Medical helicopters are filling the skies over Indiana in an unprecedented growth spurt that has sparked a heated debate about overuse and quality of care.
A market once dominated by not-forprofit Clarian Health Partners' LifeLine program has seen three out-of-state companies plant seven new helicopter bases in central and southern Indiana over the past few years.
PHI Air Medical Group Indiana, a subsidiary of Phoenix-based PHI Air Medical Services, opened bases in West Lafayette, Anderson and Columbus last year. They joined other newcomers like Missouribased Air Evac Lifeteam, which sells memberships to its program, and Louisville's StatCare, which opened shop in Seymour.
All told, 16 providers of air medical transport fly 26 aircraft in Indiana, according to the state Department of Homeland Security. Ten years ago, five Indiana-based programs operated 10 helicopters.
Experts say more growth may be on the way, a reflection of a trend seen nationally. The market's already become a bit crowded for central Indiana's long-established provider, LifeLine, which celebrated its 25th anniversary last year.
"We basically feel like these are outside vendors coming in," said Kathy Hendershot, director of operations for the emergency department at Clarian's Methodist and IU hospitals. "They don't know our EMS system; they don't know our hospital system. I think we can provide a higher-quality service.
"Bottom line, they came in to make money."
Bring on the comparisons, said Gary Stromberg, PHI Air Medical's regional director for Indiana and Kentucky. He said he'd be happy to stack up his crews and staff against LifeLine's "any day of the week."
"At least one-half of our current staff come from other flight programs within the region, including LifeLine," he said. "That comment is a good example of the traditional arrogance that prevents patients from receiving the assets in the marketplace they desire."
Welcome to Indiana
Both Air Evac, which opened a Washington, Ind., helicopter base in 2001, and PHI introduced a new concept to air medical transport when they arrived in Indiana. The companies generally base their helicopters outside city limits.
Air Evac began in southern Missouri because its founders became tired of watching injured people take three-hour ambulance rides to St. Louis, said Andy Arthurs, a director of operations for six states, including Indiana. They decided to put helicopters in rural areas to cut the time it takes for a city-based helicopter to reach patients.
Air Evac helps support its bases by selling annual memberships to individuals and families. For about $50, a person or a family buys an assurance that they will pay nothing out of pocket if they need a helicopter ride.
That means Air Evac will take only what the insurer pays for the flight. Arthurs emphasized that this membership-which encompasses about 460,000 people nationwide-can only be used for calls deemed medically necessary by a medical crew on the ground.
"You just can't pick up the phone and say, 'I want a helicopter ride,'" he said.
PHI sells no memberships, but the company also emphasizes placing bases in what it sees as "underserved markets."
"Our philosophy is, we place the aircraft where the patients are," Stromberg said.
PHI also boasts a large fleet and nearly 30 years of experience in air medical transport. The company is a subsidiary of the publicly traded Petroleum Helicopters Inc., a Louisiana-based firm founded to serve off-shore oil drilling locations.
PHI Air Medical operates more than 75 aircraft in 11 states, Stromberg said.
More growth over the horizon
So far, PHI leaders like what they see, and they want more of the Indiana market.
The company is talking with St. Vincent Health and St. Francis Hospital & Health Centers about basing additional helicopters in Indianapolis. That would give PHI a central location to support its current bases.
In addition to those possibilities, the company is working on three or four "very large health care relationships," Stromberg said. He declined to elaborate.
St. Francis plans to build a helicopter pad at its south-side campus to serve its new Cardiac Vascular Care Center. Michael Hertel, the center's director of business development, said it needs the landing pad to take cases that come from Columbus or rural parts of the state. The pad also will serve other areas of the hospital, like the neonatal intensive care unit.
St. Francis hasn't decided whether to base a helicopter there or align with PHI or Air Evac.
St. Vincent has had a pad at its 86th Street hospital for years. It wants a helicopter based there to provide a better way of bringing critically ill patients from community hospitals for high-level care, said Dr. Michael Kaufmann, EMS director. Kaufmann also serves as a medical director for PHI.
LifeLine, which added a Kokomo location, also plans to grow. The Texas-based company that provides its helicopters and pilots will add two more this summer, Clarian spokesman Jon Mills said. One will land at a base in Terre Haute by Aug. 1, and the other will land in Greensburg by Sept. 1.
Hendershot said the competition increase provided some motivation for the expansion. LifeLine, which has seen flat call volume over the past year, must protect its market share. But she said that wasn't the main reason.
"The bigger thing is, we think we're a better flight program," she said.
Justifying the growth
Helicopter transports should stick to a narrow focus, according to Clarian CEO Dan Evans.
"These helicopters are for people who've been in terrible automobile accidents, twisted piles of steel, and they're cut out by EMTs and flown to a Level 1 trauma center," he said.
Expanding the focus, he believes, can lead to the overuse that drives up health care costs. One transport can cost several thousand dollars.
That's the old definition of air transport, according to Kaufmann.
"I think, over the last several years, we've seen it evolve and take on a greater role on the medical side of things," he said.
Medicine has become more time-sensitive, increasing the need for fast patient transport. For instance, the clot-busting drugs stroke victims need must be delivered within three hours of the onset of symptoms.
Aside from the necessity of more helicopters, Evans questions the motive behind LifeLine's for-profit competition. He refers to PHI mostly by the name of its parent, Petroleum Helicopters.
"The private sector would not be providing helicopter airlifts unless it provided a return on investment sufficient to provide capital for people who wish to make money," he said.
However, Stromberg notes that LifeLine sends out a bill just like everyone else.
"We allow the patients and the physicians to make decisions about our utilization, not the institute itself," he said.
Arthurs said Air Evac also provides education and training for emergency crews in the areas it covers.
"It's way beyond just making the dollar," he said.
Learning to get along
Hendershot remembers a call last year that involved two patients and helicopters from both LifeLine and PHI. LifeLine arrived first, but its patient died at the scene, so the crew began working on the second victim.
A PHI crew then landed and claimed that patient, but LifeLine prevailed because it had a doctor on board, Hendershot said.
"We had never run into that situation before, and I'm sure they hadn't, either," she said.
As she recalled the one-time incident, she noted that it serves as a metaphor for the changing market in Indiana.
"It was kind of like trying to figure out how to play in the same sandbox with other people, and that's what we need to do," she said. "The bottom line is, we both want to give the best care; we both want to give the best service we can."