it is not surprising that many people regard ride-sharing as the natural solution for healthcare transportation. However, there are a number of complexities – inherent within the healthcare industry and other social conditions that inhibit access to care – that might preclude these companies from being able to address the entire healthcare sector. The answer is to view ride sharing not as an answer for all situations, but rather as an important piece of a broader transportation solution.
Healthcare providers looking to coordinate transportation for patients who face barriers to care have expanded options thanks to a new government rule that was introduced just a few months ago. On December 7, 2016, the Office of the Inspector General at the U.S. Department of Health and Human Services (HHS) finalized a brand new safe harbor that allows healthcare providers to coordinate local transportation, of nominal value, for patients who meet pre-determined criteria. The new rules took effect on January 6, 2017. While these rules are a welcome development for anyone who understands how transportation barriers impede access to care, this post explains important limitations and caveats of the rules, which are meant to prevent abuse and improper inducement of patient demand.
Hurdles to accessing health care make life difficult both for patients and the clinicians who take care of them. There is growing recognition that the social circumstances surrounding patients’ lives — food insecurity, housing instability and lower educational attainment — have a significant impact on health and wellbeing. Even the best caregivers cannot always overcome the obstacles of chaotic social circumstances.
Assuring access to transportation for disadvantaged populations has been an important government responsibility since the establishment of Medicaid itself back in 1965, under which each state program had to include a “provision for assuring transportation of recipients to and from providers of services." (1) While states have consistently acknowledged the value of non-emergency medical transportation (NEMT) during the past half century, the administration and financing of the benefit has changed over time. That change appears to be accelerating in the current era of seismic reform.
You have probably seen the statistic in this post’s headline repeated numerous times in different places. Indeed, it is the most reliable national estimate available. But a true understanding of the problem and who it affects necessitates a deeper dive than just labeling it with a number. Where did the number come from? What assumptions inform it? What do we know about the millions of people it describes – and the millions more who might have been missed?
Problems that have persisted for almost 50 years will never be solved overnight. But with an approach based on intellectual humility, patient-centered decision making, and with knowledge integrated from across stakeholders and sectors, we can make real progress and help build a better NEMT system that does not let patients down in their times of need.
In a world of almost unlimited needs and limited resources, it is important to understand the cost-effectiveness of NEMT programs in their current state – as well as how greater transparency and data capture will enable NEMT to become even more cost-saving while also serving ever higher numbers of patients. While it is commonly understood that NEMT reduces hospitalizations and readmissions, our investments cannot be a blank check. We can do a better job of understanding the extent to which NEMT saves money and improves outcomes, as well as for which diseases and populations such investments are most effective. Before we get too far in the future, let us examine the bedrock of existing evidence with regard to the cost-effectiveness of NEMT.
Where does non-emergency medical transportation (NEMT), which is a core component of the patient experience, stand in terms of convenience and responsiveness to need? Since the current model makes patients dial a hotline three days in advance to request a ride – with little notice of whether the ride will show up and when – it more resembles a call to fix someone’s cable box than a mechanism that would ensure their access to medical care.