The shift toward value-based care has highlighted many socio-economic factors that impact the ability for patients to access care and ultimately health outcomes.
In particular, insufficient transportation for patients to and from care sites is proving to be a root cause of many issues that can lead to reduced patient outcomes. Historically, health systems have addressed these issues by offering taxi voucher programs, shuttle services, patient valet parking, etc., in addition to ambulance services for medical transport. However, these services are costly and often do not satisfy the full scope of patient transport needs. Healthcare organizations are now looking for innovative solutions, which oftentimes requires partnering with companies outside of healthcare.
Because patients are typically responsible for transportation and these methods can vary greatly from patient to patient, there is often little data that can be used to quantify the issue. However, this lack of data should not deter organizations from pursuing creative solutions. Organizations should keep in mind the following:
- Health systems invest a significant amount of money into various mechanisms for patient transport. This annual expenditure can serve as an upperthreshold to benchmark potential savings against.
- Patients often miss or reschedule appointments due to lack of transport, which contributes to operational issues, including patient throughput, reduced access to medication (for refills), and administrative burdens on staff. Furthermore, emergency departments are often used for primary care services by patients who are unable travel to a physician’s office during office hours, further exasperating the problem.
- Some patients consider transportation a part of their patient experience and may factor this into satisfaction scores. However, the transportation experience is often outside the hopsital’s control, leaving administrators in a difficult position when issues arise (e.g., coordinating taxies for discharging patients, taxi drivers unwilling to pick up patients from a hospital, long wait times, etc.). Bringing transportation services within the organization’s span of control is a necessary first step toward improvement.
- Healthcare staff often express a desire to assist patients with transportation issues but lack the tools to do anything substansive. Assisting one patient with transportation (i.e., walking them to their car, waiting for a taxi) often means being unable to assist another patient during that time.
Regardless of whether an organization is far along the path toward value-based reimbursement or predominantly maintains a fee for service model, these are costly issues that negatively impact care in any organization.
Recently, a health system in California partnered with a healthcare transportation management company and a rideshare company to establish a framework for solving patient transport issues that can be easily replicated in other markets.
The team used a process improvement methodology that uses continuous review to identify the problem, plan a solution, implement the solution, and then review the solution for opportunities to expand or introduce additional process improvements.
The health system began using the healthcare transportation company’s “healthcare transportation hub” model where care coordinators could submit a single request to a dispatch center and book immediate transportation for patients. Patients that require medically assisted transportation would be booked with an ambulance or necessary medical support team for transportation. Patients that do not require outside medical assistance would be booked with a ride-share partner and be transported in a ride share.
Because no new technology needed to be developed and the IT department did not need to be involved, the team was able to complete a full rollout within 60 days. Users were trained using visual aids and a simple triage methodology based on qualifying clinical factors.
Impact of Patient Transport Programs
The new program received overwhelming support from staff, patients and their families and generated new data points that could be used to monitor, improve, and expand services in the future. The impact of the initial pilot included:
- Prior to the project, patients had to wait an average of 90 minutes for an ambulatory transport. Now the average wait time is seven minutes.
- Increased efficiency allowed the health system to reduce ambulatory transportation costs by 73%.
- Patients were quick to adapt to the ambulatory ride share program; an average of 60 rides are being provided per day.
- There is now information available that can be used to better understand how patients move throughout the system and gain further insight into financial metrics that can reduce overall costs.
- The hospital an increase in patient throughput, decrease in no-show or rescheduled appointments due to transportation issues, and an over 50% decrease in emergency department diversion rates (when ambulances are unable to drop off patients due to over-capacity).
The use case did present a new set of challenges, including how to handle patients that do not qualify for medically assisted transport but would benefit from additional assistance, how to handle special requests such as a stop to the pharmacy, verifying if a patient’s insurance covers non-medical transport, and how to integrate patient transport information as well as other social determinants of health into a patient’s medical record.
Mounting cost constraints, new market entrants, shifting regulations, and advances in technology have made it increasingly important for provider organizations to seek out innovative partnerships to solve problems that are not easily quantifiable. By partnering with forward-thinking companies, organizations can come up with solutions that can be expanded into other areas, such as employee transport, meal delivery and an overall increase in patient engagement—all of which are essential to succeeding in the rapidly evolving healthcare space.
The views and opinions expressed in this blog or by commenters are those of the authors and do not necessarily reflect the official policy or position of HIMSS or its affiliates.
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Originally published June 25, 2019