All Points Assisted Transportation

Transporting patients to and from local surgery centers is a growing source of business activity for a Non-Emergency Medical Transportation company such as ours. This report is designed to help define the role of the Ambulatory Surgery Center in the healthcare industry.

What are Ambulatory Surgery Centers and why are they Significant?

According to a report prepared for the ASC Coalition, ambulatory surgery centers, (ASCs), are health care facilities that offer patients the convenience of having surgeries and procedures performed safely outside of the hospital setting. Since their inception more than four decades ago, ASCs have demonstrated an exceptional ability to improve quality and service while simultaneously reducing costs. At a time when most developments in health care services and technology typically come with a higher price tag, ASCs stand out as an exception to the rule.

What Procedures are Performed at an ASC?

Among the most common procedures, were colonoscopy (27%), upper gastrointestinal endoscopy (10%), lens and cataract surgery (10%), and pain management procedures (5%). About half of the total population of patients were 60 and older, with 22% between 60 and 69, 18% between 70 and 79, and 10% were 80 or older.

ASCs Provide Care at Significant Cost Savings

Not only are ASCs focused on ensuring that patients have the best surgical experience possible, they also provide cost-effective care that save the government , third party payors and patients money. According to the Ambulatory Surgery Center Association,

If just half of the eligible surgical procedures moved from hospital outpatient departments to ASCs, Medicare would save an additional $2.4 billion a year or $24 billion over the next 10 years. Likewise, Medicaid and other insurers benefit from lower prices for services performed in the ASC setting. For example, a Medicare beneficiary could pay as much as $496 in coinsurance for a cataract extraction procedure performed in a hospital department, whereas that same beneficiary’s co-payment in the ASC would be only $195.

Non-hospital Ownership

The majority of ambulatory surgery centers are owned by physicians, or by physician partnerships. As of 2011physician ownership was approaching 80% of all ASCs. The physician owned healthcare model allows the following efficiencies:

• More intense and better focused quality control processes since ASCs offer a single setting, and smaller space and smaller number of operating rooms.

• Allows patients to bring concerns directly to the physicians involved, rather than hospital administrators.

• Physicians can personally guide innovation strategies and quality control initiatives.

Benefits of Medical Technology Advancements

Technological advancement has allowed a growing range of procedures to be performed safely on an outpatient basis. Faster acting and more effective anesthetics and less invasive techniques, such as arthroscopy, have driven ASC growth. Procedures that only a few years ago required major incisions, long-acting anesthetics, and extended convalescence can now be performed through closed techniques utilizing short-acting anesthetics, and with minimal recovery time.

92% Satisfaction Rate

As a result, patients say they have a 92% satisfaction rate with both the care and service they receive from Ambulatory Surgical Centers.

Are Ambulatory Surgery Centers Safe?

In the wake of the surgery-related death of comedian Joan Rivers, patient-safety leaders and some physicians are calling on outpatient surgery centers to carefully select elderly patients eligible for surgery and encouraging patients to question the qualifications of physicians performing the procedures.

Surgery carries risk for everyone, but older adults are more likely to have multiple health conditions that can affect how their body responds to even minor surgical procedures. “If something goes slightly wrong, it’s much more likely to turn into a big problem in an older person than a younger person,” said Dr. Jonathan Flacker, chief of geriatrics and gerontology at Emory University and a spokesman for the American Geriatrics Society.

Conclusion

The growth of Ambulatory Surgery Centers has been remarkable the past several years, and from the standpoint of our company, the results are overwhelmingly positive. All Points Assisted Transportation would like to thank the ASCs in our area for their contributions to the community.

There is nothing quite like spending the holidays with family and friends. Most of us take this privilege for granted, but there are many people who don’t have this opportunity, due to their age, an illness, immobility, or limited transportation options. The holidays are meant for us to appreciate our good fortune and help those who are less fortunate. If you or someone you know is unable to visit with family and friends this holiday season for any of these reasons, we would like you to know that there are options available to you.

At All Points Assisted Transportation, we don’t just provide transportation to and from medical appointments. We also provide transportation for elderly or wheelchair-bound people who need to perform everyday tasks like shopping, running errands, and of course, visiting with family and friends. We offer this service at a competitive and affordable rate. We also allow a family member or caretaker to ride along at no additional cost.

We believe that everyone has the right to live a more fulfilling life no matter age, income, or health status. Our mission is to help improve the quality of life for persons with limited mobility or lack of transportation. There is nothing like having the freedom and independence to pursue the things in life that make us happy, and that is what we are all about.

If you or someone you know is having difficulty getting around, but would like to spend some quality time with their friends and family this holiday season, contact us at All Points Assisted Transportation, and we will do everything in our power to help make that happen, so they can enjoy the holidays too.

Have a safe and happy holiday season!

Your friends at All Points Assisted Transportation.

Barriers To Accessing Healthcare

Every year, millions of Americans miss or delay preventative medical care due to their lack of access to safe and reliable transportation. Research has consistently proven that transportation is one of the most common barriers facing low-income Americans in accessing timely and necessary medical care because many of them simply lack the disposable income needed to own a vehicle or have access to affordable public transit in order to get to or from medical appointments.

• Approximately 3.6 Million Americans miss or delay medical care because of transportation issues.
• Approximately 950,000 children miss or delay medical care because of transportation issues.
• $367 per person is saved when providing NEMT for prenatal care.

The Medicaid non-emergency medical transportation (NEMT) benefit fills these various access gaps by providing the least costly, but appropriate method of transportation services. Please note than in my home state of California, “Medi-Cal” is the designated name of the Medicaid program. We will use the term Medicaid for the remainder of this blog since it is a national program. Throughout the nation, a network of taxis, vans and public transit systems exist for Medicaid beneficiaries that provide the means to get to and from their necessary medical appointments.

The Center for Medicaid and Medicare Services (CMS) established transportation as a mandatory benefit in order to provide consistent and efficient access to early intervention/preventive medical care for disadvantaged Medicaid recipients who would otherwise have no means of accessing healthcare services. As a result, providing access to preventative treatment prior to escalating healthcare needs has proven to be a less costly and more effective means of keeping low income, elderly, and disabled recipients out of hospitals and nursing homes; allowing such individuals to remain viable members of the community and live healthier and independent lives while lowering overall health care costs.

Return on Investment

The federal requirement concerning medical transportation assurance is based upon recognition from past experience in Medicaid that unless needy individuals can actually get to and from providers of services, the entire goal of a state Medicaid program is compromised. Healthcare costs would escalate rapidly with low-income individuals ending up in high cost emergency rooms via ambulance services at 15 times the cost of routine transportation. On average, NEMT is utilized by only 10 percent of the total Medicaid population and represents approximately 1 percent of total Medicaid expenditures.

With that said, measuring the benefits of providing access to transportation is far more difficult than measuring its costs. Nonetheless, studies have consistently shown that treatment programs that include transportation to increase appointment attendance reported positive results, including fewer missed appointments, reduced length of stay, and fewer emergency room visits. A study conducted by Florida State University concluded that if only one percent of the medical trips funded resulted in the avoidance of an emergency room hospital visit, the payback to the State would be 1108%, or about $11.08 for each dollar the State invested in its medical transportation program.

When viewed in the broader context of comprehensive healthcare reform, the assurance of such access to medical transportation is consistent with the law’s intent to provide Medicaid coverage for all low-income American citizens and is considered to be a primary component of an efficient and effective health care delivery system. This, in turn, is key to the effective management of escalating medical costs as well as addressing general health care inefficiencies for this population.

In essence, Medicaid’s transportation benefit serves as the life blood of our nation’s publicly funded health care system, allowing our country’s most vulnerable families to access critical medical services. It also lessens the financial burden on state governments by avoiding unnecessary emergency room visits, ambulance transportation and extended hospital stays. The assurance of such access to transportation has consistently proven to provide a positive impact on health care management from both an access and cost containment perspective.

This article is intended to provide a brief overview of the primary options for Non-Emergency Medical Transportation and the quality of service that patients consider most important to enhance their overall healthcare.

Ambulance Transportation:

Ambulance transportation is usually reserved for emergency medical situations. However, ambulance transportation can be used in non-emergency medical situations where the patient’s health is a concern, and the transport is deemed medically necessary to provide support for the patient. These transports are typically from hospital to hospital; hospital to home; hospital to nursing home; or hospital to outpatient services. The circumstances for the necessity of these transports vary widely, dependant upon the individual patient’s medical condition.

Due to the high cost of ambulance transportation, it must meet specific guidelines to be considered medically necessary, in order to be covered under Medicare, Medicaid, and most health insurance policies. Before using an ambulance service for non-emergency medical transportation, it is recommended you check with your insurance provider to see if you are covered for the service. Otherwise, you may be liable to pay the ambulance company hundreds of dollars out of your own pocket.

Non-Emergency Medical Transportation Companies:

Non-Emergency Medical Transportation (NEMT) companies were established to fill a unique void in medical care, by enabling patients who cannot drive or do not have access to transportation to get to their appointments. These companies provide a lower cost service than ambulance companies, and a safer, cleaner, more comfortable ride than private taxi services or public transportation. NEMT companies are also trained and equipped to accommodate special needs for physically disabled persons, including wheelchairs, walkers, and service animals. Our NEMT drivers are familiar with the locations and physical layouts of all the major medical facilities in our area, thus we are uniquely qualified to go the extra mile to assist passengers with door-through-door service, to and from the vehicle.

What is meant by door through door service? If a client was mobility challenged or anxious as to where to check-in for a first time appointment, our drivers can assist the client into the building, including holding doors open, assistance with elevator’s or stairs if requested.
A reputable, customer-focused NEMT company employs highly skilled drivers with these credentials:

• CPR Certified
• First Aid Certified
• Defensive Driver’s Training Course
• HIPAA Regulation Training
• Assisting Persons with Disabilities Training
• Emergency Situation, Procedures, and Bloodborne Pathogens Training
• Fraud, Waste, and Abuse Training

Most NEMT companies receive their work from large transportation brokerage firms that distribute the work to qualified NEMT providers. NEMT companies must adhere to high standards, certifications, inspections, and training set forth by these companies to be considered a preferred transportation provider. NEMT companies utilize sophisticated dispatching software and scheduling programs that allow them to provide reliable, on-time service.

With prior authorization, NEMT services can be covered under Medicare, Medicaid, and many health insurance programs.

Private Taxi Transportation:

Most patients whom require non-emergency medical transportation are in a certain state of distress, due to their particular medical condition. These patients deserve clean, safe, comfortable transportation from individuals who are professional, polite, compassionate, and possess the experience and understanding of their situation.

Most private taxi drivers have little or no training on how to treat or accommodate persons with medical conditions or physical disabilities. Their primary concern is to get the passenger to their destination as quickly as possible, in order to make money. It is rare to see a private taxi driver exit his vehicle, much less offer assistance through the front door to the facility check-in area. The result of this attitude is often an unpleasant, unreliable experience that can cause more stress on the patient. Furthermore, taxi drivers often subsist on “tips”, and seem to sense that seniors and persons with mobility issues understandably are less likely to afford a gratuity, and thus the service falls to levels below that given to the general population.

Under most circumstances, private taxi companies do not bill Medicare, Medicaid, or health insurance providers. Therefore, the patient must pay the transportation fee upon delivery and handle the reimbursement request themselves.

Public Transit:

Public transportation for persons with medical conditions, behavioral problems, or physical disabilities can be an inconvenient, inefficient, and stressful mode of transportation. The patient has to find a way to the bus terminal and wait for the bus to arrive, often in inclement weather. The patient is dropped off at the bus terminal closest to their destination, but rarely within safe walking distance. Seniors and persons with disabilities are especially susceptible to falls, and boarding a bus can be a daunting and hazardous task for them.

As with private taxi drivers, few public bus drivers have adequate training on how to properly accommodate the needs of persons in poor health or with disabilities. In fact, due to the fixed-route nature of public transportation, the patient’s final destination is unknown by the bus driver. They have no way of knowing if the passenger has a health issue unless they show physical symptoms. Therefore, the driver has no indication that the patient might require special care and attention. And even if they did, the driver is under no obligation to assist the patient in any way.

Few public transit providers bill Medicaid and Medicare, due to the low rate of reimbursement and the ability to meet the complex regulations. While public transportation may be the most affordable option for persons without health insurance, the experience can exacerbate their condition, hinder their recovery, or possibly even endanger their health.

Conclusion:

When determining your needs for non-emergency medical transportation, we recommend you take into consideration the points we’ve mentioned in this article. There are many other factors to consider that we didn’t cover here. So depending on your circumstances, you should consult with your health insurance provider, your healthcare provider, and your family to determine which method will provide you with the services you need.

Today (10-14-2014) the financial headlines read: “The price of crude oil is down 25% since its peak last June”. In addition, the price of crude oil today is equal to the level found way back in June of 2012! Some industry observers predict that soon the price will reach levels not seen in over 4 years. As crude oil prices decline, so does the price of gasoline and diesel at the local gas station. In much of Texas, for example, the price at the pump for regular unleaded gasoline is below $3.00 per gallon. That’s great news! It seems that just about everybody is happy when the price of gasoline comes down at the pump. Any private consumer of gasoline likes to see the price of filling the family car come down. Any commercial business operator loves to see their fuel expense come down, and bolster the bottom line. Several other industries from Airlines to Cruise Ships to Retailers who receive products by transportation companies, must love to see the fuel price decline. As an owner of a Non-Emergency Medical Transportation company, I am especially grateful for the recent decline in fuel prices. For our company, next to payroll costs, fuel costs are our single greatest expense. I am thrilled to hear that industry experts predict that this downward trend will continue well into next year…possibly much longer.

To what do we owe this dramatic decrease in fuel prices? We can begin our analysis with the basic economic concepts of Supply and Demand:

Supply: We can thank the expanding US oil production for contributing to the increase on the supply side. Oil production has been increasing in the U.S. for over 4 years now, primarily driven by expanding production from the Bakken Shale Formation in North Dakota and the Eagle Ford Shale in Texas. Newly developing technologies in oil drilling and oil extraction technologies have made it possible to produce massive amounts of domestic oil from areas that were previously thought to be non-producing. True, there are those who criticize the potential ecological dangers associated with uncontrolled and unchecked drilling for oil, but there is no denying that the recent US oil boom has greatly improved our US economy and stimulated job growth, and not to mention, relieved our dependence on foreign supply.

Demand: The demand for oil based fuels in the US has actually declined 7 out of the past 8 years. Partly the result of automobile engine efficiencies and the introduction of alternate fuels and alternate energy sources. Globally, the European market is soft due to a weak economy and decrease in demand. Asia, and specifically China, exhibit a growing demand for oil, but that demand is growing less rapidly than in past years.

In addition to the abundant supply of oil, there is a strategic geopolitical aspect which also promotes lower fuel prices. OPEC, and Saudi Arabia in particular have announced that they do not intend to cut production of oil as a means to support prices. They have made it clear that they intend to “maintain market share” and have already participated in price cutting. This position increases world oil supplies, amid declining demand.

Now we know fuel prices are declining, and why. We know that just about everybody benefits from this situation. What I find fascinating is that there are some people who may not like lower fuel prices.

Some energy experts have speculated that if the world powers of United States, OPEC countries, Europe and Asia, allow oil prices to decline, this strategy would weaken the terrorist organization known as ISIS and their war machine. It is well documented that ISIS is funded in a large part by its participation in world oil trading. (in addition to extortion, weapons trading, money laundering and kidnapping). With less revenue coming in to ISIS from depressed world oil prices, that leaves less money to buy guns and recruit followers.

We can conclude that ISIS does not like to see lower fuel prices.

Petroleum products represent 67% of Russia’s total exports. Lower energy costs will magnify the economic impact of US and European sanctions imposed on Moscow that resulted from Russia’s power grab in the Ukraine. Russia’s credit rating is in decline, and the value of the Ruble in the world exchange market is also lower.

We can conclude that Vladimir Putin does not like to see lower fuel prices.

Those who are CEO’s of multinational oil companies may not be thrilled about lower energy prices either. Exxon, Shell, BP and companies like them have seen their stock prices take a hit lately on Wall Street. It’s hard to feel bad about companies with such huge profit reserves. I’m confident that they will get by.

We can conclude that Major Oil Companies do not like to see lower fuel prices.

When all is said and done, those of us who benefit from lower fuel prices, have a lot more to be happy about. And those who don’t benefit from lower fuel prices…Well too bad.

Seniors and persons with disabilities are especially susceptible to falls, often with catastrophic consequences. Despite precautions, you should know what steps to follow if you’ve taken a sudden and unexpected fall. The best advice obviously, is to do all that is possible to eliminate the likelihood of losing your balance and taking a fall in the first place. This advice applies especially to seniors or persons with disabilities when they are required to travel in a vehicle. Entering a vehicle and exiting a vehicle are very risky maneuvers, the likelihood of experiencing a fall is further magnified when:

• The person feels stressed to “rush” and get out of the vehicle quickly, so as not to hold up traffic.
• They are accompanied by an untrained friend or spouse.
• The untrained friend or spouse themselves are physically limited to steady or catch a falling passenger due to age or disabilities of their own.
• The vehicle that they are transported in is poorly designed for accommodating anyone with a mobility issue.
• The vehicle is parked on uneven pavement, or there are curbs, or other obstacles such as bumper poles, that may prove difficult to navigate around.

When all is said and done, utilizing the services of a qualified and respected Non Emergency Medical Transportation provider is recommended to cut down the risk of falls that can occur when seniors or persons with disabilities attempt a seemingly harmless trip to the doctor.

Despite all prudent precautions, if a fall does occur, it is recommended that you take the following steps:

Step One: Stop… Stay exactly where you’ve fallen. Take a few deep breaths, then use your medic-alert call device (if you have one), or your cell phone to summon help. If these are not available, yell and then yell again. Sooner or later someone will hear you.

Step Two: Do not try to rise immediately, until you’ve accomplished step three.

Step Three: Do a self-check to assess where and how you may be injured. You will sense whether you’re badly hurt or even whether you’ve broken a bone. If help hasn’t come repeat step one until it does.

If you’ve ascertained you’re not seriously hurt, and if no one has come to give you a hand, here is what measures experts recommend:

Inside Your Home:

• Roll onto your side.
• Bend your knees up to your waist.
• Inch your way over to the nearest stable object (for example a chair or bed).
• Reach up and grab the object firmly while still on your side.
• Scrunch up close to the object.
• Using your free hand as a push-up and the object in the other, roll over onto your knees.
• If you succeed, use both hands on the object to help you rise to a standing position and then turn and sit as soon as possible.

Outside Your Home:

• Stay down.
• Do not let someone try to help you until you have done a self-assessment.
• If you’re offered a coat or jacket, accept it.
• At this point someone will probably have called 911 and if you have any doubts, stay down.
• If you think you can get up, use the nearest sturdiest onlooker as you would a chair in your own home.
• In general, don’t be embarrassed to let others help you. However, if there’s any doubt in your mind about your injury, wait for the Emergency Response people to arrive.

Traveling by vehicle to a friends house, shopping or a trip to the doctor can be a hazardous experience for seniors or persons with disabilities, even when they are accompanied by a well-intentioned friend or spouse. Please consider the services of a professional Non-Emergency Medical Transportation provider to insure your safe arrival free from incident or worry.

JOB DESCRIPTION – Driver

How is it that we as Non-Emergency Medical Transportation providers are able to get so many individuals (many of whom are first-time clients), from their homes to their medical appointments safely and on time? How do we plan routes efficiently within a congested major metropolitan area? In addition to managing the basic logistics involved in picking up and dropping off patients within precise time windows, the NEMT team must also balance ever-changing schedules, traffic, and any unexpected challenges that may occur throughout the course of the day. The answer is “Vehicle Telematics”. Long gone are the days of thumbing through map books, and relying on memory, for determining the quickest and safest routes. Even in-vehicle cell phone usage is minimized. Today, an exciting combination of technologies is available which can revolutionize the transportation industry in general and NEMT providers in particular.

“Vehicle Telematics”, is a term applied to the combination of the following technologies:

• Telecommunication
• Vehicle tracking via GPS
• Driver feedback
• Fleet management
• Satellite navigation
• Emergency warning systems
• Real time dispatch and communications
• Management reporting

To better illustrate how these technologies can combine to vastly improve the effectiveness of a fleet of NEMT vehicles, let’s take you to a typical day for Bob M. a non-emergency medical transportation driver at All Points Assisted Transportation in San Diego, CA.

6:00 AM: Bob logs on to his navigation device and “punches in” for payroll purposes.

6:02 AM: Bob downloads his entire dispatch for the day. This includes 8 to 10 trips to either pick up or drop off individuals for appointments around town.

6:15 AM: Bob completes his pre-trip vehicle inspection, then selects his first trip which is a pickup. By selecting start, a detailed route is planned complete with turn by turn mapping and voice instructions to the exact location. Real-time traffic patterns are used to calculate an accurate ETA.

7:00 AM: Bob is alerted that road construction on I-5 will delay arrival to his first pickup by 11 minutes. An alternate route is automatically generated to keep him on schedule.

7:45 AM: Bob arrives at the first pickup location. Dispatch personnel at the office are aware of the driver’s exact location and activity each step of the way. Dispatch can notify clients of delays or changes as necessary over the phone, so that Bob can avoid in-vehicle cell phone use.

8:15 AM: The navigation screen alerts Bob that his off ramp is coming up in 2 miles. A visual image appears on his navigation screen, and a voice message alerts him of the approaching off ramp, and even tells him which lane to be in during the exit.

9:00 AM: Back at the office, the dispatcher receives an add-on trip that requires download to the driver. The new order appears within seconds on Bob’s navigation screen, complete with customer name, address and turn by turn instructions.

12:00 PM: Bob punches out for lunch break

1:15 PM: A patient calls the dispatch office that they are now ready for a pickup for their return home. The dispatcher downloads the request, along with the name, address, and turn by turn directions from Bob’s current location. Again, this process avoids in-vehicle cell phone use.

4:00 PM: Bob punches out for payroll purposes.

4:10 PM: Management can analyze total daily activities for Bob, as well as for the entire fleet. Management is able to customize reports showing pick up and drop off times, vehicle speed data, hard breaking data, hard turn events, idle times and MPG estimates.

The utilization of “Vehicle Telematics” technologies vastly improves dispatch efficiencies, expedites pickups and drop-offs, influences positive driver behavior and confidence, and improves the passenger experience while enhancing overall safety.

All Points Assisted Transportation utilizes TomTom hardware on the WEBFLEET platform. DispatchBot, a NEMT tailored software solution, is also integrated into the overall system. 24/7 Dispatch and call center services are provided by NEMT Solutions, LLC.

Customers, colleagues and competitors have frequently asked me: “What qualities do you look for when recruiting NEMT drivers?” An excellent question that bears careful consideration. After all, exceptional employees are the most valuable asset of a company, right? Drivers are the front line employees of any transportation company, and they certainly are in an ideal position to create a positive or negative experience for the customer. Drivers usually provide our clients with their first and last impressions of us.

With all due consideration, I have attempted to list the 5 most important qualities that I seek when interviewing and evaluating our drivers:

1)    A desire to contribute to the successful outcome of the client’s healing process

2)    Highly customer service focused

3)    Punctual, reliable and efficient

4)    Works well independently, and as a team member

5)    Impeccable driving record and safety awareness

Other qualities that could arguably be included in any top 5 list may be:

• Cleanliness regarding both personal and equipment. Nobody wants to enter a vehicle that is filthy or reeks of tobacco, food or coffee.
• Computer and GPS technology literate
• Familiarity with the local service area and destination facilities
• The ability to recognize potential problems before they arise, and take steps to avert them

To me, Item #1 pretty much sums it all up. I am of the opinion that if a driver has a genuine desire to contribute to the client’s healing process, all other desirable qualities will develop as a result.

At All Points Assisted Transportation, we believe that we are a key contributor in the total healing process for our NEMT clients. The satisfaction that an exceptional driver receives from each successful outcome for one of our clients, more than makes up for the stress, long hours, and high demands we as set upon them as supervisors and owners.