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.