Hospitals face a wide array of challenges in their quest to take care of COVID-19 patients. And while these difficulties have been covered ad nauseum across all manner of healthcare publications, there’s one topic I haven’t seen covered to such a wide degree. This is despite its impact on patient care, patient experience, hospital revenue and readmission risk.
I’m talking about the multitude of ways in which non-emergency medical transportation (NEMT) can be used to support COVID-19 patient recovery.
More widespread availability of NEMT for COVID patients has the potential to save lives, reserve emergency resources for those who need them and provide safe pathways to primary care for the chronically ill.
I want to talk about how contracting with NEMT providers for various services can positively affect your facility and reduce the possibility that patients boomerang back to the hospital upon discharge.
The most obvious benefit of an NEMT partnership is the ability to transport patients to and from the hospitals and between varying levels of acuity.
When a COVID-19 patient needs transportation to the hospital, it’s typically because of a deterioration of condition or a lack of adequate personal transportation. Because those patients also can’t rely on public transportation given the viral transmission risk, most incoming hospital traffic will arrive via ambulance.
NEMT providers come into play once the patient has stabilized and is ready to be discharged from the hospital. And to be perfectly blunt, there is a downright lack of vehicles with the expertise, personal protective equipment and infection control procedures available to ensure safe, appropriate transport of a stabilized COVID-19 patient.
Prior to the pandemic, much was made of partnerships between healthcare systems and ride-share companies like Uber and Lyft. These partnerships were a great idea that sought to address one of the key social determinants of health, that of transportation.
But the onset of the pandemic led to a multitude of rideshare vehicles shutting down. And even if they weren’t taken out of commission, those vehicles certainly weren’t capable of the types of infection control necessary to protect drivers. In fact, many NEMT vehicles, not just those related to rideshare partnerships, lack those kinds of precautions.
What this means is that patients who are technically recovered enough to leave an acute care setting, but who don’t have someone to transport them, become stuck in a hospital for much longer than they otherwise would need to be. This creates capacity issues, particularly if your area experiences a spike in COVID cases, and it ultimately presents patient recovery risks and revenue shortfalls for your organization.
Getting Where You Need to Be on Infection Control
In your area, there may actually be a number of NEMT providers who want to be part of the solution but simply haven’t encountered a situation quite like this (who has?). In these instances, and where the regulatory landscape allows, some hospitals have actually found success by working closely with NEMT providers to offer their insights and guidance into things like infection control in order to get those services back online.
Acute care providers are uniquely positioned to provide guidance on the steps NEMT providers will need to take in order to protect themselves and patients during transportation. The first step should be ensuring providers are staying up to date on the latest guidelines from healthcare authorities. The CDC has a fantastic guide to disinfecting non-emergency transport vehicles. Many states have also released their own resources targeted toward this information.
Your own experience is its own valuable resource. Consider scheduling an informational webinar where you talk about the types of infection control procedures you use at the hospital and that could be adopted to a vehicle. Alternately, reach out individually to NEMT agencies you’ve utilized in the past to see where they stand with infection control procedures and offer your consultative services to get them to a point where they’re capable of accepting your COVID patients. Consider a certification program where those transport companies, who may also be feeling a financial pinch because of COVID-19, can meet certain thresholds to demonstrate their capabilities and get on your hotlist of preferred providers.
Being able to rely on NEMT providers for the transportation of stabilized COVID patients has a lot of upside for your organization. It frees up emergency resources, such as ambulances, for those patients truly in need. It has the potential to reduce length of stay and free up bed space, as you won’t have to wait 14 days to ensure the patient is no longer contagious. This then creates a better patient experience, as they get where they need to go without a substantial wait in an acute space.
Addressing the Social Determinants
Just as important as transport out of the hospital is ensuring the patient’s condition doesn’t worsen to the point where they need to be readmitted. And this is yet another way NEMT can be enlisted to aid your organization’s fight against COVID.
Proper deployment of NEMT resources can help patients stay healthy by targeting social determinants of health. NEMT can be relied upon to ensure the delivery of things like groceries, medical supplies, prescriptions and other items that can make a large difference in a patient’s recovery. Some states won’t even allow you to discharge a patient if they don’t have two weeks of groceries available, and leaning on NEMT to guarantee this access can remove that barrier.
Even if your NEMT providers don’t have the protocols in place to transport COVID patients, they can help you solve for disparities in social determinants of health. It’s become clear that the very people most at risk for COVID-19 are those who also don’t have access to resources others might take for granted, and by addressing these, you can boost the path to recovery beyond what would otherwise be possible.
Consider working with NEMT providers to schedule pick-ups and deliveries on those basics that will help the patient recover. Doing so can massively reduce the risk of readmission.
We’ve emphasized previously how important it is to regularly interact with your post-acute network to gauge their capacity and their ability to accept COVID-19 patients. This is just as true for NEMT providers, whether those transporting patients or those providing services aimed at addressing the social determinants of health.
You should communicate regularly with your providers, and you should have a system in place that lets you quickly schedule pick-up and drop-off of patients and the supplies they need to continue on their path to recovery. Ideally, you’d be able to monitor these rides in real-time and use the data to make even more strongly informed decisions about your NEMT providers in the future.
Transportation is a struggle in the COVID-19 era, but hospitals are getting creative with how they’re safely discharging patients. I hope these tips will help you as you evaluate NEMT and its role at your organization.