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Air ambulance presence grows, but does Iron Range need two helicopter bases?

EVELETH, Minn.—More isn't necessarily better when it comes to air ambulance service.

"Having a helicopter is good for a rural community," said Tom Judge, executive director of LifeFlight of Maine, the only air ambulance service in Maine. "Are more helicopters better? ... At some point, all of these helicopters, that's part of what's driven up (costs)."

The question became relative in northern Minnesota this week with the announcement that Twin Cities-based North Memorial Health has established a base for an Augusta 109 twin-engine medical helicopter at the Eveleth-Virginia airport. The new base is just a few miles away from the long-established Hibbing, Minn., base for Life Link III.

The doubling up of coverage reflects a nationwide trend, said Judge, a nationally-recognized expert on the subject.

"There's no other sector of medicine which has quadrupled in size over a 10- to 15-year period," he said. "The country went from 300 helicopters to 1,100 helicopters. There are some states that are just buried in helicopters."

That meant the helicopters were carrying fewer patients, Judge added. Around 2000, the average helicopter in the U.S. moved between 600 and 700 patients a year. Over the past 15 years, that has dropped to an average of 324 patients per helicopter.

"Well your fixed costs, if anything, have only gone up," he said. "So your two reactions are find more people to put in helicopters and increase your charges."

Indeed, the cost for air transportation to or between hospitals has risen dramatically. The average charge for the for-profit Air Methods rose from about $13,000 in 2007 to $50,200 last year, Consumer Reports reported in April, citing data from the independent firm Research 360.

Those flights may be only partially covered by insurance, or not covered at all.

"There are horror stories out there about people being transferred by air that didn't need to and not having the coverage to pay for that," said Terry Hill, senior adviser to the Duluth-based National Rural Health Resource Center. "Air ambulance rates have become very lucrative."

Judge said for-profit companies believe they can make money from air ambulance service in the absence of regulation in the air carrier industry and increased reimbursement for air medical transportation under the national ambulance fee schedule that went into effect in 2002.

Like LifeFlight of Maine, both Life Link III and North Memorial Health are nonprofit entities. Officials for the two agencies, when contacted this week, said their air ambulance services stress cooperation over competition.

"It's kind of a Kumbaya, but we ... often bring our patients to partner hospitals that are part of the Life Link consortium," said Lesa Bader, spokeswoman for North Memorial Health.

Likewise, Life Link III is dedicated to getting help to patients regardless of whose helicopter is sent, said Kolby Kolbet, vice president of clinical services for the Minneapolis-based provider.

"We frequently do send an aircraft that's not Life Link in the best interest of a patient," Kolbet said.

Dispatchers determine which provider to send to an accident scene, he said.

Nonetheless, each was happy to discuss the advantages of their respective air ambulance services. Unlike North Memorial, Life Link III is certified by the Commission on Accreditation of Medical Transport Systems, Kolbet said. Its aircraft are equipped with portable labs, the ability to conduct ultrasound in flight and a CPR device on board. Its crews are equipped with night-vision goggles.

Bader said North Memorial air ambulance crews have instrument flight abilities that allow them to fly in conditions that leave other helicopters grounded.

She also cited the ability of North Memorial's flight crews.

"Our flight crews all have training and experience in high-volume intensive care units," Bader said.

Judge said North Memorial's entry might have more to do with competition among hospitals than among air ambulances.

North Memorial Health is a consortium that includes two hospitals: North Memorial Hospital and Maple Grove Hospital. Life Link III is a consortium of nine health care providers, including Essentia Health and St. Luke's hospital.

"Sometimes even if you're not necessarily making money on the helicopter, you're providing more services and getting more patients into your specialty care center," Judge said. "It would seem, at least on the surface, that the North Memorial system was looking at this saying ... we better put something there to help keep patients coming into our system."

Hill also said competition among hospitals could be a factor.

"It could simply be North has taken on a more aggressive kind of approach to trying to be more of a statewide player," he said.

Northern tier states tend to be less overrun in the air ambulance wars than those in the South, Judge said. He had a positive assessment of the providers for the Northland.

"I think that both North Memorial and ... Life Link are high-value systems," he said. "I think they have good business ethics."