Improvements Sought in Medical Transport Service
December 15, 2014
DECEMBER 15, 2014 | COURIER POST | LINK TO ARTICLE
The Rev. Dr. Marilyn Dixon Hill heard the same complaints over and over from patients she visited at Camden’s Abigail House and Northgate Towers II.
A state-funded medical transportation service that was supposed to take Medicaid patients to their medical appointments often didn’t. Patients said they were often picked up late, if at all.
Health care providers echoed their stories, telling of missed or rescheduled appointments and patients left waiting for a ride home, sometimes even abandoned.
One of Dixon Hill’s congregants, an active woman in her 80s, said she walked back home to Camden from an appointment in Voorhees when her ride never showed.
“She couldn’t get a ride back,” said Dixon Hill, a former nurse and a member of Camden Churches Organized for People.
“I almost fell on the floor.”
Turns out, it wasn’t just Camden residents with a problem. But thanks to a joint effort by CCOP, Faith in NJ and the Camden Coalition of Healthcare Providers, the state and its contractor are working to fix it.
Since 2009, New Jersey has contracted with LogistiCare, an Atlanta-based medical transportation broker, to arrange rides using local vendors. Before then, the state relied on a patchwork of local- and county-level transportation services.
LogistiCare is paid about $165 million annually to conduct background checks on drivers, safety checks on vehicles, and confirmation checks to ensure patients are covered through Medicaid. To reduce confusion, it uses a single call center to coordinate rides for 1.5 million New Jersey patients.
The company operates in 40 states and says its system saves millions in taxpayer dollars. It claims a 99 percent complaint-free rating.
“But we spend a large amount of our time on that 1 percent of the trips where things didn’t go as expected,” said Chris Echols, LogistiCare’s senior vice president of operations.
“When you’re doing hundreds of thousands of trips every month, it can add up to a decent-size number.”
Based on their discussions with residents, patient advocates believe the percentage of complaints is much higher, though there are no hard data to back that up.
Angeline Dean, a transportation advocate for Faith in NJ, said she even heard stories about cancer patients who decided to end treatment rather than deal with transportation troubles.
It’s a problem statewide, according to Dean.
“It is a lot more than 1 percent, and I mean a lot more.”
To hear the complaints firsthand, Valerie Harr, director of the state’s Division of Medical Assistance and Health Services, and LogistiCare officials attended community meetings on site.
At a Camden high-rise residential building, Northgate Towers II, they heard residents were often delayed by slow or broken elevators. Too many vendors waiting outside led to confusion among residents over which vehicle they were supposed to take.
They also learned residents sometimes waited at a different entrance from where their ride was stationed.
Lori Bonderowitz, general manager for LogistiCare’s New Jersey operations, said the visits were “really enlightening for me.” She learned it can take a half-hour for a resident to reach the street level from a high floor.
“We didn’t realize,” Bonderowitz added. “Obviously, we wouldn’t know if we weren’t there.”
To address such issues, LogistiCare launched two pilot programs in Camden and Trenton during the summer of 2013. It rolled out confirmation calls to patients; instituted monthly calls to a social worker on site; agreed on pickup sites; and reduced the number of vendors serving each site, to cut down on confusion.
It also now provides drivers with a phone number to the building’s security desk, so they can learn whether a resident is stuck on an elevator.
The pilot programs have already improved service, said Mark Humowiecki, general counsel for the Camden Coalition of Healthcare Providers.
That means patients are getting to necessary primary care and specialty care appointments, he noted, especially important as the coalition works to reduce the hospitalization rates of Medicaid’s “super-utilizers,” the portion of patients accounting for the heaviest costs.
“People are actually happy,” Humowiecki said. Building relationships among patients, providers, vendors and residential buildings has led to a sense of accountability, he added.
“They know they can call each other if there’s a problem.”
Advocates now want to see such improvements across the state. LogistiCare’s latest contract extension ends June 30. Within the next few months, the state will publish a new request for proposal, or RFP, with new contract requirements for its transportation broker.
In an unusual move — and at the request of the Camden Coalition and its partners — the department invited public comment earlier this year on the new proposal.
Dixon Hill wants access to the complaint data and how they’re compiled. She thinks patients like her congregant are sometimes reluctant to complain for fear they will be penalized.
Advocates want the payments tied to incentives to improve service, and they want a GPS tracking system put in place, such as those used by UPS or Amazon.
Ultimately, they hope such improvements will lower health care costs and improve patients’ health.
“Why shouldn’t a Medicaid patient receive quality service?” Dixon Hill argued. “It’s absolutely waste.”