NonEmergency Medical Transportation

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Non-Emergency Medical Transportation

• Lessons from the Mountain State of West Virginia

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Background

• a high proportion of emergency
  transportation may be for non-emergencies, e.g.,
  transporting elderly patients from the nursing
  home to the hospital and back again
• In Webster County, West Virginia, 1/3 of their
  EMS trips are for NEMT.

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West VirginiaTransportation for Health

• Demonstration funded through the SRAP.
• Additional funding from the 21st Century
  Challenge Fund and the Claude Worthington Benedum
  Foundation.

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Definitions

• Fixed-Route Transit Service
• Demand-Response Transit Service
• Deviated-fixed route
• Door-to-Door Service

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Community Model 1

• Public bus transportation for 5 county service
  area.
• provides fixed-route and demand response services
  
• offers route-deviated service , up to ¾ of a mile
  from the regular route, when requested in
  advance.

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Community Model 2

• Combination senior services center and transit
  system for county residents.
• offers route-deviated service, up to ¾ of a mile
  from the regular route, when requested in
  advance.
• in addition to NEMT, provides service to senior
  citizens and the County Sheltered Workshop.

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Community Model 3

• Senior services agency provides services to
  county residents.
• In addition to NEMT, transports senior citizens
  to nutrition sites, shopping, activities, and
  medical appointments.
• only provider of door-through-door service for
  clients, when required and requested in advance.
• No fixed route

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Who used the services of these providers?

• 70 of riders were female
• Average age 54.9 years
• 36 gt65 y/o, 58 19-64, 6 lt19
• 12 first-time users

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How was the service paid for?

• Medicaid is the primary payer
• Of the approximately 5000 trips over a 12 month
  period
• 85 covered by Medicaid
• 28 of Medicaid covered trips for those gt65 y/o.
  67 of NEMT riders gt65 are covered by Medicaid.

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Where are clients going?

• Top three locations
• The doctors office
• Therapy
• Dialysis (Hospital, Tests)

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How far are clients traveling?

• Average mileage/trip 41.2 miles, std deviation of
  another 41.1 miles
• 28.6 of NEMT trips are over 51 miles roundtrip
• Miles traveled range from 1 mile to 336 miles
  roundtrip

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Is NEMT paying for itself?

• Not so far.
• Transit authority is the only formal model
  approaching break-even, will still require some
  degree of subsidy
• Larger operation, can spread costs.

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Differences between providers

• Proportion of traditional transit users
• Methods of collecting sliding fees
• Nature of service
• Curb-to-curb
• Door-to-door
• Door-through-door
• Deadhead miles as a percentage of total

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Challenges

• Issue 1 Single payer-Medicaid
• Issue 2 Specialty care/treatment not available
  locally
• Issue 3 Coordination difficulties

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Possible (not yet proven) Solutions

• Informal/volunteer models (VT Good News Model)
• Broker model connecting rider to the provider,
  regional models
• Medicare coverage for NEMT
• Subsidize NEMT like traditional mass transit

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2004 Update

• September 2004. All three programs continue to
  offer NEMT services.
• The transit authority is the strongest.

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Conclusions

• The need for cost effective and efficient NEMT is
  growing.
• More RD is needed
• Policy changes are necessary