Featured SPonsors:
NEMTAC Inaugural Conference Edition
Moving Forward Together
Featured Article:
Summer 2019
Revability
Raising the Bar on Non-Emergency Medical Transportation
Capstone Transportation
Developing a Successful NEMT Marketing Associate
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NEMTAC Board of Directors
Moving Forward Together: Opportunities to Improve Program Integrity in Medicaid Non-Emergency Transportation
The Importance of Mandatory Wheelchair Transport Standards
How Software Can Benefit the Delivery of NEMT Services
How Healthy is Your NEMT Technology?
Letter from NEMTAC's President
Capstone Transportation: Introducing One of NEMTAC's Platinum Corporate Sponsors
Do You Train Your Drivers to Use Common Sense?
NEMTAC Advisory Board Members
Revability Solution Designed to Enhance Accessible Vehicle Ownership Experience
Unsafe Behaviors are Your Choice
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Veyo in Arizona: Can Ridesharing Work in NEMT?
Changing Healthcare Models Create New Opportunities for NEMT Providers
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Pedal to the Metal: Bringing NEMT Offerings and Outcomes Up to Speed for Providers and Their Patients
The Changing Landscape of Rides: NEMT and the EverTransit Difference
Dialysis Center Riders - a Tough Market to Serve
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NEMTAC Conference Speakers
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Handbook Recommends Strategies to Improve Access to Healthcare and Lower the Cost of NEMT
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Table of Contents
Lunchtime Panel Discussion
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Pitfalls of Manual Data Entry
NEMTAC Corporate Sponsors
A Letter from NEMTAC's President We are pleased to present the second edition of NEMT Today, the official publication of the Non Emergency Medical Transportation Commission and the first national publication devoted entirely to the NEMT industry. Response to the first edition exceeded our expectations; it's clear the NEMT industry is booming and thirsty for more information from thought leaders across the operational spectrum, as well as buyers, regulators and other NEMT stakeholders. Since our first edition just a few months ago, we have seen more research, position papers and regulatory proposal changes published from a range of sources, and all reflect the important and expanding role NEMT as a key social determinant of health (SDOH) and the powerful financial, medical and societal ROI from well-delivered NEMT. The former "afterthought" of EMS and healthcare is now at the forefront of change in our healthcare system and is already a $12B industry with over a million trips a day provided mostly by small businesses and increasingly very large corporations. In September NEMTAC will host the first national conference focused on the NEMT industry at the spectacular Talking Stick Resort in Scottsdale, AZ. We have an outstanding group of speakers and presenters and dynamic keynote presentations planned, as well as a full house of the premier vendors, suppliers and advisors to the industry. Due to the generous support of our corporate and conference sponsors, such as Capstone Transportation and Revability, we have been able to keep the cost of attendance low and assure rich content and high value for all who attend. If you have not registered, please don't delay as attendance and our deeply discounted rooms are limited. I am honored to serve as the founding Board President of NEMTAC, an organization driven by volunteers with a shared vision to establish standards, provide resources and create a forum for thought leaders in the NEMT industry. Key to our mission is the growing support from our corporate sponsors and a range of industry professionals providing their time, talent and token to serve on advisory boards tasked with developing NEMT standards. I thank each and all of them for their commitment and support of NEMTAC. We hope you enjoy this second quarterly edition of NEMT Today. Please tell us what you think and let us know of additional topics or issues you would like to see covered in future editions. Enjoy,
A Letter from NEMTAC's President
Steve Lewis, Board President
Doug Allen, Board Member
Stanton Sipes, Board Member
Melissa Jankowski, Executive Director
Robert Brown, Board VP
Chris Kelly, Board Member
Board of Directors
David Marhoffer, Board Member , not pictured
Peter Hicks, Board Secretary
Gail Bauhs, Board Member
Michael Shabkie, Founder/ Board Treasurer
David Aboudi, Partner, Aboudi Legal Group Maggie Adams, Owner, EMS Financial Services Kelly Addy, Owner, Clear Choice Express, LLC, Michael Adelberg, Principal and Healthcare Strategy, Faegre Baker Daniels Jim Adkins, Owner, SouthStar Emergency Medical Services Gautam Aggarwal, MD, Medical Director, Arizona Complete Health Jonathon Anthon, National Sales Dir, RountingBox (Buffalo Intelligent Tech Systems) Carlos Ayestas, VP of Client Relations, Priority Transportation Services Howard Berkowitz, VP Business Ops, H&S Personal Car Service & Consulting, Inc, Dori Boyle, Medicaid Program Specialist, Idaho Department of Health & Welfare Sufian Chowdhury, Founder & CEO, Kinetik Healthcare Solutions, Inc Imran Cronk, CEO, Ride Health Adonica Dawkins, Director of Operations, Chariot Transport, LLC, Larry Dorsey, Regional Director of Business Dev., MedicOne Medical Response Travis Draney, Owner, Nonpareil Care, LLC Tom Fairhurst, President, Highland Patient Transport Laura Fleet, CEO and Co-Founder, SendaRide, Inc Mindy Ginsberg, VP of Sales, FR Conversions Mike Gonzalez, VP of IT, Alivi Myron Hammes, Managing Partner, Schedule Viewer Sarah Hope, CEO & Founder, Vertical Identity Background Screening & Drug Testing, Jessica Hylander, Director of Healthcare Compliance, First Transit Martha Kendall, Network Oversight Manager, Tennessee Carriers Eric Lane, Commercial Risk-National Accounts, Bankers Insurance Manuel Leon, VP of Business Development, Alivi Miriam Manary, Sr Engineering Research Asso, Univ of Mich Transportation Research Inst
Advisory Board Members
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Russ Maxwell, Owner, Medical Answering Services Brendan McNiff, Director of Transportation, Roundtrip Misti Mills, Co-Founder, Two M Insight Group Marcus Norton, National Sales Director, Mobility Support Solutions Mark Porterfield, Owner, Caliber Care+Transport Anantha Rao, CTO & COO, Wellryde Dan Reid, Owner, Grove Transit Robbins Schrader, Co-Founder and CEO, SafeRide Health Ray Shanahan, Director of Sales, Medic-CE Jim Smith, President, JC Paratransit Solutions Shelly Snider, Connect-Ability Specialist, Connect Transit Jason Stempin, Commercial Business Development Manager, VMI Kevin Teasdale, Managing Partner, Secure Medical Transportation Scott West, CEO, NEMT Solutions, LLC Teresa Wilke, Owner / Principal, Silver Arrow Strategies
Advisory Board Members cont.
Platinum Sponsors
Corporate Sponsors
Silver Sponsors
Bronze Sponsors
Emerald Sponsors
Sapphire Sponsors
By Michael Shabkie, Founder/Board Treasurer, NEMTAC You've got the best non-emergency medical transportation (NEMT) company in the market. You have invested in great equipment, hired competent staff and ordered some pens and notepads. You’re ready to grow, but how do you communicate this to your customers? The simple answer is to hire a marketing associate to go out every day and drum up business. The problem is that there is usually very little time and possibly even less money for training. Most NEMT companies hire one of their drivers to instantly become the “marketing rep” for the company. As you can imagine, this can be a challenge. The skillset that makes for a great NEMT professional is not necessarily the same set of skills that make a great salesperson. Are you setting your company and your new marketing associate up for failure? The key to success is to have a formal sales training program. Why would you promote from within but only hand them some pens and send them out to grow your company? NEMT Marketing is a People Business The first rule of the hiring process is to make sure your marketing associate is strong when it comes to the basics. Good communication skills and a genuine interest in meeting people are the golden keys to success. It sounds simple, but many folks are great in a small personal setting but freeze up when meeting new people. You can train a person to sell, but it is almost impossible to train a person to be a “people person.” Selling is about attitude. Is your new Marketing Associate friendly, utterly reliable, and eager to learn? NEMT Sales Training 101 If your company doesn't have its own in-house training department and you cannot bring in an outside sales consultant, you'll need to look closely at your staff to develop a sales training program that fits your company's needs.
You'll want to identify which of your management team not only has the strongest grasp of what the business goals of the company are but also has the most enthusiasm and interest in your services. In addition to providing a detailed overview of the services your NEMT company offers, the following topics should be covered: Mission Statement and goal setting for the next 24 months Organization and time management skills Selling your NEMT service line Focus and follow up with potential customers Creating the sales pipeline Prospecting and lead generation Dealing with fear in sales Developing presentations that focus on company strengths How to close the deal How to add value during the sales process Relationship building and networking Contract Negotiations 101 As homework, make sure they read at least one good book on sales, for example, the One Minute Salesperson. Discuss with them what they are learning from the book as they read it. Putting it all Together After the initial sales training program, you'll want to test the associate's grasp of both the technical and sales skills they've learned. Ask them to teach you about the company and evaluate how well they explain the services, their overall level of persuasiveness, friendliness and approachability. You'll be looking for an associate that can model the kind of sales behavior that develops relationships, creates a sales pipeline and persuades a decision-maker to contract with your company.
Developing a Successful ... cont.
Provide Refresher Training Even your best marketing associate will move away from the basics the longer they stay in the business. It's not at all uncommon to see associates succeed in their first year of business, only to watch them fall into a slump when they get away from the basics. Make sure there is formal refresher training for the marketing associate. Your marketing associate will only be as good or bad as you train them to be. If you have poor producers, the fault may be in the lack of ongoing training. If it is, correct it. At a minimum, make your marketing associates role-play certain selling situations to strengthen them in the basics. Final Thoughts I believe that a marketing associate can know virtually nothing about the NEMT industry, yet still succeed, as long as he or she knows how to sell. By the same token, I believe that a marketing associate, who knows everything about the industry, but nothing about sales, will eventually starve. If you start with a simple sales training program and use the previous principles we discussed, I believe you'll find that your salespeople will function to their maximum efficiency and effectiveness. About the Author Michael Shabkie in the Founder of Non Emergency Medical Transportation Accreditation Commission (NEMTAC.org). He has also served as an industry consultant tasked with developing revenue-generating marketing strategies, developing winning RFP proposals, managing political and public affairs, and acting as an executive advisor on operational improvement for both NEMT and ambulance organizations. For more information visit: www.nemtac.org.
Opportunities to Improve Program Integrity in Medicaid Non-Emergency Transportation By Josh Trent , Principal, Leavitt Partners and Charlene Fizzera, Senior Advisor, Leavitt Partners Leavitt Partners released a new white paper, "Moving Forward Together: Opportunities to Improve Program Integrity in Medicaid Non-Emergency Transportation." This paper examines Medicaid's non-emergency medical transportation (NEMT) benefit and makes specific recommendations on key actions federal and state policymakers can take to improve program integrity. The recommendations were based on a robust analysis of existing research, as well as interviews with former Medicaid program staff, Medicaid managed care organizations, a transportation network company, NEMT transportation brokers, a medical provider trade association, and other Medicaid stakeholders. The white paper is authored by Josh Trent, principal at Leavitt Partners, and Charlene Frizzera, senior advisor at Leavitt Partners, who both shaped federal Medicaid policy during previous roles in Congress and the Centers for Medicare & Medicaid Services (CMS), respectively. The paper examines Medicaid's non-emergency medical transportation (NEMT) benefit and makes specific recommendations on key actions that federal and state policymakers can take to improve program integrity. The recommendations were based on a robust analysis of existing research, as well as interviews with former Medicaid program staff, Medicaid managed care organizations, a transportation network company, NEMT transportation brokers, a medical provider trade association, and other Medicaid stakeholders. NEMT "enables Medicaid beneficiaries who lack reliable sources of transportation to use a benefit that will ensure they can access their primary care provider, dialysis appointment, child wellness check-up, addiction treatment, and other forms of non-emergent care," Trent and Frizzera explain. "Patients who are low-income, who have multiple chronic conditions, or who face challenges related to the social determinants of health are too often challenged in accessing reliable transportation to and from health care providers." Trent and Frizzera highlighted how the Medicaid "benefit helps to remove transportation barriers to needed health services, improve health outcomes, and reduce utilization of more expensive emergency services," concluding that "for may patients who lack reliable transportation, the value of the NEMT benefit is clear."
However, Trent and Frizzera also underscore that "states have faced challenges with program integrity in administering NEMT to beneficiaries." Highlighting recent examples of oversight audits and enforcement actions, the authors warn "improper payments can undermine the quality of care for Medicaid beneficiaries, create reputational damage for entities involved in delivering the NEMT benefit, and erode public support for Medicaid services." At the same time, they note that "many of the opportunities to improve program integrity within the Medicaid NEMT benefit may not be specific to NEMT per se, as much as they are reflective of challenges facing Medicaid more generally." "Moving Forward Together" calls for "vigilance through strong program management and risk management strategies to protect the program from those who would exploit or defraud the program and could cause harm to Medicaid beneficiaries." Toward that end, the white paper specifically outlines key areas that Medicaid programs are focusing on to improve program integrity: ensuring access to qualified transportation providers, harnessing technological tools, and appropriately utilizing ride-sharing platforms. "The delivery of Medicaid NEMT services has evolved in the last decade or so, as external forces have created new opportunities and placed new expectations on the program," Trent and Frizzera write. "Abundant research and program audits show the need for additional federal and state actions to improve the program integrity of Medicaid NEMT services," the authors explain. "Moving forward," they wrote, "It is essential that Medicaid leaders across Medicaid state programs, brokers, managed care plans and delivery systems work collaboratively to improve the integrity of the program for the benefit of patients and the program itself." Key recommendations are that: CMS should: Update NEMT program integrity review Facilitate collaboration on leading practices Provide technical assistance to states Implement the U.S. Government Accountability Office's open recommendation Require basic program integrity Analyze the Transformed Medicaid Statistical Information System data for insights State Medicaid programs should: Require public transparency of key Medicaid NEMT data
Moving Forward Together cont.
Leverage existing data to continually improve program integrity Position state systems to detect and prevent known fraud schemes Use prior approval strategically Ensure robust complaint and Medicaid appeals processes for beneficiaries Use contracting arrangements to incentivize program integrity and quality Transition to/between transportation brokers with careful planning Consider the role of TNCs and use them strategically The white paper can be viewed here. About Leavitt Partners: Leavitt Partners is a health care intelligence business. The firm helps clients successfully navigate the evolving role of value in health care by informing, advising, and convening industry leaders on value market analytics, alternative payment models, federal strategies, insurance market insights, and alliances. Through its family of businesses, the firm provides investment support, data and analytics, member-based alliances, and direct services to clients to support decision-making strategies in the value economy. For more information please visit www.LeavittPartners.com.
Introducing One of NEMTAC's Platinum Corporate Sponsors Revability Solution Designed to Enhance Accessible Vehicle Ownership Experience Getting stuck on the side of the road is a challenge, especially when the vehicle is used to transport a passenger in a wheelchair. Inconvenience aside for all involved, passenger safety is also typically in question because while an inoperable vehicle can be towed to the nearest auto shop, what about the wheelchair passenger? How are they accommodated, especially if the vehicle is stuck on the road during adverse weather conditions or in an unsafe location? Revability now offers customers an easy, convenient solution—VMI Assurance. VMI Assurance is backed by Revability’s parent company, Vantage Mobility International (VMI). There are two components to the VMI Assurance program: 1) Mobility Roadside Assistance (MRA), and 2) Wrench Fleet service. MRA is somewhat like many of the leading roadside assistance service programs in the marketplace today, but where it differs is that it’s dedicated to serving customers who require mobility assistance. Many of the other roadside assistance providers, such as AAA, do not accommodate passengers who use wheelchairs. MRA specializes in meeting the unique needs of wheelchair users. So, if a consumer or a transportation provider finds themselves with an inoperable vehicle or accessible equipment, MRA will be there. A call to MRA will deploy a tow truck and paratransit transportation to ensure that the wheelchair user can continue to their destination safely. In addition to providing paratransit transportation, MRA also covers services commonly expected from a roadside assistance provider, such as: battery service, jump start, lock-out assistance, tire repair, towing, winching/vehicle extraction and emergency fuel delivery. Mobility Roadside Assistance is available throughout the U.S. and Canada. Another component of the VMI Assurance program is the Wrench Fleet service. Wrench has partnered with VMI and Revability with an exclusive agreement to service accessible vehicles put on the road by VMI and Revability dealers or commercial customers. What’s unique about the service through Wrench is not just the fact that expert, certified auto mechanics will service the vehicles. Wrench mechanics will go where the vehicles are located and service one vehicle or the entire fleet.
This ensures that vehicles are maintained at the fleet owner’s convenience while maximizing vehicle utilization. Wrench mechanics will provide services such as brake adjustments and caliper replacement, oil and filter change, engine tune-up, vehicle parts replacement, A/C service, battery replacement, perform vehicle diagnostics and service the wheelchair ramp system, to name just a few. Wrench Fleet is currently available in select cities within the contiguous United States. Expansion of service coverage is planned in 2019 and will continue into 2020. VMI Assurance is the solution that has been much needed for all who are part of the disability community, whether they are individual consumers or those who provide a service in mobility transportation. Revability and VMI have provided wheelchair accessible vehicle solutions for a combined total experience of over 50 years. As the leading innovators in the mobility industry, VMI Assurance was created to deliver a positive vehicle ownership experience for the life of the vehicle. Revability customers will receive 20% off on their first Wrench Fleet service. Additionally, customers will be signed up for a one-year complimentary Mobility Roadside Assistance membership for up to three vehicles owned with every new Revability or VMI conversion purchased. One-year memberships may also be upgraded to a two or three-year membership. To sign up for MRA membership to cover existing vehicles, visit http://bit.ly/RevAbility. For more information about VMI Assurance, call Revability at (844) 864-4232. As a platinum corporate sponsor, NEMTAC’s board of director's appreciates the support and active participation of the Revability leadership team.
Revability cont.
By Ryan J. Larsen, Senior Vice President, Ecolane USA, Inc. Healthcare services are essential to every segment of the population, but some of our more fragile populations face challenges in having reliable transportation to reach their medical appointments. Some subsets must rely on family and friends or local community organizations to transport them. If these options become limited, Non-Emergency Medical Transportation (NEMT) can fill in this gap. How Do We Define Non-Emergency Medical Transportation (NEMT)? NEMT can be defined as a transportation service provided to individuals who are not in an emergency situation but need more assistance than a taxi service is able to provide including but not limited to: accommodating wheelchairs, providing or utilizing stretchers in the vehicle and meeting other special needs. How Does NEMT Work? NEMT services are most often provided by booking travel through transportation brokers via specialized software. This software locates available transportation providers and schedules the appropriate trip after the brokerage has verified eligibility for the patients to ride based on specialized funding criteria. Medicaid will sometimes pay for this type of service but not everyone has Medicaid coverage. In other cases, state and local programs, departments of aging, and hospital systems will fund NEMT transportation. How Does NEMT Software Benefit Riders? NEMT software allows people with special transportation needs to maintain their independence and at a time when or where public transportation isn’t an option. Evidence suggests that this feeling of independence can provide a much greater sense of well-being, helping recovery and/or management of a chronic illness. NEMT broker software doesn’t just help the broker and their providers to manage client trips effectively, it also allows for efficient and timely trips for the clients through: The optimization of trip routes through algorithms and routing of trips to mobile data tablets (MDTs) The ability for brokers to communicate directly with drivers and dispatchers Real-time tracking of individual trips, GPS, driver actions and behavior Management of riders' details for future trips, including the address and contact information as well as current qualifying status and payment preferences, which can mean speedier service for regular clients
Good NEMT software can offer a better experience for clients by providing efficient and timely booking, scheduling, and payment options, thereby offering clients easy solutions to their transit challenges. On top of that, it can bring about peace of mind when trying to get to and from important medical appointments. How Does NEMT Software Benefit Transit Agencies? Transit agencies stand to benefit greatly from NEMT software, it increases efficiency in various operational areas: 1. Ride request management Personnel can more accurately and efficiently handle client ride requests. 2. Route and trip optimization The ability to see real-time route and scheduling options that can help brokers optimize routes and trips across an entire fleet of vehicles. 3. Real-time tracking Good software can help brokers keep tabs on the fleet itself by tracking vehicles and the routes they run, the actual location of vehicles along a given route or trip, and note which vehicles are most appropriate for each ride depending on the client's specific mobility needs. 4. Rider experience optimization The retention of client information within the software enables the agency to access relevant data on repeat riders, in order to make future trip requests faster. 5. Reporting and analysis The software can generate an array of reports for analyzing the efficiency of NEMT operations from week-to-week and month-to-month, and can help agencies better understand areas they can improve upon. On the brokerage side, good software helps in: coordinating provider availability as well as client funding eligibility, keeps GPS location on drivers and vehicles at all times, keeps brokerage costs under control and increases on-time performance on the day of service rather than seeing a decrease. Over the long term, the right software is an affordable and effective solution to building out and supporting an NEMT brokerage. How Do You Select the Right NEMT Software? Selecting the right software is a crucial part of the success of any agency that provides NEMT services. Agencies will need to cultivate a discovery process where they hash out what they need as an agency to succeed and what items they find most important in any software.
How Software Can Benefit the Delivery of NEMT Services cont.
Purchasing a software platform that doesn’t fit their needs can haunt an agency for years to come, because the lifetime of a software contract is often five or more years. Therefore, agencies need to look for what they want to see as part of their package in the long-term future and not just what they need currently. Due Diligence Researching the options NEMT software providers should include looking at not only the features and pricing of the software itself but also gathering data on the company's track record in similar-sized markets. Follow up on current customer references to determine how the software stacks up next to the pre-sales promises. Customer Support The level and quality of customer support before, during and after adopting the software is another important element in the decision-making process. This information can be obtained by querying current users of the software as to their experience with that company. Software adoption is not easy. Having a hands-on support team can make a huge difference in the software adoption rate. Beyond the Current Contract Having access to data on both the current level of NEMT service, as well as estimates for how that might change in the near future, will go a long way. Find out about what your relationship will look like past the current contract. Look into potential future changes in price models, level of service, software updates, etc. Keep in mind that the technology trends of today will look different in five to ten years. Remember that when purchasing software, the agency should look beyond today and at least five to ten years into the future.
Handbook Recommends Strategies to Improve Access to Healthcare and Lower the Cost of NEMT by Linda Cherrington, Texas A&M Transportation Institute and Gail Bauhs, TripSpark Medical Consider this Scenario: John lives in an urban area and has several health issues. He uses a cane to support himself when he walks more than a few feet. He is a very low-income senior, making him eligible for Medicaid healthcare. John can use fixed-route public transit for many of his trips, as his home is close to a transit stop where there is frequent bus service. However, some of his medical appointments are at a new facility that is not accessible because the transit stop is not nearby and because the facility is on a steep incline, not accessible for individuals with limited mobility, like John. Three times a month John must travel to the new facility for a Medicaid-authorized appointment. Since he does not own a vehicle or drive, John arranges to get a ride through the Medicaid non-emergency medical transportation (NEMT) program. The NEMT broker has told John that he needs to call ADA paratransit to schedule his door-to-door trip to this new facility. John has a significant level of stress and nervousness because of the situation. Medicaid is a joint federal and state program that provides health coverage for millions of individuals and families with limited incomes. The assurance of transportation to necessary medical care is an important feature that sets Medicaid apart from traditional health insurance. Medicaid NEMT is an important benefit for Medicaid beneficiaries who need to get to and from medical services and have no personal transportation. Similarly, public transit is a lifeline for a variety of trip purposes for the transportation disadvantaged (older adults, individuals with disabilities, and individuals and families with low incomes). While NEMT, human services transportation, and public transit often serve the same transportation disadvantaged individuals, the different types of transportation providers often do not coordinate. In recent years, numerous state Medicaid agencies have separated NEMT transportation services from local or regionally coordinated transportation systems to create a statewide or regional brokerage service for NEMT trips. As a result, qualified Medicaid recipients must call a broker to request transportation to medical appointments, and the broker then follows multiple steps to verify recipient eligibility, obtain approval for the trips, and arrange for the most efficient and economical ride—often from a privately owned, rather than a public transit agency. Public transportation coordination and mobility management professionals are concerned about this trend, citing less coordination, more service
Improving Access to Healthcare
Improving Access to Healthcare cont.
duplication, and loss of local revenue for public transit agencies that can be used to match federal transit grants. The Transit Cooperative Research Program (TCRP) decided to examine these concerns through TCRP Research Report 202. Texas A&M Transportation Institute (TTI) in association with SkyCastle Enterprises, Community Mobility Solutions, and the University of Kansas Transportation Research Institute, conducted the research. The research team created a helpful handbook to provide background information about NEMT and public transit and to identify strategies to encourage coordination between NEMT brokers and public transit agencies. The handbook includes seven in-depth case studies of states based on interviews with stakeholders, including state Medicaid agencies, state departments of transportation, brokers, public transit agencies and other human services transportation providers, as well as advocates for Medicaid beneficiaries. Researchers discovered that stakeholders for NEMT, human services transportation, and public transportation have common desired outcomes for providing NEMT services: Improve health outcomes Provide a better quality of service Lower the cost of transportation services The research team found that state Medicaid agencies use the NEMT broker approach for a variety of reasons, such as controlling costs, ensuring compliance with Medicaid guidelines, and reducing the administrative burden to the states. A top priority for the brokers is to arrange the lowest cost transportation available, creating an opportunity for public transit agencies to partner with the brokers to provide this much-needed transportation service. Where appropriate, individuals can travel to medical appointments on fixed-route public transit for a low transit fare. Public transit agencies benefit from NEMT riders on fixed-route service to increase productivity and cost-effectiveness. Brokers benefit from the lowest cost for an NEMT trip. If the state Medicaid agency contracts for NEMT as a fee-for-service, the state directly benefits from the lower cost. Federal regulations implementing the Americans with Disabilities Act (ADA) require public transit agencies that provide local fixed-route transit service (bus or rail) to operate complementary demand-response (paratransit) service for
individuals who cannot use the local fixed-route service because of a disability. Regulations do not permit a public transit agency to deny a trip request from an ADA-eligible traveler for any trip purpose. If a Medicaid beneficiary also qualifies for ADA paratransit for some or all trips, the NEMT broker can coordinate with the provider of ADA paratransit to schedule trips when necessary on ADA paratransit. The federal Center for Medicare and Medicaid Services (CMS) says that a Medicaid agency or broker can pay more than the public transit fare for an NEMT trip using ADA paratransit, but no more than the rate charged to other human services agencies for similar trips. NEMT brokers can negotiate with ADA paratransit providers to establish the Medicaid-consistent trip rate. The fare charged for ADA paratransit service covers a small portion of the actual cost of the ride. Federal/state/local dollars pay for the majority of the cost of the service, and the rider pays for a small share of the cost as the ADA fare. This is similar to how insurance and co-pays work in the healthcare industry. When negotiating a rate for NEMT trips on ADA paratransit, public transit agencies look for NEMT to assist with covering a greater share of the trip cost, as each additional demand-response ADA trip impacts overall service capacity and costs. Based on the team's research, coordinating NEMT with public transportation offers numerous advantages. The TCRP Research Report 202: Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination identifies opportunities and suggests 14 overall strategies for improving coordination. The following five strategies can improve access to healthcare and help to lower the cost of NEMT: Align goals and objectives to achieve common desired outcomes.
Coordinate transportation to enhance quality of life for Medicaid beneficiaries by providing access to employment, education, community activities, and better nutrition, as well as to medical appointments. Use technology to enhance NEMT program administration and verify medical trips. Use fixed-route transit if available for the NEMT trip and appropriate for the Medicaid beneficiary Create Medicaid-consistent NEMT trip rates for ADA paratransit. All strategies included in the handbook do not necessarily apply to every state or every NEMT model. However, stakeholders can use the handbook and the strategies included to start collaborating on opportunities that apply best to an area's specific circumstances and make NEMT coordination with public transit possible. And better NEMT coordination with public transit increases the likelihood that customers eligible for Medicaid can access a variety of trip purposes and ensures efficient use of limited transportation resources.
Changing Healthcare Models
Changing Healthcare Models Create New Opportunities for NEMT Providers By Chris Kelly, Attorney, Page, Wolfberg & Wirth Is there a role for non-emergent medical transport (NEMT) car services, wheelchair van or stretcher van companies in Mobile Integrated Healthcare (MIH) systems? Is there a place for these alternative transport services in Accountable Care Organizations or Health Management Organizations? Does the new CMS Emergency Triage Treatment and Transport (“ET3”) model offer an opportunity for non-ambulance transportation services as well? I think the clear answer to all of these questions is: YES! The goals of MIH systems, ACOs/HMOs, and ET3 are in line with the Institute for Healthcare Improvement’s Triple Aim Initiative ®. The three parts of the Triple Aim are: Improving the patient experience of care Improving the healthcare of populations Reducing the per capita cost of healthcare This sounds like a challenge- improving patient experience and health while reducing cost at the same time. Is it even possible? With help from the non-emergent transportation industry, it probably is. To see how you can help, consider each piece of the puzzle: Patient experience, the first aim, can be measured by satisfaction surveys. These surveys are important since they play a role in how facilities are paid in value-based payment systems. These facilities, therefore, have a financial interest in how their patients respond to the surveys, which is why facilities are careful in how and who they select to partner with for ancillary services, such as transport. By providing prompt, clean, and professional transport services, patient experience can be enhanced- reflecting positively on the hospital system and resulting in higher payments to them from the patient’s insurance program. The second aim, improving the healthcare of a community, first and foremost requires access to good medical care. A key component of that access is transportation, but not just any transportation- the appropriate and most cost-effective transportation. Improving the healthcare of a community also requires identifying and providing solutions for non-medical needs such as access to nutritious food. When these needs are met, patients are better able to afford the care they need, adhere to treatment plans, manage their medical appointments, and stay out of emergency rooms. When this happens, the third aim is automatically met- the overall cost of care for the patient is lowered. Another way to look at these goals is by getting the right patient, to the right care, and at the right time.
If you provide a level of care higher than what the patient needs, it can lead to unhappy patients and huge medical bills. If the care given is too minimal, it can lead to exacerbating issues that cause E.R. visits later down the road. So timing and getting the right care is crucial to the success of any healthcare model, and transportation is certainly a key component. For MIH systems, having NEMT partners to transport patients to medical appointments, a pharmacy, or even the grocery store can be vitally important to the patient’s overall health. For ACO/HMOs, having NEMT providers that can offer multiple levels of transport options, and therefore multiple price points can help reduce their costs. In the ET3 model, which allows for transport of patients to alternate destinations such as clinics that are not open 24 hours a day, having an NEMT partner who can guarantee that a patient gets transportation back to their home before the close of business is especially important to the patient’s experience and comfort. Just like understanding a patient’s needs will lead to better care for the patient, understanding the needs and goals of ET3, MIH and ACO/HMO programs will lead you to better serving these models/organizations. If you work backward from the goals of the Triple Aim and the financial incentives of facilities operating under a value-based payment model, you can see the need for quality transport providers. This need creates an opportunity for NEMT providers to get involved with ET3 and MIH programs, and in ACO/HMO organizations, to offer a cost-efficient and professional option for their patients. NEMT can be a part of the solution, getting the patient to or from the care they need in a cost-efficient manner. These models will create new opportunities. Are you ready? About the Author Christopher Kelly is a lawyer with Page, Wolfberg & Wirth LLC, who focuses on regulatory healthcare law. This article is not intended as legal advice. For more information, he can be reached at (717) 691-0100 or email to ckelly@pwwemslaw.com.
Changing Healthcare Models cont.
Bringing NEMT Offerings and Outcomes Up to Speed for Providers and Their Patients By Alexandre Theoharidis, President and CEO, Acuity Link Today’s healthcare ecosystem is in a dramatic time of change. New payment models, data-driven decision making, renewed focus on social determinants of health, population health models and more are changing the way care is delivered and outcomes are achieved. One constant throughout all of this change, however, is the role of transportation in care. Transportation is a critical deciding factor in whether or not patients get the care they need, when they need it, and how seamlessly they move through their care journeys. With the healthcare industry ever-evolving, it is important that non-emergency medical transportation (NEMT) continues to evolve along with it. This starts with replacing many of the archaic manual NEMT request processes that are in place today – e.g., time-consuming paperwork such as medical necessity forms, phone calls and faxes – that are prone to human error, and result in slowing down the discharge process, while patients wait for appropriate medical transport. As if a patient waiting to be transferred wasn’t bad enough, these delays in getting the right medical transport can result in a lag in hospital discharges, which can lead to adverse consequences for both financial and physical well being. A poor patient experience typically results in decreased patient satisfaction and poor patient survey results. Poor survey outcomes will often lead to decreased reimbursement rates and a measurable financial impact. This also means that if a patient cannot be discharged, their bed remains filled - not allowing another patient to be admitted for the care they require and costing valuable time and money for providers and payors as well. Inefficient NEMT processes have a negative effect on hospital operations as well, especially during peak seasons. When beds are not turned over in a timely manner, many emergency rooms are left with bays full of patients waiting to be admitted to a room, which takes time and resources away from emergency care teams who need to triage and attend to cases that continue to arrive. On the practice side, every missed appointment is a missed opportunity for reimbursement to the physician and their employed providers. With revised reimbursement and payment models for affiliated or private practices, the more patients providers are able to see in a day, the higher the reimbursement. This dynamic is particularly prevalent in practices employed by health systems.
Pedal to the Metal
We can’t continue to blame the system for disconnect and failures in patient transport. We in the NEMT industry have to be the change, and understand that we are just as much a part of the patient experience and their quality outcomes as providers on the front lines in the facilities themselves. We must use technology and the data it produces to partner with hospitals in solving these long-standing industry issues. It’s time we recognize the technology solutions needed that can empower stakeholders who coordinate patient care to operate at the highest level to improve workflows by: Automating the Transport Request Process and Enhancing Pre-Scheduling Capabilities – With easy-to-use SaaS solutions, the vehicle request process can be entirely automated, from trip ordering to communication, to dispatch. In addition, case managers and other medical care providers can pre-schedule one-time, multi-destination and recurring transport for inbound/outbound patients, replacing traditional processes of relying on a taxi voucher system to request transport. Meeting All Levels of Care and Transport Requirements – Let’s link healthcare systems with NEMT providers and ambulance crew members for all levels of care and transport requirements. This enables us to manage transport logistics ranging from interfacility critical care, advanced life support, basic life support, and wheelchair transportation, to ambulatory patient transport. Providing Advanced Intelligence – The technology is there, so let’s use it to the patient’s advantage. NEMT technology platforms should utilize proprietary algorithms that quickly identify and assign the closest appropriate medical transport for the patient, mitigating the financial risk of patients who receive more expensive transport than required, and ensuring that patients who need a higher level of transport care will be matched to the best-suited
Pedal to the Metal cont.
vehicle and personnel. Advanced mapping integrations, as well as automated medical necessity authorization forms, allow case managers and other healthcare providers to align patient admission resources and appointments with the arrival of the patient, as well as the arrival of the most suitable NEMT provider for patient discharge – thus creating a seamless transition of care. The tools are there for us to get it right for patients and work in partnership with providers and healthcare systems to achieve performance improvement and quality goals. With the implementation of these methods, NEMT providers have the opportunity to break down the barriers for decision support within the hospital setting, diminish the resource-intensive process for transport ordering and tracking, and help align case managers and caregivers with discharges and arrivals of their transports.
Conference Speakers
This panel discussion will highlight the incredible opportunities within the NEMT industry. Panelists will discuss the importance of developing the first set of national standards, implementing an accreditation program, and certifying the NEMT professional.
Lunchtime Panel Discusion
Moderator Steve Lewis Board President, NEMTAC
Monday, September 9, 2019 NEMTAC's Important Mission Within the NEMT Industry
Panelist Effie Carlson EVP of Growth, LogistiCare
Panelist Katie Zito Senior Govt Relations Director, Anthem Indiana Medicaid
Moderator Michael Adelberg Principal, Faegre Baker Daniels Consulting
Tuesday, September 10, 2019 NEMT’s Opportunities and Challenges at the National Policy Level
Panelist Jami Snyder Director, AHCCCS
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Veyo in Arizona: Can Ridesharing Work in NEMT? by Stanton Sipes, EVP, Business Development, Veyo The Ridesharing Revolution In the last ten years, technology has radically transformed ground transportation for the better. Cloud technologies, GPS-tracking, and mobile apps have been connected to a virtual, scalable, and cost-effective fleet of drivers and their vehicles. This new model of transportation allows for tracking, insights, efficiencies, and increased levels of service like never before possible. But consumer TNCs were built to primarily serve individuals in urban geographies without any special needs. They excel in dense, urban areas with passengers who can easily find a vehicle on a crowded street and jump in with no assistance. What happens when the passenger lives in a rural setting or requires a wheelchair for mobility? Adapting Ridesharing for Healthcare In 2015, Veyo launched a new model for Medicaid transportation, adapting these TNC innovations for the complex needs of the healthcare industry, and most critically, Non- Emergency Medical Transportation (NEMT) beneficiaries. Central to Veyo's strategy was creating its own vertically integrated ridesharing network - purpose-built for the healthcare industry and the unique needs of the Medicaid population. These highly qualified and NEMT-specialized rideshare drivers use their own vehicles to accept on-demand trips and transport Medicaid and Medicare patients to and from their healthcare appointments. They are fully credentialed to meet all federal, state, and managed care plan requirements, including background checks, drug tests, CPR certification, HIPAA training, customer service training, and sensitivity training. When partnered with traditional transportation providers, this combination creates a less costly, more responsive, and more transparent transportation solution that can handle ambulatory, wheelchair, bariatric, stretcher, and other modes as required.
Can Ride-Sharing Work in NEMT?
Arizona: A Case Study Since the model was introduced just over three years ago, Veyo IDPs have conducted over 6.5 million trips in the Arizona market and brought a more reliable, faster, higher quality, and lower-cost service to Arizona's Medicaid members. Veyo's rideshare fleet has: Increased the Arizona NEMT capacity by over 3,000 vehicles, while the capacity of traditional NEMT fleets has continued to decline. Completed over 6.5 million trips in the Arizona market, with nearly 3,000 Veyo IDPs completing between 7,000 and 8,000 trips each day. An on-time rate of 95% and a grievance rate of just 0.02% - 10x lower than the average grievance rate from a traditional provider fleet. An average time from trip dispatch to member pickup of just 14 minutes. To learn more about Veyo and view the full Arizona case study, please visit https://veyo.com/arizonawhitepaper/.
Can Ride-Sharing Work in NEMT? cont.
Introducing One of NEMTAC's Platinum Corporate Sponsors While running an Arizona skilled nursing facility in 2015, Jason Postl, the CEO of Capstone Transportation, was less than thrilled with the non-emergency medical transportation (NEMT) services his patients were receiving. As his concerns grew, he began to recognize a huge need in the NEMT sector of the industry. Postl’s solution and vision was to provide resources and operational support to all NEMT divisions in the United States, providing a higher standard of compliance and patient care. Thus, Gold Standard Transportation was born and quickly grew from approximately 100 employees in 2016 to over 450 employees operating in 6 locations today, under the Capstone Transportation name and oversight. Not only does Capstone Transportation provide NEMT to patients in Arizona, it is a resource center for six different entities across the United States. Capstone Transportation supports operations in Arizona, Idaho, Texas, and New England and provides them with legal, billing, fleet management, human resources, accounting, safety compliance and marketing services. Capstone Transportation was founded on Jason Postl’s deep belief in the E.D.G.E motto, which stands for: Elevate employee experience, Drive sustainable margins, Grow community influence, and Elevate customer experience. “We put a huge emphasis on the employee and elevating the employee experience,” said Capstone’s COO, David Heckel. “Having the right employees makes all the difference. If we elevate the employee experience, they will elevate the customer experience which in turn drives sustainable margins and grows community influence. We want our employees to know they are just as valued as our customers.” Because Capstone Transportation believes that happy, well-trained employees will provide a safe and comfortable patient transport experience for its customers, all their transport tech’s attend an extensive training program before they are allowed to transport patients. This training includes defensive driving, CPR, and PASS certifications, as well as training on HIPAA compliance, communicating with facilities and patient handling. Each transport tech is required to demonstrate proficiency in the proper use of loading both wheelchairs and stretchers. All transport technicians are required to wear uniforms and name badges.
Another item that distinguishes Capstone Transportation as a leader in the industry is its’ emphasis on patient and technician safety. The company employs a compliance and safety committee in order to ensure that the highest level of safety standards is maintained throughout the organization. Each vehicle has an in-cab camera and is equipped with NAUTO technology which detects, and coaches distracted and aggressive driving in real time. None of the company’s vehicles are more than 4 years old and they each contain state-of-the-art lift and ramp systems. Capstone Transportation’s leadership team has a vision of providing these services in order to support their NEMT divisions across the country. The company’s growth model includes acquiring established NEMT organizations and launching in new markets by partnering with NEMT brokers, insurance providers, and national healthcare facilities. As a platinum corporate sponsor, NEMTAC’s board of director's appreciates the support and active participation of the Capstone Transportation leadership team.
Capstone Transportation cont.
by Nick Hoffmeyer, VP of Marketing, Broda There is an alarming lack of mandatory transport standards for some vulnerable adult populations that are dependent on mobility equipment like wheelchairs. When you compare them to the stringent — and numerous — transport standards for car seats and booster seats used by dependent infants and children,1 those for elderly and disabled individuals in need of safe non-emergency medical transport (NEMT) seem almost nonexistent. Unfortunately, this lack of NEMT equipment standards often results in mistakes and accidents — and sometimes even death. However, not all NEMT providers are bad; most are committed to exceptional service in getting this vulnerable population to and from essential medical appointments reliably. Working together, NEMT providers, caregivers, healthcare facilities, non-governmental organizations, and lawmakers need to create a better framework for solutions that benefit all stakeholders. Safer transportation equipment and processes for seniors also result in lower overall healthcare costs while increasing accountability, holistic healthcare outcomes, and profitability for healthcare and transportation providers. Digging Deeper There has been some effort to regulate NEMT services and drivers who transport individuals who have disabilities. For example, the American National Standards Institute and the Rehabilitation Engineering and Assistive Technology Society of North America have taken a position on the standard for wheelchairs that are used as seats in motor vehicles. These organizations say that wheelchairs that will act as passenger seats in motor vehicles should show that they can be secured and offer support under the same conditions that are tested for transporting children. It also states that wheelchairs in vehicles should facilitate the proper placement of belts and have design features that let the wheelchairs be secured. This is important because of the risk posed for people being transported in wheelchairs. According to RESNA's position paper, those riding seated in wheelchairs are 45 times more likely to be injured in a crash than a typical passenger. The paper also states that recent studies show that a large percentage of injuries and fatalities to passengers in wheelchairs
are caused by non-collision events, like abrupt turns and hard braking. (1) A study from the NHTSA found that over a five-year period, 2,494 wheelchair users were injured or killed due to improper or no securement, and 1,035 were injured or killed while transferring to or from a motor vehicle. (2) Proper Use Lack of proper transportation equipment isn't always the issue, education on using the equipment is just as important. Not every elderly or disabled person has an NEMT experience that results in a severe injury, and research is incomplete regarding the number of people who are injured. Among the injuries identified in preliminary reports, though, 35% were attributed to improperly secured wheelchairs. (3) Because the WTS standards are not readily available or mandatory, caregivers and transporters have little education, inconsistent rules to follow, and few incentives to not cut corners for the sake of expediency. Knowing how to properly use these tools can be just as important as having them.
The Importance of Mandatory Wheelchair ... cont.
Cutting Costs Many dependent persons in complex and long-term care rely on NEMT services to attend medical appointments. Because they need high levels of support and comfort, they cannot use regular vehicle seating. Some people naturally wonder why dependent persons cannot merely take an ambulance to their appointments. It's certainly an option, but the astronomical cost of this service makes it unfeasible for day-to-day services. Let's say an ambulance ride costs about $500. If a facility transports only four individuals a month, then transportation costs alone would run $24,000 annually. By contrast, a ride in an NEMT van costs about a tenth of an ambulance ride — a total of $2,400 annually for the same trips in the previous scenario. If the facility also purchased a WC19-certified Synthesis Transport Chair for about $4,000, it would only end up paying $6,400 for a chair and a year's worth of rides. Moving forward, the facility would save tens of thousands of dollars annually while ensuring a higher quality of care during patient transport. Transportation receives just 1% of Medicaid funds each year. Medicaid receives 44% of federal funding to states. (4) This is significant because transportation to medical care and appointments sustains a healthcare system. Access to transportation leads to better medical outcomes for patients and cost savings for the system overall.
Setting the Standard Mandating the use of WC19/20-compliant wheelchairs and mobility devices is one of the first critical steps in improving wheelchair transport safety, especially in the use of NEMT for seniors. Before they can be used as seating in motor vehicles, wheelchairs must be tested to ensure they can function as such. They need proper four-point straps, and the chairs must conform to ANSI/RESNA requirements. An example of a WC19 compliant wheelchair transporting system is Broda's Synthesis WC19 Transportation Wheelchair. Broda's Synthesis WC19 Wheelchair comes with armrests that swing away and are removable for easy no-lift side transfer applications. Improving regulations and having definitive criteria for choosing an outside transportation agency will make facilities more confident that they're making the right choice. The transparency that accompanies those regulations would force agencies to embrace best practices, meaning patients would know that they are receiving the best care possible. Making the same equipment standards mandatory for NEMT vehicles would help ensure safety and comfort during transport. Setting a new standard further benefits the transportation and healthcare providers as they all become components of the same care continuum, reducing costs and risks for all stakeholders involved. Sources 1. RESNA, “RESNA’s Position on Wheelchairs Used as Seats in Motor Vehicles,” https://www.resna.org/sites/default/files/ legacy/resources/position-papers/RESNAPositiononWheelchairsUsedasSeatsinMotorVehicles.pdf. 2. National Highway Traffic Safety Administration, “Wheelchair Users Injuries and Deaths Associated with Motor Vehicle Related Incidents,” https://www.resna.org/sites/default/files/legacy/resources/position-papers/ RESNAPositiononWheelchairsUsedasSeatsinMotorVehicles.pdf (Sept. 1997).
By Gail Bauhs, NEMT Industry Solutions Consultant Preventative care works for both humans and databases. While stethoscopes and tongue depressors aren’t required for databases, the concept of regular system health checks can help ensure your NEMT scheduling and dispatch software works at peak performance for years to come. Neglecting the health of your technology leads to administrative inefficiencies, misunderstandings, and inaccuracies – directly contributing to lost revenue and poor service. What is a Health Check? Typically, your technology vendor will do an onsite assessment of your software system and database, looking for specific issues. After conducting a detailed assessment, the vendor will provide a written report with recommendations such as additional training, configuration changes, and ways to clean up the data. A health check will look at five areas: Ensure job roles match up with the user interface configuration. Check to see if the configuration of ancillary data matches with the organization’s workflow. Ancillary data is background configuration data such as passenger types, mobility devices, provider rates, etc. Assess if driver behavior matches mapping and scheduling configurations, and if not, use historical data to refine process accuracy. Evaluate if there are any unnecessary features that can be disabled to speed up performance. Conduct a HIPAA assessment to assess security risks, looking for poorly implemented internal security, SSL implementation, password policies and data separation. Number three warrants additional background explanation. When NEMT software is first configured, trip data is matched with Google route and trip length estimates. These won’t match up with actual historical agency data, as regional variations in traffic and driver behavior mean trip times can be faster or slower than estimated. After an agency or brokerage has been in business for several years, they have gathered enough history to recalibrate their software to match how drivers are performing, ensuring higher accuracy. Health Check vs Database Cleanup NEMT brokerages and agencies that have been in operation for several years and have rapidly growing databases may develop an issue with dirty data. A database cleanup from your technology provider will look for: Duplicate data, such as passengers, vehicles, drivers, facilities, and addresses Obsolete data, such as non-active passengers, vehicles, drivers, and system users Invalid data of various types Out-of-date change logs
Purging or consolidating data cleans up the database, resulting in improved operational efficiency and reduced billing and service errors. A leaner database also means faster booking entries. Best Practices There are general networking and staffing best practices that can also help your software run efficiently, without outside help. Check if you are using the latest version of the database engine and the correct drivers to communicate with your database. Database maintenance is often overlooked, and NEMT software requires routine scheduled maintenance tasks. A special task, scheduled to run once or several times daily, will rebuild indexes and improve the performance of frequently used queries based on historically used data. Hardware should also be periodically assessed to ensure it is up-to-date and can support the software and load placed on it. As an organization increases services, hardware needs to be upgraded to meet these higher demands. Having experts available to regularly check the health of the technology environment is key. A database analyst maintains the database and will do data archiving; a system administrator or network administrator will manage your network and hardware; an information security analyst oversees security. Set up tools to regularly monitor and identify bottlenecks with hardware (typically servers) and within the network, in order to prevent serious performance issues. Archive data that is no longer needed to speed up performance. Old data is removed or moved to a separate database. Common datasets that can be archived are historical trip data, client eligibility data, providers, vehicles, drivers, credentialing, and audit tables/logs. Because the software itself knows the structure of the data and where to prune it for integrity, it can be an automated process triggered by date. While we have covered a lot of ground in this article, it comes down to this: preventative maintenance ensures a healthy system.
How Healthy is Your NEMT Technology? cont.
Budgeting for these activities long term can prevent serious gradual degradation in your system’s performance. Wondering if you need a health check or database cleanup? If you answer ‘yes’ to several of these assessment questions, it’s worth looking into: Health Check Is the onboarding process for new staff complicated and confusing when it comes to software training? Does it take a long time to prepare trip assignments for the upcoming schedule? Is your schedule filled with exceptions, errors and violations that your schedulers assure you are okay? Are you worried about staff having access to information that could pose a HIPAA risk for your agency? Do staff complain that using your software is cumbersome or inefficient? Data Cleanup Does your agency have difficulty producing clean historical reports? Are your screens and menus filled with options your agency never uses? Are duplicate passenger records making it difficult to determine eligibility? Does your software sometimes throw strange error messages when you try to access older data? Have you tried to clean up your data yourself, but found that you couldn’t?
Dialysis Center Riders – a Tough Market to Serve
By Steve Yaffe, Yaffe Mobility Consulting LLC My involvement in dialysis transportation began in 1990 when I became the Planning Manager of the consolidated human service transportation provider for Fairfax County, Virginia. Riders sponsored by different agencies for a variety of purposes travel together if they are going from the same general area in the same direction at about the same time. Through the scheduling principle of “Geography Rules”, we could provide more rides at a lower cost than would have been accrued by redundant services for each agency’s clientele. By the time I left in 2006, the number of dialysis centers served had grown from 4 to 15 and dialysis center ridership increased consistently by 10% annually. Much of the country has had a similar experience. Like many NEMTAC members, we initially had no control over which dialysis center that a patient was assigned to or which shift at that center. Also like many NEMTAC members, we got caught between a focus on customer service (“I’m tired and ready to go home now”) and the need to tamp down the cost per ride provided. Because our on-time performance was good – unlike other providers of publicly subsidized rides in the County – we were the preferred provider. That gave our schedulers leverage to work with dialysis center personnel to group clients who live in the same vicinity or in the same direction onto the same dialysis shifts. Our on-time performance also gave us leverage with those who shared rides due to geography. Our tracking of on-time performance showed that some riders, especially older adults, need more time after coming off the machines to recover before going home. Those return trips were then adjusted later as the need developed – while keeping the group together. Even with this scheduling approach, our service in recent years has had to refuse requests for dialysis center rides that did not go to a nearby center. My interest in dialysis transportation led to a George Mason University Transportation Logistics capstone class project on dialysis transportation and some years later to justifying funding of a national research project on this subject.
That research project culminated in TCRP Report 203: Dialysis Transportation: The Intersection of Transportation and Healthcare. The full report – including an Excel-based tool to forecast ridership growth – is available on-line from the Transportation Research Board at http://www.trb.org/Main/Blurbs/178786.aspx. Developed by a team lead by Elizabeth Ellis of the KFH Group and including a professor of public health, as well as a Johns Hopkins University nephrologist (kidney specialist), the report shows the national demand for rides to dialysis centers is growing by 20,000 annually from a 2015 base of 700,000. While some patients dialyze at home, ninety percent of those on dialysis travel to dialysis centers – usually three days each week. Missing treatments or truncating treatments directly and quickly affect patients’ health. While these riders depend on the on-time performance of ride providers, both patients and ride providers are limited in their control over that transportation for several reasons. Some operators do not have the ability that we had to group riders by geography, placing the bulk of them on standing order subscription schedules and maximizing vehicle occupancy. More patients could dialyze at home. After the report was finished, Seema Verma, Administrator of the Centers for Medicare and Medicaid Services (CMS) in the US Department of Health and Human Services, announced that CMS is realigning payment policies to improve care in the early stages of kidney disease to prevent kidney failure, increase access to kidney transplants, and favor home dialysis over clinic-based treatment. Patients are often very limited in their choice of dialysis centers. Their insurance may have a contract with just one dialysis provider. Their nephrologist may only be registered with one center or one dialysis chain (Fresenius and DaVita are the biggest dialysis providers). The dialysis chain may be forcing new patients to use the newest center in the area, which may not be close by. Dialysis centers often have three shifts of patients on a Monday-Wednesday-Friday schedule and another three shifts Tuesday-Thursday-Saturdays – but may only have an opening for a new patient on one or two of those shifts. Due to these factors, riders may be traveling long distances, which has greater risks for on-time performance and affects their health.
Dialysis Center Riders – a Tough Market to Serve cont.
Dialysis centers are nearly entirely for-profit and very focused on their profit margin. Consequently, dialysis shifts usually begin on-time, last four hours, and end on-time regardless of when the patient arrived for the shift. Personnel have set and limited times to change out hosing, etc. for the patients on the next shift. Those shift times cannot be adjusted to accommodate long travel times. Many states’ oversight rules for Non-Emergency Medicaid Transportation (NEMT) do not allow sharing rides with other clientele groups. According to DialysisPatients.org https://www.dialysispatients.org/advocacy/key-issues/medicaid, nearly half of dialysis center patients receive Medicaid benefits. However, new patients are not immediately eligible for Medicaid (varies by state). While at Fairfax County’s consolidated human service transportation provider, I negotiated an agreement with Virginia’s Medicaid transportation broker to transport their clients with other riders. That agreement would not be possible in many states due to their interpretation of CMS’ rule that the NEMT trip is on the lowest cost available transportation mode appropriate for the client. You can learn more about how your state administers NEMT from another recent project, TCRP Report 202: Handbook for Examining the Effects of Non-Emergency Medical Transportation Brokerages on Transportation Coordination - http://www.trb.org/Publications/Blurbs/177842.aspx As ride providers, you should be aware of the importance of on-time performance to the health and morale of dialysis center riders. Both the likelihood of hospitalization and their mortality rate (along with their stress level) increases along with missed or shortened dialysis treatments. Their stress level also increases with long waits after treatment for that ride home. On-time performance is the focus of the complaints collected from patients and clinics as part of this research project. Ride providers are caught between pressures to be efficient; orders to provide sometimes needlessly long rides when another center is closer; the need to repeat the same trip for neighbors who are different shifts at a center; the inability for Medicaid recipients and other clientele to share rides; and a differential between newer/younger riders and older riders in the time required at the dialysis center after treatment ends before they are ready to go home. Indeed, dialysis center riders are a very tough market to serve – but their lives depend on your service.
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The Changing Landscape of Rides
NEMT and the EverTransit Difference By Scott Newman, Eliza Wellington, and Patrick Mulivhill Three decades ago travel reservations were made very differently then they are made by consumers today. Back then, travel meant our parents would call an airline or travel agent, then make multiple calls to hotels for price and availability, followed by a call to rent a car. Today consumers log on to a single website where the entire process is streamlined and seamlessly billed to a credit card that earns loyalty points. In the age of the internet, Amazon replaced the Sears catalog and Expedia has replaced the local travel agent, yet NEMT solutions remain open to technology innovation and reimagination. If history is any guide, the disrupters will not be incumbents but new players unencumbered by legacy thinking. The following outlines our view of how fleets can remain competitive in a rapidly changing landscape. For Medicaid and Medicare members, NEMT is a key benefit. NEMT ensures that patients can comfortably attend appointments in a cost-efficient manner and empowers them to fill their prescriptions and to access other non-urgent healthcare facilities more easily. It is widely known that nearly 3.6 million Americans miss rides each year because of transportation barriers. The solution, simply put, is NEMT. As the market for NEMT remains underserved while the need continues to grow, taxi fleets would benefit from engaging directly with private pay accounts and widening their customer offerings. At EverTransit, we have found that fleets willing to adapt have been met with great success. The only way for many fleets to remain competitive in the age of ride-sharing services is to find an adaptive niche. We believe that niche is NEMT. EverTransit’s end-to-end platform offers a highly automated and user-friendly booking process that allows medical facilities to easily book and track patient and resident rides. Our “front desk” feature streamlines the transportation booking process, minimizing miscommunication, reducing missed rides, and creating greater transparency for all involved. This is especially helpful for private pay accounts with a high demand for NEMT and for those with disabilities who don’t always require emergency transport but who often have low mobility and need additional assistance in their transport. The market of elderly people who don’t necessarily need to attend an appointment but who still want to spend more time outside of their home is huge. The EverTransit platform is clean, simple, and effective. Just ask our customers. It works. EverTransit’s Director of Growth Patrick Mulvihill described the platform as a “modern version of the old traditional route optimization model.” Auto-dispatch sends out rides based on availability. Plain and simple.
EverTransit takes a people-first approach. For us, the rider experience is everything. Over time, it has become abundantly clear to us that private pay accounts and patients benefit by partnering with independent fleets. The advantages are threefold. First, fleet owners have a guaranteed supply of vehicles, something that rideshare services, especially in rural areas, don’t. While ridesharing services are mostly concentrated in metropolitan areas, NEMT is everywhere. Private pay accounts and patients who rely on ridesharing services consequently suffer from delays and cancellations. With independent fleets, this is much less likely to happen. The reason for this is that while some ridesharing services may have more supply in sheer numbers, they have no effective control over that supply. Drivers drive whenever they want, so there is no guarantee that a patient on their way to get the dialysis that they desperately need will not miss their appointment. Second, the vast majority of fleet drivers are trained in first aid and CPR. Rideshare drivers rarely hold such credentials. When it comes to NEMT, these certifications are critical. On the one hand, it makes logical sense that a driver transporting an elderly patient to and from dialysis appointments should be first aid and CPR certified. More than that, however, these certifications give the families of these patients peace of mind. The last and perhaps most important point, however, is that fleet drivers get out of the car. That is, they assist passengers with special needs and help them get door to door. They don’t just do pickup and dropoff. It is no good, after all, to wait outside for a dialysis patient if they have forgotten about the ride. It is just as bad to drop somebody off at the hospital if they never make it inside. So how does EverTransit work and what features distinguish it? Perhaps the most exciting new service that we offer is a Premium Executive Booking Portal, a feature that allows clients to seamlessly book and manage transportation on behalf of members, employees, and residents, eliminating the need for phone calls or email scheduling while increasing transparency with ride tracking in live time. Stepping back, it’s useful to look at the current NEMT market. Let’s start with a story. Consider Joe, a retired 70-year-old living outside of Philadelphia. Joe gets all of his rides to and from doctor’s offices paid for by Medicaid. He always uses the same service. But when he asks them to bring him to the movies or anywhere that is not a doctor's office, they turn down the ride because they can't accommodate it. So the ride is unfulfilled, which is bad for both the customer and the transportation provider. EverTransit’s auto-dispatch feature fixes that by load balancing and connecting fleets in a network of NEMT services.
The Changing Landscape of Rides cont.
Right now, it is fractured. Dispatching platforms and services exist but they are siloed to specific regions and overly-narrow niches. EverTransit changes that because it is end-to-end, has fleets, almost anywhere, and can guarantee quality NEMT transportation. It is less of a platform than an ecosystem. We created EverTransit because we believe in the power of NEMT. Fleet owners benefit by receiving a consistent stream of rides at a premium cost. Private pay accounts benefit by receiving a simplistic and reliable booking platform. Patients benefit from high levels of support and assistance. For more information, check out our website – evertransit.com. We'd love to have you on board.
The Importance of Safe Vehicle Operations in the NEMT Industry By Mark G. Gardner, CEO, Avatar Management Services, Inc. I bet there are hundreds or even thousands of people celebrating their wedding anniversary today. I'm celebrating an anniversary of sorts as well. Twenty-seven years ago, today I was forced, by a hit-and-run driver, head-on into the path of a 26,000-pound Peterbilt tri-axle dump truck. Obviously, I survived, but trust me when I say that it was a miracle. Ironically, I was at the time working in the transportation safety industry via an insurance company, studying unsafe driver behaviors. I even followed my own advice, but the speed and circumstances were too much for my skills and abilities. Based on the speed of the truck and my car, the collision was later estimated to be 80 miles per hour. Buckle Up Your Unsafe Behaviors Back then, there were no airbags, but my seat belt saved my life. The impact broke both my legs, nine ribs, my sternum, my clavicle, my left arm and wrist in several places, my left hand, my fingers and my right foot and toes. Medics quickly arrived. In about an hour, they managed to cut me free from the wreckage. They gave me a helicopter ride to the trauma center while jamming a four-inch needle into my chest to inflate my crushed right lung. Only 1% Chance of Making It I lay broken, in pain, and surrounded by a dozen medical trauma experts. They began the challenging task of saving my life. For this, I am forever grateful. I learned later that they only gave me a one percent chance of making it through the night. I also found out the hard way that medical protocol doesn't allow any pain medication – not even an aspirin. It can cause problems in surgery. I begged and even tried to bribe them, but nothing worked.
Unsafe Behaviors are Your Choice cont.
They cut open my belly and probed inside me for internal bleeding. They inserted tubes where tubes shouldn’t go. They probed into my heart with a catheter through my groin, looking for a torn aorta. It all hurt, but I joked with them the whole way through. Apparently, it was some bizarre, shock-induced response mechanism. Maybe it’s why I’m still crazy to this day. Our Daily Choices Affect Lives No one ever found the culprit who caused the accident. He had just passed the dump truck and several cars traveling in the opposite direction. When he came over the hill, he was on the wrong side of the double yellow line, aimed right at me, all of which are unsafe behaviors. Was he drunk? Maybe he was late for work? Was he distracted? Did he even understand the risk he was taking? We'll never know. What we do know is that his choice that day has affected the lives of more than a million people in a positive way. Dedicating My Life to Safety As I lay in the hospital after the third surgery, I decided to dedicate the balance of my life to making the world a safer place. I founded Avatar Management Services, Inc. and later AvatarFleet, The School Bus Safety Company and TAPTCO. They all continue to provide effective safety training for truck, bus and ambulance drivers today. We’ve done well. We’ve saved lives and made the world a safer place. But every day while driving, I still witness unsafe behaviors. People following too closely, texting, changing lanes without signaling, driving too fast for conditions. The list goes on and on. Do you see it? Do you do it? If so, why? Are we nothing more than stupid animals? Humans are Capable of Choice We’re not reliant on instincts, but rather cognition. Every minute that you are driving is an opportunity to make a choice. You can choose to drive defensively and with caution or pursue a selfish reward by accepting too much risk and unsafe behaviors. We’re tempted to speed, run red lights or break other laws because we think we’ll get somewhere sooner. We’re tempted to text while driving to keep in touch with a friend or to avoid boredom. But the benefits we get from making these choices are insignificant when compared to the potential calamities unsafe behaviors pose.
By Taylor Lioy, Marketing Strategist, Buffalo Intelligent Technology Systems Introduction: With the various data entry options surrounding the NEMT industry, whether manual or through software, it's hard to know which option is best for your organization. By switching to software that streamlines your data entry, the time and money you save can be reallocated to places that could benefit from more attention. There are various reasons to switch from manual data entry to software that can streamline the process. Here are a few things to keep in mind when considering a software solution: Manual Data Entry Is Time Consuming Companies can spend countless hours every day manually entering data from their NEMT trips. Transferring information from the trip sheets you gave to your drivers into manually typed information can waste vital time that your organization may not have. If manual data entry is not one of the designated core tasks of the business, it can divert your employees' focus from completing more valuable tasks. Data entry forces employees to allocate their time towards a short-term goal, instead of the greater, long-term goal. Data Entry Can Be Expensive Some organizations choose to hire companies to enter their data for them or may even hire an employee solely dedicated to data entry. Both options are very costly and can impact the organization negatively. Here's an example of the financial stress that manual data entry can cause your organization: Let's say a mid-sized company hires a data entry employee who works on manually entering data for 8 hours every day. If it takes about 4 minutes to enter all the data for one NEMT trip into the system, and there are roughly 4,000 trips each month, this employee is spending 16,000 minutes, or, about 267 hours each month doing manual data entry. They're not only paying this employee for their time, but the amount of time wasted is costing countless dollars by not being able to allocate this employee to more important things. This seems like a waste of time and money since this process can
Pitfalls of Manual Data Entry cont.
easily be replaced by software designed for data entry. Higher Data Inaccuracy Rate Errors such as illegible handwriting, inadequate training of data entry professionals, copy and paste errors, misinterpretation of wording, and misspellings. The repercussions for any of these errors occurring can be debilitating for the company. Hopefully, the organization can identify the error and make the necessary changes to recover the integrity of the data. Software Validation and Industry Compliance Without data validation, significant errors can be made. Focusing on the NEMT industry, one of the main repercussions for bad data is not getting accurately paid for completed trips. This consequence along with many others proves why it's important to implement best practices when capturing and entering data. Compliance with the regulations for any industry is a crucial part of a company's success. Failure to comply with state and federal procedures can have a very serious impact. For these reasons, you will want to make sure all your data is validated and compliant. Using software to assist with validating your data will, in turn, assist with compliance. Reporting Becomes More Valuable Reporting becomes more extensive, useful and readily available. With the amount of time it takes to manually enter data, there's hardly any time left to analyze, strategize and plan to improve your current processes. With manual data entry, reporting takes the back seat in your organization's procedures. It takes a good amount of time to enter the data which will be used to generate reports.
Come audit time, you do not want to have poor or missing data. Reports are a good way to discover or confirm suspected issues. Many times, you may not know a problem exists. Reporting can provide insight into what is working and what needs to be improved on. It's circumstances like this where reports prove their value. They can easily show you where the error exists. To protect a company and maintain compliance within its industry, it's recommended that companies use software to provide data validation. If your driver accidentally marked the pickup and drop off times as the same time, you're not going to get paid for that trip since no mileage was used. Software could have easily identified this problem and calculated the bill amount based on the mileage it tracked using geocoding. If these companies were to manually create reports based on the data that was manually entered, this would not be a good use of time. If any data was entered incorrectly, the reports would be generated based on incorrect data. It's best to avoid these possibilities and use software that provides and supports data validation and industry compliance. On-The-Go Driver Needs When on the road, drivers need a quick and efficient system to assist with their trip data entry. A mobile app with designated software will remove the possibility of error from manual data entry and eases the process of capturing and entering data into the system. There will no longer be human error such as illegible writing, inaccurate data, and "typos". As an NEMT provider, you need accurate information for a variety of reasons such as audit trails, maintaining compliance and driver/ rider integrity. Data including automatic geocoding and time stamps eliminates any possibilities for false information. Conclusion: Manual data entry is one of the most inefficient ways to keep track of your organization's data. When searching for a software solution for data entry, it's important to find one that gives your company its time and data validation assurance back. Instead of piecing together your manually entered data, invest in a system that's built to create higher efficiency and a productive working environment. Protect your organization from any possible human error or inaccurate data by implementing software that validates your data to ensure you're compliant within your given industry. It's time to use data to your advantage and stop allowing it to sit in forgotten or overlooked folders where it's unusable. With software that assists with data entry, you can improve your process and creating a better business.
By Joe Rubino, Principal of JMRubino Transit Consulting As the driver drove away from the dialysis clinic she was clueless... no, she was absolutely oblivious to the boneheaded thing she had just done. In her mind, it was no big deal letting a grown man, sitting on the sidewalk in his wheelchair, have the pleasure of a smoke before he went into his dialysis treatment. After all, the man would soon be reclining immobile for several hours so why shouldn't he have a bit of a break before that ordeal? But while the driver's heart may have been the right place, her common sense was nowhere to be found. It seems that this 63-year-old man had no legs, and therefore nothing to secure the lower part of his body to his wheelchair. In addition, the spot she left the man sitting was by the rear entrance of the clinic, a part of the building with no windows. This back door faced only the empty parking lot. In other words, no other human being, either inside or outside the building, could see this man while he smoked in his wheelchair. Have you figured out what happened next? For reasons unknown, the man leaned forward, fell onto the concrete sidewalk, and laid there for a long period of time before anyone found him. Making this tragedy worse for his family was learning that the man had actually been delivered safe and sound inside the building before the driver brought him back outside onto the sidewalk. That's right, after bringing him inside the dialysis clinic, where there were many employees on duty, the passenger asked to be brought back outside for that smoke. Several weeks later, the man died. Unfortunately, on a regular basis, NEMT passengers are slipping, sliding, or falling out of their wheelchairs while in the process of being transported. Oftentimes, it is not the driver's fault. Many wheelchair passengers, especially elderly ones, have a habit of slouching down in their wheelchair while riding. Some sit on cushions that reduce friction between their body and the chair, and most have weak lower bodies to begin with. Despite the best efforts of their drivers to secure these passengers as well as their wheelchair, the combination of the forward momentum of the vehicle and the passenger's inability to stabilize themselves during the ride contribute to these unfortunate events. But while many of these incidents occur despite the driver doing his job to the best of his ability, many others would be prevented simply by the driver applying some common sense. Since 2008, I have served as an expert witness about 180 times, usually on civil cases involving passengers being injured during NEMT transport.
Do You Train Your Drivers to Use Common Sense? cont.
During case review, I get to read the training syllabus used by the transportation provider. While most of these training syllabi have been very comprehensive, I rarely see something like "Don't Forget to Use Your Common Sense." Trust me, a section like that could've helped in many of these unfortunate situations. I remember the case of a driver giving in to the request of the passenger not to use the foot rests on his wheelchair. The passenger said it was "more comfortable" for him that way. The driver thought she was being nice in leaving the foot rests in the "up" position. One day, after arriving late to a medical appointment, the driver was hurriedly pushing this passenger down a declining walkway, when the toe of one of the rider's shoes caught on the pavement. The elderly man was immediately catapulted forward out of his chair. If only the driver had used her common sense and explained to the man that the foot rests always had to be kept in place. In another case, where the passenger was riding on her scooter, the driver paused the wheelchair lift halfway up because the front of the scooter was catching on the frame of the van. With the lift 2 feet off the ground and the scooter stuck, the driver asked the passenger to back the scooter up a inch or two on the lift. I am not making this up. You can imagine what happened next.
Your operation can have the most thorough, comprehensive driver training program and yet if you don't teach your drivers to use their common sense, none of your training matters. In a case I worked on a few years ago, an NEMT driver opened the transit door, and his very spry, very mobile, 80 year old female passenger went down the steps and then started walking toward her house. It was winter and there were icy patches on her asphalt driveway. She only had walked a few steps when her feet went out from under her. She slipped. She fell. And the driver never saw it happen. Here's why: His company penalized its drivers for having incomplete or inaccurate data, and one of the driver's duties was to record the mileage on the vehicle's odometer at both pickup and discharge. So, while this elderly woman was walking down the van's steps and then crossing the icy driveway, the driver was fastidiously and accurately recording the woman's discharge time, as well as the vehicle's odometer reading, taking great care to make sure it was recorded in the correct box and in the correct manner on his trip manifest. He was certain his supervisor would be pleased. So the good news is that all the trip information was recorded properly. The bad news is that tragedy ensued. Within a month after falling on the ice and hitting her head on the pavement, the woman died. The driver had gone through an extensive training program and had an excellent driving record. But he was never trained to use his own common sense. About the Author Joseph M. Rubino is the Principal of JMRubino Transit Consulting in St. Augustine, FL. He has worked on transit projects in 47 states. His web site is www.jmrubinoconsulting.com.
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