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

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).

Potential legislative priorities for Congress during the lame duck

The Obama administration and current 114th Congress still have items to resolve before the end of the year. One of the issues Congress must address is funding the government. Congress passed a short-term spending bill, H.R. 5325 - Continuing Appropriations and Military Construction, Veterans Affairs, and Related Agencies Appropriations Act, 2017, and Zika Response and Preparedness Act, on September 28. The bill keeps the government funded through December 9, 2016. Now, with that deadline looming, lawmakers will need to address government funding before adjourning for the year.

What remains uncertain are the fates of initiatives by President Barack Obama's administration to galvanize medical progress in cancer and precision medicine specifically. A lame-duck Congress could help preserve them. Additionally, the fate of 21st Century Cures passage during the lame duck session is also unknown. Medical innovation has been a large focus of both chambers of Congress, as parallel bills have been working their way through the House and Senate. However, lawmakers have disagreed on how to pay for the provisions. Several Congressional leaders have indicated that passing this legislation is a priority for the lame duck session.

Aside from legislative work, the lame-duck will also see the House and Senate elect new leaders for the next Congress. Senate Majority Leader Mitch McConnell (R-KY) is expected to remain the GOP leader. Democrats are expected to elect Senator Charles Schumer (D-NY) as the new Minority Leader with retirement of Senator Harry Reid (D-NV) at the end of this Congress. In the House of Representatives, Speaker Paul Ryan (R-WI) is likely to be re-elected by his caucus, despite some concerns expressed by the House Freedom Caucus. House Minority Leader Nancy Pelosi (D-CA) is expected to be re-elected unless she decides to vacate the post.


The critical care transport community lost a long-time advocate and champion in Dr. Ralph N. Rogers, MD, CAMTS' Emeritus Chairman of the Board, who passed away June 2 after a long battle with cancer.

Dr. Rogers spent more than 25 years as a board-certified emergency physician at Spectrum Health in Grand Rapids, Michigan. His legacy includes initiatives in critical care, trauma and pain management. His ability to clearly and succinctly provide situational analysis positively impacted physician and advanced practice provider engagement, clinical service lines, regional hospital clinical integration and the development and success of CAMTS.

Read an article about Dr. Rogers on the CAMTS website

Read Dr. Rogers' full obituary

Survivors Network seeks to be a resource that enables resiliency in the high-stress, high-consequence critical care transport environment

Article courtesy of the Survivors Network

What is a Survivor?

If you look up the definition of the word “survivor” you read things like, “to remain alive or in existence;” “to carry on despite hardships;” or “to cope with or persevere after a trauma or setback.” For the purposes of the Survivors Network for the Air Medical Community, we employ the broadest definition of the word “survivor.”

There are medical crewmembers, communication specialists, pilots, mechanics, administrators, programs, support staff, families, friends, our colleagues in public safety, and communities who are “survivors” in their own right, based on their experiences. Further, the cumulative stress, secondary or vicarious trauma, and compassion fatigue that air medical and emergency medical response professionals may experience over the course of their career make them “survivors” too.

We have an industry full of “survivors.” 

The National EMS Memorial Service’s Weekend of Honor and National EMS Memorial Bike Ride took place in late May to honor EMS professionals whose lives were lost in the line of duty.

The Weekend of Honor began with the welcoming of the National EMS Memorial Bike Ride East Coast Route riders on Friday, May 20th, at the Hyatt Regency-Crystal City in Arlington, VA.

Recently published statistics shed light on the increasing incidence of laser strikes on aircraft in the U.S. According to the FAA, reports of lasers striking civilian aircraft in the U.S. have nearly tripled between 2010 and 2015, rising to a rate of more than 21 per day in 2015.

Despite ramped-up efforts to identify and arrest offenders, very few successful prosecutions have taken place to date.

Dr. Suzanne Wedel, CEO of Boston MedFlight, ACCT board member, and influential industry leader, passed away March 30 following a long battle with cancer. Here are some stories published in her memory and honoring her legacy of advocating for patients and advancing critical care transport.

From Boston MedFlight:
On March 30, 2016, the Boston MedFlight community lost a dear friend and colleague when Dr. Suzanne Wedel, CEO of Boston MedFlight, passed away following a long battle with cancer.

On May 16, Senator Bill Cassidy (R-LA) introduced the “Protecting Patient Access to Emergency Medications Act of 2016" (S. 2932). S. 2932 clarifies that the current practice of physician Medical Directors overseeing care provided by paramedics and other emergency practitioners via “standing orders” is statutorily allowed and protected.

Senators Hoeven (R-ND) and Tester (D-MT) offered an amendment to address rates charged by air ambulance companies and exempt air medical services from the Airline Deregulation Act (ADA). The amendment would allow states to enact priority dispatch lists for air ambulance services, dependent on an air medical service contracting in network with health insurance providers, within the state. The North Dakota legislature recently enacted this law, which was quickly struck down by the federal courts, in a summary judgement, under the ADA.

Appropriators in the House of Representatives have included $103 million for programs to address the abuse of opioids in the fiscal year (FY) 2017 Commerce-Justice-Science spending bill. This money would help to fully fund the recently passed H.R. 5046, the Comprehensive Opioid Abuse Reduction Act of 2016. This spending level comes in below the $132 million to combat the opioid abuse epidemic included in the Senate measure advanced in April.

The House and the Senate approved two very different funding packages to combat the Zika virus. The House cleared a bill on May 18 sponsored by Appropriations Chair Hal Rogers (R-KY) that would provide $622.1 million in funding to combat the Zika virus. The Senate passed $1.1 billion in emergency funding on May 19 to combat the Zika virus, setting up a faceoff with the House, which approved only $622 million despite a veto threat from the White House.

The House Ways and Means Committee unanimously approved legislation that would revise a measure impacting hospitals included in last year’s budget deal. H.R. 5273, the Helping Hospitals Improve Patient Care Act of 2016, would allow hospitals that were already in the process of constructing off-campus outpatient centers last year to be grandfathered into outpatient payment rates.

As the number of UAS/drone encounters rise, it is essential that air-medical programs work to educate their communities about safe operation, and report incidents to local law enforcement, to the closest tower, as well as to the FAA directly. The myriad of rules and regulations can be confusing to law enforcement, though. To help cut through the clutter, the FAA has compiled some resources that you can share with your local law enforcement that can assist them in knowing what is legal, what is not, and what to do when they encounter unauthorized drone utilization.

For more information, visit

LifeFlight of Maine is taking a new approach to orienting new crew members.

Facing the need to develop a more effective and cost efficient means of bringing new staff concurrent with ever higher skills for undifferentiated age and disease ranging from neonates to ECMO, LifeFlight of Maine (LOM) upended the traditional system of orienting new staff in favor of an Academy approach. Lead clinical staff and medical directors developed a structured curriculum with constant measurement to prepare new providers to be a proficient member of the critical care team.

The pilot program is consistent with the new ACCT Critical Care Transport standards with next steps of transitioning the program to onboard hospital critical care staff for LOM’s associated and parent tertiary centers. The course consists of a mixture of didactic, clinical exposure and high fidelity simulation to propel students through the first 2 phases of transport orientation.

The program encompasses all aspects of emergency and critical care medicine as it pertains to the transport environment. Aviation, Just Culture, CRM, survival skills, advanced airway and procedure lab and altitude physiology are all included during this trial 8-10 week period. The Academy is designed around the instruction of experienced providers with at least 3 years of critical care experience and looks to build on their current knowledge with the goal of having them become proficient in best practice protocols and critical thinking decisions.

Each week consists of 2 days of didactic followed by clinical exposure and simulation related to the previous didactic content. The following weeks build off all of the previous week content and several sessions of simulation to evaluate the progress of students.

The 3 phases of orientation are:
• Orientation to the transport environment / Critical Care Medicine
• Patient assessment phase with preceptor
• Primary with back up preceptor phase

The first phase is completed within the first 3-4 weeks of the Academy, during which several simulation sessions will determine if the student is able to “test out“ into the next phase. The second phase starts to incorporate equipment and flow of the transport environment while letting the student perform actual assessments during transports. The third phase brings the whole process together integrating assessment, equipment proficiency and working in the cabin of the transport vehicle while supervised under a third crew member.

Version 2.0 of the project is designed to bring on an entire new base team in a joined model of onboarding hospital critical care staff. An associated project is developing a pathway to credential LOM providers in the hospitals.

The ACCT spring meeting in March is designed in a roundtable format for member programs to share innovations with a number of programs presenting.

Representative Richard Hudson (R-NC) joined by Reps. G.K. Butterfield (D-NC), Steve Cohen (D-TN), Blake Farenthold (R-TX), Joe Heck, M.D. (R-NV), Raul Ruiz, M.D. (D-CA) and Bruce Westerman (R-AR) introduced legislation (H.R. 4365) that ensures the continued ability of emergency medical services (EMS) practitioners to administer controlled substances to countless individuals who are sick or injured enough to need them.

The Senate Commerce, Science, and Transportation Committee marked up the Federal Aviation Administration Reauthorization Act of 2016 (S. 2658) March 16. The bipartisan bill would reauthorize Federal Aviation Administration (FAA) programs through September 30, 2017. The text of the bill is available here.

Notably, the Senate’s FAA reauthorization bill does not include the controversial air traffic control (ATC) reform provisions from the House Transportation and Infrastructure Committee’s FAA reauthorization, the Aviation Innovation, Reform, and Reauthorization (AIRR) Act (H.R. 4441). The AIRR Act would remove ATC from FAA and transfer operation of air traffic services to a federally-chartered, not-for-profit corporation.

On March 9, the Senate approved the Comprehensive Addiction & Recovery Act (CARA) (S. 524). It passed the Senate Judiciary Committee in February with a unanimous voice vote. A companion bill was introduced in the House last year.

S. 524 is aimed at combating the growing abuse of opioids and heroin that has been afflicting communities across the United States. S. 524 would authorize grants to states to train first responders for naloxone use, implement and expand medication-assisted treatment for those addicted to opioids, expand programs to dispose of unwanted prescription drugs, and fund treatment alternatives to incarceration for addicts.

CMS has met its goal of tying 30 percent of Medicare payments to alternative payment models — nearly a full year ahead of schedule. Medicare is projected to pay more than $117 billion to accountable care organizations, bundled payment programs and other alternatives to fee-for-service medicine in 2016 according to CMS. The agency seeks to tie half of Medicare payments to alternative payment models by 2018. Click here to read a summary of what CMS says are its alternative payment models.

CMS’ Innovation Center has announced the second and final round of applications for the Next Generation Accountable Care Organization Model. This program will begin its second performance year on January 1, 2017. Building upon experience from the Pioneer ACO Model and the Medicare Shared Savings Program, the Next Generation ACO Model offers a new opportunity in accountable care—one that sets predictable financial targets, enables providers and beneficiaries greater opportunities to coordinate care, and aims to attain the highest quality standards of care. Click here for all the details.

Senator David Vitter (R-LA) and Rep. Pete Sessions (R-TX) introduced legislation, S. 1149/H.R. 822 that updates the Air Ambulance Medicare Fee Schedule. The legislation requires the Secretary in the case of air ambulance services furnished during calendar 2017 through 2021 to make a percentage increase in the base rate of the fee schedule: (1) by 20% during 2017, and (2) by 5% during 2018-2020. 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 recommends that any increase in reimbursement should be targeted to the specific areas of greatest need with measured quality and safety improvements. Accordingly, ACCT is circulating draft legislative language calling for a Medicare Payment Advisory Commission (MedPAC) report on clinical and aviation capability, uncompensated care and the need to direct payments to low volume rural areas.

ACCT continues to identify congressional champions to advance the MedPAC study.

Provides Resources, Information About Prevention, Recovery

By Krista Haugen
Co-Founder of The Survivors Network

The Survivors Network for the Air Medical Community is happy to announce the release of their new website:

The Survivors Network was started in 2009 by HEMS crash survivors Krista Haugen, Megan Hamilton, Teresa Pearson, and Jonathan Godfrey. Realizing the lack of resources available to help survivors and organizations cope with the aftermath of crashes, the group began to develop resources with input with many other survivors from the air medical transport industry. "There are far more people impacted by crashes than those who were in the aircraft," Haugen explained. "The ripple effect is extensive, and we value the perspectives of all of those 'survivors' as well."

By Denise Landis, Chair
University of Michigan Survival Flight

The ACCT Board held its annual strategic planning retreat a few weeks ago in Kansas City and had two great days of collaboration and outlining the priorities of ACCT for 2016 to ensure we remain a strong association focused on the patients we serve, as well as providing high value to our members.

Now it's time for the real work to begin.

By Greg Hildenbrand, Chair - Policy Committee
LifeStar of Kansas

As a patient advocate association, ACCT continues to monitor policy related initiatives, related to our industry, and how those will ultimately affect the patients and the care they receive. The ACCT Policy Committee has developed a new position statement on Transport Reimbursement (click to see). Please feel free to use this in your advocacy efforts with your legislators as well.

If you have any questions or would like to get involved in the ACCT Policy work, please do not hesitate to reach out to the me at This email address is being protected from spambots. You need JavaScript enabled to view it..

By Tammy Chatman, Communications Committee
Flight For Life Transport System

The holidays are a season for giving. We all spend lots of time picking out those special gifts for those we love. But what about giving a gift that can mean the world to those in need; people you don't even know? A gift that costs you NOTHING. That gift is blood.

New Education Flyers Available; Tips for Handling Drone Encounters

The Federal Aviation Administration has released its Unmanned Aircraft System (UAS) registration rules. The law goes into effect December 21, and requires all unmanned aircraft owners to register. The $5 Registration fee will be waived for the first 30 days. The rule also imposes civil and criminal penalties for drone owners who do not register.

"Decision is a sharp knife that cuts clean and straight; indecision, a dull one that hacks and tears and leaves ragged edges behind it." --Gordon Graham

By Dr. Bill Hinckley, MD FACEP CMTE
Retrievalist and Medical Director, UC Health Air Care & Mobile Care, Cincinnati

CICO (can't intubate – can't oxygenate) is rare, especially given our teams' extraordinary prowess in laryngoscopy and our excellent supraglottic rescue airways, but it still occurs. CICO is real. The HEMS / CCTM literature from the last 20 years suggests that our teams will encounter a CICO situation on 0.7% - 2.4% of transport missions for which airway management by the CCTM team is required. If you haven't yet encountered it, you very likely will at some point in your career. When that day comes, your patient is depending on you to know how to handle it decisively and skillfully. Therefore, it's incumbent upon each of us to practice cricothyrotomy as often as possible, both physically and (especially) mentally.

By Steven Sweeney
The Air medical Memorial was founded in 2009 to honor all air medical line of duty deaths. Currently, the memorial recognizes mroe than 400 Line of Duty Deaths and maintains a comprehensive web site and database of air medical accidents and loses. The organization has received roughly 10 acres of land near Littleton, Colorado, where the group intends to build a permanent memorial and park.

Senator David Vitter (R-LA) and Rep. Pete Sessions (R-TX) introduced legislation, S. 1149/H.R. 822 that updates the Air Ambulance Medicare Fee Schedule. The legislation requires the Secretary in the case of air ambulance services furnished during calendar 2017 through 2021 to make a percentage increase in the base rate of the fee schedule: (1) by 20% during 2017, and (2) by 5% during 2018-2020.

On November 24, the Centers for Medicare and Medicaid Services (CMS) published a final rule that would bundle payments for knee and hip replacements. The Comprehensive Care for Joint Replacement (CCJR) Model for Acute Care Hospitals would bundle all related care for a 90-day episode. CCJR resembles Model 2 of Bundled Payments for Care Improvement (BPCI), CMS' pilot program for bundled payment. But unlike BPCI, any hospital in 67 Metropolitan Statistical Areas (MSA's) would be required to participate.

In late November, CMS proposed new standardized insurance plans and called for new provider network adequacy standards. The agency also proposed new payment parameters and provisions related to the risk adjustment, reinsurance, and risk corridors programs for health insurers. CMS plans to hold the enrollment period between November 1, 2016 and January 31, 2017. Public comments are due December 21, 2015. Click here for a good 5-page CMS summary. Click here for the 381-page proposed rule.

The House Energy and Commerce Committee approved five pieces of public health legislation including The Ensuring Terminated Providers Are Removed from Medicaid and CHIP Act (H.R. 3716) which addresses the problem of health care providers terminated from Medicaid in one state who still participate in Medicaid and CHIP programs in other states. The Medicaid Directory of Caregivers Act (H.R. 3716) would require state Medicaid programs that operate under fee-for-service and/or primary care case management programs include a directory of physicians who served Medicaid patients in the prior 12 months on the Medicaid program's website. The bills now await consideration by the full chamber.

Rep. Pat Tiberi (R-Ohio) will take the gavel on the House Ways and Means Health Subcommittee. Tiberi is the fourth-ranking Republican on the committee and will be giving up his chairmanship of the Trade Subcommittee. He lost to Kevin Brady (R-Texas) earlier this month in the race to choose Speaker of the House Paul Ryan's (R-Wis.) replacement as the chairman of the full committee. Rep. Brady previously chaired the Health Subcommittee. The Subcommittee's jurisdiction includes the Medicare program and issues dealing with the Affordable Care Act (ACA). Rep.

CMS released their final regulation that includes modifications to Stage 2 of the EHR Incentive (meaningful use) Program and outlines the requirements for Stage 3 of the program. The rule also specifies EHR certification standards and finalizes the government's "interoperability roadmap." For meaningful use in 2015 through 2017, major provisions include:

  • Shortened 2015 reporting period (from all year to any 90 consecutive days in 2015);
  • Ten objectives for eligible professionals including one public health reporting objective, down from 18 total objectives;
  • Reduced number of measures that are required to be reported;
  • Reduced measure threshold for View, Download or Transmit (from 5% to just one patient in 2015); and
  • Reduced measure threshold for Secure Messaging (from 5% to simply having the capability in 2015).

Treasury Secretary Jack Lew announced a November 5 deadline for raising the debt limit in order to avoid a potential default on current loans. This date is earlier than many experts had predicted. The current limit is set at $18.1 trillion. In his letter, Lew explained that by November 5 the government will have less than $30 billion on hand, falling short of $60 billion often needed to pay government bills on a particular day. The administration has said that the President will not negotiate a raising of the debt limit. Additionally, both outgoing Speaker of the House John Boehner (R-Ohio) and Senate Majority Leader Mitch McConnell (R-Ky.) have stressed that default is not up for debate. The government technically met its borrowing limit in March, but since then the Treasury has been able to employ extraordinary measures to delay reaching the debt limit.

Abigail Brown received the 2015 ACCT Patient Advocate Award during ACCT's annual meeting in August.

Abby is an Acute Care Nurse Practitioner for Critical Care Transport Services at Cleveland Clinic. She is the Quality Coordinator for the hospital-based program and oversees all the quality monitoring, quality improvement and chart review programs. In addition, she arranges quarterly case reviews for staff, interfaces with consultant medical directors throughout the health system and processes patient safety reports. Her service offers Mobile ICU, Rotor Wing and Fixed Wing with approximately 5,500 patients transports per year.

On Sept. 28, the Centers for Medicare & Medicaid Services (CMS) released its long awaited Request for Information (RFI) to seek public comment related to provisions in the Medicare Access and CHIP Reauthorization Act of 2015 (MACRA): Merit-based Incentive Payment System (MIPS), Alternative Payment Models (APMs), and physician-focused payment models (PFPMs). The RFI will be formally published in the Federal Register on October 1. Comments are due at 5 p.m. on October 30. Rulemaking activity is expected to begin next year, with 2019 being the start of the APM/MIPS payment updates.

Sept. 25, 2015

As you know, 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.

The House and the Senate recently passed a clean continuing resolution (CR) that funds the government from October 1, the start of fiscal year (FY) 2016, through December 11 of this year. The stopgap spending measure provides funding for federal agencies at a rate of $1.017 trillion, approximately flat compared to fiscal 2015 levels. The CR keeps federal funding for Planned Parenthood intact.

Sen. Dean Heller (R-Nev.) and Sen. Martin Heinrich (D-N.M.) introduced legislation to repeal the Affordable Care Act's (ACA) "Cadillac Tax." The tax will go into effect in 2018 and will impact any employer health insurance plans that cost more than $10,200 per year for individuals or $27,450 per year for families. Employers will have to pay 40 percent of the cost above the statutory limits. A study has shown that approximately a quarter of employers will be subject to the tax unless they change their benefit plans. The bill sponsors argue that the tax unfairly targets people who receive health insurance from their employers. A bill to repeal the tax was introduced in the House by Rep. Joe Courtney (D-Conn.) earlier this spring, but has yet to see a vote. Repeal of this ACA provision is estimated to cost $87 billion.

On a provider call, the Centers for Medicare & Medicaid Services (CMS) confirmed that four state Medicaid agencies will be unable to directly adjudicate claims containing ICD-10 codes by the Oct. 1 deadline. California, Maryland, Louisiana and Montana will be "crosswalking" ICD-10 codes back to ICD-9 codes in order to adjudicate claims. As a result of this approach, there is concern that practices could experience a higher number of pended or rejected claims due to the imprecise nature of the ICD-10 to ICD-9 crosswalk.

House Ways and Means Committee Republican leaders introduced three major hospital bills on July 29 that build off of the Hospital Payment Improvement (HIP) Act discussion draft that was released in November. The bills are part of its larger effort to reform the hospital payment system.

Chairman Paul Ryan (R-Wis.), Health Subcommittee Chairman Kevin Brady (R-Texas), Health Subcommittee member Kenny Marchant (R-Texas), and Human Resources Subcommittee Chairman Charles Boustany (R-La.) spearheaded the legislation:

H.R. 3291, the Medicare Crosswalk Code Development Act of 2015 would help translate diagnosis codes between inpatient and outpatient systems.

H.R. 3292, the Medicare IME Pool Act of 2015, would give teaching hospitals lump-sum payments for Indirect Medical Education (IME) costs.

H.R. 3288, the Strengthening DSH and Medicare Through Subsidy Recapture and Payment Reform Act of 2015 would begin reimbursing disproportionate share hospitals (DSH) through lump sum payments. H.R. 3288 would also increase DSH funding to those hospitals that are located in states that have not expanded their Medicaid programs under the Affordable Care Act (ACA) by recouping overpayments for subsidies under the law.

These bills took into account comments received on Rep. Brady's Hospital Improvements for Payment discussion draft. Rep. Brady plans to introduce a larger package that includes these three bills later in the fall.

The Association of Critical Care Transport welcomed new board members at its Annual Meeting in August at the Pinnacle Conference.

New members included: 

Karen Arndt

OSF Life Flight

Karen Arndt is the Outreach Coordinator for OSF Life Flight in Illinois.

Ms. Arndt has 20 years of leadership experience in both air and ground critical care transport services. Prior to her employment at OSF Life Flight, Karen was the Chief Flight Nurse/Administrative Director at the University of Chicago Medical Center, and the Business Operations Manager at IU Health Lifeline in Indianapolis.


Stearns Jeffrey 125pxJeffrey Stearns

Mayo Clinic

Jeffrey Stearns has been a critical care transport nurse for the Mayo Clinic since 1995.

He has been integrally involved in the program's quality and safety debrief programs as a quality management coordinator, and has presented original research on clinical and triage topics. Jeff received his undergraduate and graduate degree in nursing from the University of Wisconsin – Eau Claire. "I am extremely honored to be a part of an association that places quality patient care and safety first."


Ahlers Mary 125pxMary Ahlers

Cincinnati Medical Center Air & Mobile Care

Mary Ahlers is a Clinical Coordinator for University of Cincinnati Medical Center, Air Care & Mobile Care.

She has a lifetime commitment to the advancement of BLS, ALS and Critical Care Medical Transport and shares the goal to facilitate the advancement of medical services outreach and transport to ill and injured patients through quality and safety standards, with emphasis in areas of the underserved rural areas of special needs. She is passionate about best practice through evidence-based research, education and standards for a cross-continuum of patient-centered care. She embraces advocacy for national recognition of critical-care curriculum development, certification with state and federal program support.

CMS released July 8 the proposed rule for the CY 2016 Medicare physician fee schedule (PFS). The proposed rule will be published in the Federal Register on July 11, 2014. CMS will accept comments until September 8, 2015.

Please see the summary. Please direct questions to Miranda Franco. The final rule will likely be released by the beginning of November and the new payment provisions will go into effect January 1, 2016.

CMS is asking for provider comments on key aspects of MACRA that have not been defined, such as the types of metrics and benchmarks that will be used in evaluating provider performance. This is a key opportunity for stakeholders.

Link to Summary

In late June, the Centers for Medicare & Medicaid Services (CMS) released its 2016 Proposed Hospital Outpatient Prospective Payment System (OPPS) rule, which also includes the Proposed Ambulatory Surgical Center (ASC) payment update. The agency did not release the Medicare Physician Fee Schedule; we expect it early this week.

Notably, the rule revisits the controversial "Two-Midnight" policy implemented in 2014. Also, in the rule are provisions related to Ambulatory Payment Classification (APC) restructuring, expansion of packaged ancillary services, and changes to quality reporting requirements.

Read the summary here

The Air Medical Memorial and National EMS Memorial services were held in Littleton and Colorado Springs, Colo., from June 25-28. 

The Weekend of Tribute event honors EMS workers who died in the line of duty. Each year, families, friends and coworkers from around the nation come together to not only recognize and honor their sacrifice, but also provide support to the loved ones who are left behind.

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