One in three Americans lives in rural areas where getting urgent medical care for events like cardiac emergencies, stroke and trauma are extremely difficult due to the distance of appropriate medical facilities. Since 1990, over 22% of America’s hospitals have closed.

Getting timely, appropriate medical care is deadly serious. Trauma doctors refer to the first hour after a traumatic injury as the “Golden Hour” because during this critical window, the right kind of medical care can lead to vastly better outcomes with regard to saving lives and preserving quality of life. Eighty-five million Americans who live more than one hour from a hospital with a Level 1 or Level 2 trauma center by ground transport can only access these centers within the Golden Hour because of air medical services. For these Americans there is literally no way to get appropriate emergency care without air transport.

Emergency air medical transport providers, which most often use helicopters, provide a high level of life-saving care that involves highly-trained nurses, paramedics, pilots and state-of-the art medical equipment requiring professional maintainers. The crew only responds when called upon by a first responder or physician; they do not self-dispatch. And when called, they go immediately, helping to expand the reach of hospitals and trauma centers and ensuring that rural communities maintain access to medical care. Air medical transport providers operate in one of the most regulated industries in the country.

There is an unsustainable problem, however: air medical service providers are being squeezed by drastically low government reimbursement rates and some insurers who refuse to negotiate in good faith. The result is that the burden of paying for air medical transport is being shifted to insured beneficiaries, and worse, real lives and rural communities are being put at risk.

Being ready to deploy advanced aircraft and highly-trained crews 24 hours a day, seven days a week, 365 days of the year, costs about $3 million annually per air base. LifeNet of New York is an air medical transport provider in New York State. More than 70% of our transports are reimbursed by either Medicare, Medicaid, other government sponsored insurance, or are uninsured. Unfortunately, the current reimbursement rates under these programs are dramatically below our costs. The average Medicare reimbursement is about 50% of actual transport costs.

If a provider is reimbursed substantially below costs for seven out of every 10 transports, it means the remaining transports are essentially paying for the whole system. While most private insurers are good actors who pay at or close the full billed charges, there are some in the industry who will not negotiate in good faith and refuse to recognize the true cost of services.

So how do we preserve critical air medical transport services for communities all over the country with a solution that is cost-effective, fair to patients and stakeholders, and durable?

First and foremost, we must fix the dramatic shortfall in Medicare reimbursement by passing S. 1149 and H.R. 822, federal legislation that helps bridge the gap in payments versus actual costs and enables the issue to be studied in depth. The Medicare fee schedule for air transport was set in 1998 and was completely disconnected from actual cost data; this status quo cannot hold. At the local level, states must take similar action to align reimbursement rates for Medicaid with the true costs of service. And lastly, insurers and air medical transport providers must work in good faith to forge fair in-network agreements that recognize the value of air medical services for all Americans.

Air medical transport is essential for rural communities to have access to high quality, timely trauma, cardiac and stroke care. It is time to act to preserve this critical service.

[David Poulsen is vice president of Air Methods, LifeNet of New York with bases across Upstate New York, including Harris next to Catskill Regional Medical Center, Fultonville, Hornell, Potsdam, Seneca Falls, Wallkill, Watertown and Windsor.]