As more rural hospitals close and access to healthcare clinics and physicians gets harder for rural residents, researchers in Duluth, Minnesota, are looking at the impact transportation has on rural healthcare.
At the University of Minnesota Duluth, researchers and faculty members are working with the Arrowhead Regional Development Commission to find ways to sustain and re-imagine healthcare transportation. Arrowhead is a development organization serving northeastern Minnesota, specifically the counties of Aitkin, Carlton, Cook, Itasca, Koochiching, Lake and St. Louis. The goal of the organization is to bring together governments and citizens to identify regional needs and solve problems.
For Beverly Sidlo-Tolliver, principal planner at Arrowhead, the need to look into the issue came when she was working in healthcare. While she was attending a workshop on dialysis, the issue of transportation came up. Just two weeks prior, one of the medical transport companies had pulled out of the Arrowhead region of the state, she said.
“What really stuck out was that there wasn’t any process established, from the state, dictating that when these providers pulled out, that there were certain steps they needed to take to make sure that the patients scheduled [for dialysis] still had a ride,” Sidlo-Tolliver said in an interview with the Daily Yonder.
“They pulled out and people were scrambling. There were at least two people who did miss their dialysis that was scheduled with this provider and ended up hospitalized,” she said. “That really revealed to me the need to really dig into the system in place.”
Her efforts to determine how to change the system were met with requests to come up with numbers about how many people it was affecting.
Working with Empowering Small Minnesota Communities to research the issue, David Beard, a professor and researcher at UMD, joined Sidlo-Tolliver to interview a wide range of people in rural communities in their region over the past year to get insight into what the issue is and how to fix it.
The solution for rural residents is not as simple as hiring a driver, or getting volunteers to drive patients to the hospital and back, they said.
“People don’t understand it’s not like it is in Duluth where you can call a cab or an Uber,” Beard said. “In some cases, getting to an appointment and back is a day-long project.”
“We’ll have people from small towns who have a medical crisis, they’re brought to Duluth; sometimes from as far away as the Upper Peninsula of Michigan,” Beard said. By car, Duluth is nearly two hours west of that state line. “They have to figure out how to get home. There are commercial providers that can do that, but the costs are high, the arrangements are complicated, and the Medicaid and the state regulatory systems do everything they can to make it economically challenging.”
Additionally, lack of transportation can keep patients from getting follow-up care or getting routine testing. Skipping dialysis can exacerbate chronic conditions, Beard noted as an example.
“Miss your dialysis appointment, and then two days later, you’re in the hospital,” he said. “Or miss your annual colonoscopy, and you miss early detection on something that becomes life-threatening later. We never want someone to believe that their inability to get a ride could be a contributing factor in death.”
It’s an issue that impacts the profitability of hospitals themselves, Beard said.
“It’s been verified that it takes, on average, eight minutes to reschedule every missed appointment,” he said. “There’s some research that looks at the drag that creates on hospitals. How many missed appointments times eight minutes per appointment? How much money is lost in billable hours when people miss appointments and need to reschedule them?”
And as the patients sit in hospitals taking up beds and other resources waiting for someone to come pick them up, those are resources that can’t be used to treat other patients, another money loser for hospitals regardless of whether they are rural or urban, he said.
The problem is complex, Sidlo-Tolliver said. The people doing the driving need to be certified in order to have their time reimbursed by Medicare or Medicaid. The drivers need to be trained how to transfer a patient from a wheelchair to a car, or what to do if the patient has a medical emergency in transit.
“My research has been on creating consistent coordination and facilitation of the providers that provide this transportation in the region,” Sidlo-Tolliver said. “One of the things that is also an issue is the ‘unloaded miles.’ The unloaded miles is an issue when a provider is driving to pick up that individual. During that part of the trip, they are not reimbursed. So, they are unloaded, and then they get the person, now they are getting paid, and they drop them off. But when they return to their home city, that is unloaded miles. And Medicaid doesn’t pay for unloaded miles, so their reimbursement rate is not reflective at all to the (total) cost of that ride to the providers.”
Getting certifications to become a qualified medical-transport driver is extremely cumbersome, she said, requiring licensing from two separate state agencies, the Minnesota Department of Health and the Minnesota Department of Transportation. That extra certification creates high barriers to entry, which decreases the number of people willing to provide those non-emergency rides.
The solution may be in changing the way healthcare providers view transportation, not as something that is the patient’s problem, but part of healthcare itself, Beard explained.
“Doctors envision transportation as the patient’s problem to solve, not an intrinsic part of how we envision the healthcare system,” Beard said. “What does it mean for the county or the state to imagine that offering transportation is part of their responsibilities, right? To not see transportation as an add-on outside the healthcare system, but to see providing non-emergency medical transportation as an intrinsic part of how we care for each other.”
Viewing the issue differently could help change not only awareness of the problem, but also help create solutions, he noted.
So far, after a year of interviews, the researchers are continuing to look into the problem and come up with possible solutions. A documentary created from the research is also on its way. But showing how many people need those rides is no longer a focus of the research, Sidlo-Tolliver said.
“As we went through this process, the focus maybe was better set at even the number of “one” is an issue,’” she said. “If one person is going to suffer, or possibly die, because they cannot access the healthcare they need due to this issue, that’s enough [to act].”
Regardless of whether it means providing five rides or 5,000 rides, Sidlo-Tolliver said, the people who use the transit are the main reason to provide the transportation services.
“Those people are people, and they deserve to access the things they need to live just as well as anyone who could operate a car,” she said.
The post Researchers Tackle Non-Emergency Medical Transportation appeared first on The Daily Yonder.
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