their recreational use continues to soar and as rules for commercial use are developed.
Here are some important drone-related topics and links where you can find more information:

In late January, the ACCT Board of Directors came together for a retreat. The purpose was to engage in a strategic planning meeting to reaffirm ACCT's mission, vision and values, and to develop a strategic plan to guide the association's future efforts. Together they created the below document as a template for guiding 2015 initiatives.

March 2015

The Washington Update is prepared by Miranda Franco, Senior Public Affairs Adviser for Holland & Knight

ACCT Applauds Committee's Passage of Trauma Reauthorization

ACCT congratulates the House of Representatives Energy and Commerce Committee on its action to approve "The Trauma Systems and Regionalization of Emergency Care Reauthorization Act (HR 648)" and "The Access to Life-Saving Trauma Care for All Americans Act" (HR 647) for consideration by the House of Representatives.

"The Trauma Systems and Regionalization of Emergency Care Reauthorization Act" would among other provisions, reauthorize the Trauma and Emergency Care Systems Grants through 2020. These programs are essential to improvement of trauma systems and piloting regionalized systems of emergency care to create greater efficiency of emergency medical care and transport, as called for by the IOM.
"The Access to Life-Saving Trauma Care for All Americans Act" would among other provisions reauthorize the Trauma Care Center Grants and The Trauma Service Availability Grants through 2020. These programs would provide grants to prevent further trauma center closures and address shortfalls in trauma services and improve access to and the availability of trauma care in under-served areas.
These programs are critical to ensure the coordination of trauma care delivery among trauma centers, ambulances, helicopters, state and local governments as well as implement and evaluate innovative models of regionalized emergency care systems.
Thanks to the leadership of Dr. Burgess and Rep. Green and the tremendous efforts of ACCT and the trauma and EMS community this vote is the first step in the 114th Congress toward improving trauma care. ACCT and our advocacy partners submitted support letters to the committee in advance of the mark. To view the letters, please visit the links below:

Trauma Coalition Support letter Parts A-C 2015 MF
Trauma Coalition Support letter Parts D, F and H 2015 MF

GAO Releases Report on Shortages of Controlled Substances

ACCT worked diligently with the American College of Emergency Physicians (ACEP) to ensure the Government Accountability Office (GAO) conducted a study on the number of factors that may be contributing to the drug shortage issue, as there is debate over the reasons.
CCT providers administer life-saving care, often through the use of specialized equipment or drug therapies, while transporting a patient from the scene to a medically appropriate receiving hospital or between hospitals, typically moving patients to a higher tertiary care facility. If patients do not have access to these drugs within a very short time window, it can mean the difference between life and death or serious disability.
ACCT called for an investigation of the root causes of the shortages through congressional outreach. The report was requested by Senators Grassley (R-Iowa) and Whitehouse (D-Rhode Island). Accordingly, GAO conducted a study to examine the cause of drug shortages and provide recommendations on how to alleviate such shortages. The report may be viewed here.

Supreme Court Hears Oral Arguments for King v. Burwell

On March 4, the Supreme Court heard oral arguments for King v. Burwell, a case challenging the subsidies available to individuals on federally-facilitated ACA health insurance exchanges. This challenge is not about a violation of the Constitution; it is about how to interpret a law created by Congress.
This case hinges on five words: exchange established by the state. The petitioners (or challengers) believe that the Patient Protection and Affordable Care Act (ACA) only permits subsidies for exchanges established and run by the state.
When the ACA was implemented, sixteen states created their own exchanges. There is no dispute that consumers who purchase health insurance in those states are eligible for subsidies. However, the other thirty-four states chose not to set up an exchange and, under the ACA, the federal government set up exchanges for each of those states. The petitioners' view is that subsidies are not available to those thirty-four states because Congress said what it meant - "established by the state". The Supreme Court is expected to deliver its decision by the end of June.

White House Releases FY 2016 Budget Proposal

On February 2, 2015, President Obama released his Fiscal Year (FY) 2016 Budget. The President's budget proposal would use federal savings and revenues to reduce the deficit, replace sequestration of Medicare and other federal programs for 2016 through 2025, and pay for new spending priorities.
The President's fiscal blueprint, for the budget year that begins Oct. 1, 2015, proposes spending $4 trillion and projects revenues of $3.53 trillion, leaving a deficit of $474 billion. The budget request exceeds the spending caps established in 2010 by $74 billion spread evenly between military and non-military discretionary spending. The Administration is proposing offsets to cover some of the expanded spending ($1.8 trillion over a 10-year period). To view the health and CCT provisions in the budget, please click the links below.
FY 2015 President's Budget Proposal EMS.pdf
FY2016 President's Health Budget FINAL.pdf

Implementation of ICD-10 is on Track

The House Energy and Commerce Committee Subcommittee on Health held a hearing last week to discuss a Government Accountability Office (GAO) report that outlines the progress and activity of the CMS in preparing to implement the tenth revision of the International Classification of Diseases (ICD-10) on October 1, 2015. The vast majority of committee members were supportive of transitioning to ICD-10 on the current schedule.
All medical claims submitted by health care providers to payers, both public and private, for reimbursement have an ICD code. Currently, the ninth revision is in use in the United States. The transition to the 10th revision is scheduled to take effect on October 1, 2015, after twice being delayed for one year. ICD-10 provides more specificity in labeling patient diagnoses and in categorizing inpatient procedures.

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