March 4, 2011
On Thursday, February 17th Member Robert Sumwalt and Dr. Bob Dodd (RE-10) met with Administrator Donald Berwick of the Centers for Medicare and Medicare Services (CMS) to discuss NTSB recommendations to CMS regarding helicopter emergency medical services (HEMS) safety standards and reimbursement practices. A letter of recommendation addressing this topic was sent September 24th, 2009 to Administrator Kathleen Sebelius of Health and Human Services (HHS), the umbrella federal agency which includes CMS.
Administrator Sebelius responded to the Safety Board recommendation letter on April 26, 2010, highlighting her opinion that the Federal Aviation Administration (FAA) is responsible for flight safety and that the role of CMS is that of reimbursement and not flight safety. At the time of Administrator Sebelius’ response, Dr. Berwick was not at CMS. The objective of meeting with Dr. Berwick was to inform him of the rationale for the Safety Board’s recommendations and to provide him the opportunity to learn more about the risks associated with HEMS transport.
Dr. Berwick and his staff responded actively to Member Sumwalt’s presentation asking thoughtful questions and engaging in discussion of the risks and factors associated with HEMS transport. Dr. Berwick seemed particularly interested, commenting many times on how fascinating the topic was.
One key aspect of the discussion centered on the fact that simple single engine helicopters like the Bell 206, are not able to carry the medical equipment carried by larger helicopters due to weight limitations. This limitation reduces its ability to provide the same level of patient care as larger aircraft. The CMS staff was not aware of this fact and was concerned that their reimbursement practices are predicated on an established level of care. Dr. Berwick also seemed interested in the problems associated with HEMS operators entering and leaving markets at will.
Dr. Berwick directed his staff to continue the dialog between NTSB and CMS to further define the problems associated with HEMS and CMS potential roles in addressing these concerns. Follow-up actions have not been scheduled at this time.