O2105: Air vs Ground: What's the Cost?

Background: In establishing a multi-modal neonatal transport team, we looked to create an objective tool to differentiate appropriate use of ground versus rotary assets. By creating a “transport matrix” we were able to objectively assess the risk/benefit ratio of putting a flight team in the air. Analyzing each neonate by acuity, diagnoses, and location, we looked to facilitate medical decision-making with a secondary goal of ensuring high reimbursement rates from insurance, all along optimizing the safe use of our resources and staff.

Methods: Using retrospective transport data to create the matrix, the following elements were accounted for: airway, circulation, disability, environment, and diagnosis. Education of team members and medical control providers took place and refreshers continued throughout the study period. We retrospectively analyzed data from August, 2019, thru December, 2021, as sourced from the matrix, our hospital’s accounting department, and the rotary transport vendor records. (see Table 1).

Results: When comparing insurance reimbursement for rotary transport, our transport team saw a 100% reimbursement for 2019, 87% for 2020, and 76% for 2021; versus rotary neonatal transport reimbursements for all of our state at 100% for 2019, 94.5% for 2020, and 87.3% for 2021. Since the inception of rotary transport in May 2019, with the matrix starting in August 2019, our team received 82% reimbursement compared to 87.25% for all of state neonatal rotary transports. Deviations in the mode of transport documented were due to weather, maintenance, helicopter/crew unavailability, and helipad issues. In 2020, 8 flights were denied. And in 2021, 43 flights were denied. Compliance with the use of the matrix continued to rise throughout the study period.

Conclusion: Limitations to our data collection and barriers to matrix implementation included: incomplete matrix completion, limited time frame of the study with low numbers, insurance reimbursement data lag time of 9 months, inaccurate use of matrix by providers, need for several minor revisions of the matrix during the period to account for unforeseen required elements to aid in strengthening of the decision making power of the matrix, medical control re-education, physician bypassing the matrix if not readily available, and medical control’s personal fear of the team flying with regards to safety and financial reimbursement.
Initiatives for making the matrix a success made over time were adjusting the matrix periodically to include diagnoses/delivery and other elements not initially accounted for, education of transport team including medical control at staff meetings, adding the matrix to Dropbox for easier accessibility by medical control, and attaching it to the intake form. As use of the transport matrix improves, so has our team’s comfort in the decision-making process when choosing rotary transport.