Keeping costs down to earth

As if her husband’s heart attack wasn’t enough of a shock, Denise Wisener got another jolt in June when she opened the bill for the air ambulance ride to Sacred Heart Medical Center.

The Northwest MedStar fee for the 120-mile trip from the couple’s home in Republic to the Spokane landing pad was $11,517, about $8,500 more than their insurance company would pay, she said.

“I almost had a heart attack myself,” said Wisener, 49, a massage therapist who had to ask for an installment plan.

Eight months after the incident, Bob Wisener, a 57-year-old log-truck driver, is recovering well. And on Monday, his wife became one of the first to sign up for a new MedStar subscription service that she hopes will avert financial fallout from future medical emergencies.

“I hope we never have to use it again,” Denise Wisener said.

For $59 year – or $150 for three years – the Wiseners and other regional households can join a MedStar membership program that bills public or private insurance for the cost of emergency air transport – and then pays the bulk of the bill that’s left.

The cost covers the subscriber, his or her spouse, and any family members listed as dependents on income tax statements.

Officials at MedStar, a service of Inland Northwest Health Services, said they started the program this month after five years of planning and the passage of a 2006 state law exempting air ambulances from insurance regulations that classified them as health contractors.

Under the plan, membership fees offset flight costs that can average $12,000 a trip, said Eveline Saltmarsh, director of Northwest MedStar, which is based in Spokane.

“It’s a kind of community effort,” said Saltmarsh. “When everybody is pitching in, everybody is pitching in for the individual who can’t pay.”

Washington joins at least 18 states – including Oregon and Idaho – that allow subscription air ambulance service, according to a study by the state Office of the Insurance Commissioner.

MedStar organizers expect memberships to top 200 a month or at least 1,000 in the first year, Saltmarsh said. That’s about a third of the 3,237 adults and children from four states who were transported to regional hospitals in 2006 after emergencies.

But it’s only a fraction of the number of people admitted to area hospitals. At Sacred Heart Medical Center, for instance, there were more than 1,500 MedStar arrivals, but nearly 31,000 total admissions last year, officials said.

MedStar organizers acknowledged that the chance of needing emergency air transportation is slim. But they also said that certain people – those with histories of high-risk illness, for instance – will eagerly seek the service.

And, in a region where the most popular recreational activities are often the most dangerous, officials said residents might want the peace of mind the membership provides.

“I’m the mother of three sons. I intend to buy the membership,” noted Nancy Vorhees, MedStar’s chief operating officer. “I drive my car; I water-ski; I snow ski. I do all the things that we all do. It will be interesting to see what the Spokane population does.”

The membership program is not aimed at making a profit, primarily because federal billing rules require that costs approximate insurance co-payment amounts, Saltmarsh said.

But Vorhees said the nonprofit business, which posted gross revenues of $27 million in 2005 and expects revenues of $32.5 million in 2006, is still rebounding from losses a year ago.

MedStar cut wages and closed a Moses Lake base after $1.5 million in losses. At least part of that was attributed to low reimbursements from private insurance and Medicare, which amounted to about 75 percent of costs.

Added to that was the failure or inability of some clients to pay hefty air ambulance bills. Last year, MedStar posted about $15.5 million in charity care, which included Medicare and Medicaid shortfalls, officials said.

“We face the same problems as the hospitals,” Saltmarsh said.

MedStar is one of two air ambulance services in Washington. Airlift Northwest, a Seattle firm, has more than 400 households signed up for the new ambulance service, said business manager Lenora Henderson.

Residents on the West Side north of Seattle were used to subscription emergency services. MedFlight, operated by St. Joseph’s Hospital in Bellingham, ran from 1985 to 2002, and primarily served residents of Island, San Juan, Skagit and Whatcom counties.

It shut down after the high cost of meeting insurance mandates and, later, private operating expenses grew too great. Changes in federal Medicare reimbursements complicated the arrangement.

Airlift Northwest, which took over MedFlight, could not afford to offer the membership service under existing insurance rules. Concern by residents of San Juan County and elsewhere prompted last year’s legislation.

Airlift and MedStar are finalizing reciprocal arrangements with other nonprofit air ambulance firms in the West, part of a collaborative professional agreement.

“We’re not competitive with each other because there’s a natural boundary called the Cascade Mountains,” Henderson said.

On this side of the range, new clients like Denise Wisener are simply glad the service exists.

“Something like this is worth its weight in gold,” she said. “If you use it just once, it’s more than paid for itself.”