Highlights
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The Challenges of Medicaid Transportation
David Raphael: “Today Medicaid covers 55 million people, almost a quarter, more than a quarter of the population. It spends on non-emergency medical transportation, combined federal and state, 3 billion dollars annually. Now to put that in perspective, that’s roughly 20 percent of the entire federal transit budget. It’s only 1 percent of the Medicaid budget. Medicaid spends 300 million a year, and only 1 percent of that goes for transit.” -
Keynote Teaser
Dale Marsico: ”I’ve got two words …for today. One word is fantasy. The other word is reality. Fantasy. What would fantasy in our field be? Well, we know that fantasy is politics. Politics and reality. People are very strange sometimes when they talk about our medical transportation policies because they somehow seem to think they’re supposed to make sense. But, most of our policies are written in far away Washington…, much further than Hawaii. And reality. What is the reality in this case? What is our fantasy and reality? It’s how the political system provides health care, transportation for people who need it. Politics versus reality.” -
Health Care, Mobility and Medical Centers
Dan Dirks: ”The lesson is that yes, public transit is an option, but one of the things that is going on or can go on, especially when you have medical institutions and you have like partners in the area, if you can get through the barrier of just trying to work with folks in the area, it is amazing what you are going to be able to do.” -
Health Care, Mobility and Elders
Mary Deroo: ”The Medical Advocacy Program that we developed at Elder Services is a program where we utilize volunteers and we train them on medical issues. Not complex but just simple medical issues and also how to take somebody to a doctor appointment. Case Managers and nurses could order up transportation but our elders could not get down that flight of stairs and into the taxi or into the transportation or they needed help putting their coat on, tying their shoes. So, what we did was we developed this as through the door to assist getting an elder up and ready.
Presentations
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The Challenge of Medicaid Transportation
Keynote Address
Health Care, Mobility and Medical Centers
Health Care, Mobility and Elders
Health Care, Mobility and Collaboration
Health Care, Mobility and Children
Health Care, Mobility and ADA Paratransit
Challenges and the Way Forward
Call to Order
Non-Emergency Stretcher Transportation
Recent Comments
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That one clinic where they were able to calculate the cost of using the medical transportation versus the financial benefits it provided in terms of preventing cancellations and determine that they broke even provided an interesting sort of statistic. It would be interesting to see whether that cost/benefit, in purely financial terms, was fairly standard. In cases where public officials create budgets for transportation – or don't create those budgets – it could be significant, because the cost of not providing transportation is a much softer cost. This study - http://onlinepubs.trb.org/Onlinepubs/tcrp/tcrp_webdoc_29.pdf - also points out that it is much harder to estimate the costs of medical transportation than the benefits.
Anne | September 11, 2009 -
In general this presentation focused on mobility for elders, but a lot of the discussion was about using volunteers. Since Medicare does not guarantee nonemergency medical transportation it seems to make sense that so many people were relying on volunteers for non-ambulance trips. Since a lot of the elders seemed to need help getting in and out of the house or in and out of the facility, and help while in the doctor's office or at the pharmacy, it seems like one-on-one rides were more efficient, because you didn't have a situation where a driver had to help somebody in or out while everybody else using the transportation had to wait. At the same time, there are a lot of issues with using volunteers: training them, retaining them, relying on them, etc. And I wonder if there were any cases where a volunteer had to be fired, and how to handle that. It looks like there are quite a few programs for volunteer medical advocacy for older adults – like this one in Maine [http://www.smaaa.org/volunteer_medical_advocates.php] – but as many people mentioned, transportation is an issue that involves liability and it is also a technical skill. It would be interesting to know whether defensive driving and similar types of training were also part of the volunteer training. Coordination was also a big issue: coordinating with different agencies and nonprofits. But in light of some of the other panel discussions, it seems like it might be worthwhile to ask what kinds of collaboration was working best. Did resource sharing – things like vehicle maintenance – work well? Or trip coordination? What kinds of coordination were the most helpful with this population of elders? It seemed like Tri-Met did a lot of that resource coordination while in Massachusetts the coordination was largely trip coordination. What circumstances dictate which kind of coordination will work better?
Anne | September 11, 2009 -
A lot of this brings to mind something the keynote addressed: how much health care has moved towards treating people by using ongoing therapeutic systems that involve frequent visits for an extended period. All the presenters noted that dialysis and cancer treatments often leave people in a weakened state, where it really isn't feasible for them to drive themselves or take public transportation. In Kansas, it was pointed out, some people are driving themselves home from dialysis but this causes real concern because people who have just undergone these treatments may not always be fit to drive. So in these cases nonemergency transportation really had to be available, and in these rural areas it is difficult to manage. It seemed, across the board, like coordination was the work of time. Transportation providers in rural areas especially had to show that they were reliable and would continue to be available and providing service in the long run before they could really get hospitals and other centers to buy in. And patients in these rural areas, who were unused to the idea of public transportation, needed to be convinced that this really was something they could depend on for these critical treatments. Showing the value of the service couldn't be restricted to quantifying how much money was saved by reducing missed appointments or cancellations, it also had to involve providing a service that really took the worry and trouble out of transportation. And it also meant handling blocking in a productive way: getting patients into appointments in a way that meant they could share rides without making them wait for really extended periods in the facility before or after their appointment and then taking a really long trip home.
Anne | September 11, 2009 -
It's interesting that Medicaid is the only federal program that guarantees transportation, and that it does so not because of how it was written but because court cases determined that it was not actually operating as an entitlement if only those with resources – transportation – could access the care. You have to wonder whether policy changes currently underway would move towards making healthcare an entitlement and then making medical transportation part of that. But since it is administered by states it depends on states to have and dispense the resources that make the entitlement a real entitlement. On the other hand, the brokerage system in Washington seems to both integrate and keep separate a long of services. It is interesting to think about how, firstly, changes in health care policy that tend towards seeing health care as an entitlement might make room for expanding the idea of nonemergency medical transportation as an integral part of the provision of services. And secondly, with the brokerage systems and the different states and possibly a different federal role in health care sometime in the future, how services might coordinate going forward – whether technology might have a role to play in that, for example.
Anne | September 11, 2009 -
I thought one of the more interesting things he brought up was how changes in care have made transportation more important. People live longer, survive accidents, survive cancer and serious illness, and they go home sooner and go back for regular therapy more. Doctors, he pointed out, don't make house calls. And this trajectory is continuing, and it means transportation is really part of providing health care in a way that it wasn't in the old days.
Anne | September 11, 2009
