Successful healthcare organizations think and act in a patient-centered manner. What does that mean, aside from being a nice buzz term? It boils down to seeing the world from the patient’s perspective and doing what it is his or her best interest. That empathy helps providers understand what patients will need and proactively fulfill those needs. Aside from leading to higher quality care and more engaged, empowered patients, a patient-centered approach can also improve the level of patient satisfaction recorded through important surveys that have increasing influence over provider reimbursement.
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.
The current model does not accommodate patients who have chaotic social circumstances that make planning and resource coordination difficult. It also often does not accommodate those who have language barriers, health literacy problems, or lack dependable access to a phone or the web. What about patients who are simply unaware of NEMT benefits for which they are eligible? The current model works for some, but fails many others.
Perhaps the most important shift in our mental models about NEMT will be that from a patient-driven, call-center based process to a provider-driven, automated process that takes care of the details of transportation coordination and lets patients focus more on their healthcare needs. In all other stages of the care process, providers coordinate the details: medication prescriptions, specialist referrals, insurance billing and reimbursement, follow-up visit scheduling and more. Why should transportation – the means by which patients access care – not also be handled by providers in cases where patients face barriers?
Under new payment reform models, providers are responsible for a patient’s stay and a certain period afterward. Why should episodes of care not include the minutes immediately prior to the visit when the patient is traveling to care? Transportation is part and parcel of the experience of obtaining medical care. The cost of local transportation is nominal and covered by the payer in circumstances where a patient is eligible for such assistance, so the only question is who should coordinate it and how. We believe that healthcare providers are best positioned to coordinate transportation for several reasons:
- Providers benefit from coordinating transportation because it gives them visibility into when patients will arrive – and for that matter, a guarantee that patients who have a ride will not be no-shows.
- Providers are physically closer to the patient experience and can more easily verify that covered medical services were indeed provided. Placing the systems for ride requests and verification in the providers’ hands can help reduce waste, fraud and abuse as compared with trusting a transportation provider or broker to be truthful.
- Providers can conduct proactive outreach to their patients (usually two or three thousand patients per doctor) who might not be aware of their NEMT benefits, preventing patients from falling through the cracks. Payers who have hundreds of thousands, or millions, of beneficiaries may not be as well-positioned to inform patients of their benefits and help them request rides. Proactive data analysis across a provider’s patient panel can help pinpoint patients who might need a ride before access challenges arise.
In the case of Medicaid and Medicare Advantage patients, providers would be coordinating the rides but the payer would be funding them. There are few legal concerns in such cases. However, when providers choose to fund the rides – perhaps for patients who do not formally qualify for NEMT benefits through their insurer, but who still need a ride – there are a few conditions that must be satisfied in order to comply with guidelines that have been proposed by the Office of the Inspector General (OIG) at the Department of Health and Human Services. Because the rides would be considered patient remuneration, steps must be taken to avoid “induced demand” where choice of provider is unduly influenced by such remuneration. In other words, providers cannot use subsidized transportation as a marketing scheme to attract patients.
In order to avoid induced demand, providers should limit their provision of transportation to patients who meet a defined criteria such as being low-income. In addition, recipients should be established patients of the practice or health system. Finally, the mode of transportation should be the least costly and most appropriate available. Limousines are not fair game here, since it would veer into the territory of marketing. These are fairly simple conditions to meet, but they are crucially important for maintaining program integrity and preventing waste, fraud and abuse in Medicare and Medicaid.
While many stakeholders – from patients to insurance payers to transportation providers – will continue to have important roles in NEMT, the center of gravity for coordination should shift to the medical office. The care coordinators, nurse navigators and social workers want the tools to be able to help patients with transportation just as they help with other non-medical aspects of healthcare delivery.
New innovations in this regard must take care to understand the current workflows of a busy practice so as to be a value-add and not a burden on providers. Done right, we will realize a world wherein every provider – from large urban medical centers to far flung rural physicians – will be able to support patients with transportation barriers. Healthcare professionals always go the extra mile, and soon they will be able to help their patients do the same.