The current crisis has made it more important than ever for hospitals to pay close attention to what happens beyond their four walls.
You’re seeing this in conversations surrounding the discharge process, post-acute case management and digital care plans. Hospitals must work to establish a set of appropriate criteria for patients to follow 30 days, 60 days and longer from the time they exit the acute care setting.
Clinical specialists and hospital administrators are being judged (and paid) based on what happens to the patient beyond their acute stay. And as we gain a better understanding of how the social determinants of health affect the patient’s overall health and their likelihood of checking back in to the hospital, the top minds of the healthcare field realize the only way to do justice to patient wellbeing is to stop focusing exclusively on the provision of acute care and instead help the patient in ways that have traditionally fallen outside the scope of the traditional clinical setting.
That includes paying closer attention to transportation and its impact on patient health. Transportation plays an outsized role in the patient’s ability to attain timely healthcare, to stick to a care plan and to reach an acceptable threshold for other social determinants of health that can have an impact on wellbeing. A coordinated transportation plan can even reduce hospital costs by freeing up beds sooner, thus reducing strain on resources and staff alike.
Continue reading to learn more about how transportation plays a role in patient wellness, as well as strategies to enfold transportation coordination within an overarching care management model at your facility.
Transportation: The One Social Determinant You Can’t Ignore
First, a quick review of some of the key social determinants of health:
- Nutritional wellbeing/access to healthy foods
- Job/economic security
- Drug and alcohol dependence
- Educational resources
- Peer pressure
- Community initiatives
All social determinants of health play into and affect one another, but the nucleus around which so many of them revolve is transportation.
An inability to secure effective transportation on demand can negatively impact the patient in myriad ways. Without access to transportation, the patient lacks a reliable means of making it to their appointments. Their work and grocery options become limited to a specific geographic area. They may be unable to reach the community-based organizations (CBOs) that can help address other social determinants. They lack easy connection to familial, spiritual or community structures that can also have a direct impact on wellbeing.
With this in mind, it’s important for hospitals to understand that shoring up the patient’s transportation needs builds the foundation to address the numerous other factors that could play into the individual’s chronic or acute condition. By connecting the patient to transportation, you’re giving them the freedom to address the other aspects of their life that are creating challenges to attaining optimum health.
And it’s not just the patient. A lack of transportation for the patient also impacts the hospital in a variety of ways. Here are just a few:
- Length of Stay: If a patient relies on Non-Emergency Medical Transportation (NEMT) in order to be moved to a post-acute or home setting, any delay in ride assistance means an extension of the time the patient must occupy a bed within your facility.
- Acute Staff Productivity: A patient experiencing a delay in discharge resulting from a lack of adequate transportation puts strain on your staff, including nurses, physicians, specialists and anyone else who experiences a touchpoint with that patient.
- Readmission Rates: After discharge, inadequate access to transportation increases the likelihood of readmission due to missed appointments, non-consumption of medication and overall nonadherence to the care plan.
- Revenue: Depending on your facility’s payment structure (i.e. if you’re a part of an Accountable Care Organization), if transportation inadequacy triggers a readmission, this can reduce your payment under the value-based care structure.
- Case Manager/Social Worker Productivity: Case managers working with individuals suffering from transportation access woes will have to put in far more time communicating with the patient via email, phone calls and more. They will also have to coordinate with other healthcare and community professionals to ensure the patient’s timeliness to appointments and their ability to receive adequate care.
In these ways, transportation has a far-reaching effect for both hospitals and patients. And now that you’ve seen the many ways transportation can affect your organization’s ability to provide care, we can now turn our attention to how to administer a transportation plan that addresses these various concerns.
A Modern Transportation Option
A transportation plan that addresses all of the above information isn’t possible using the staid methods of booking NEMT via manual phone calls. That type of system doesn’t take into account the continually changing levels of supply and demand, leading to delays if the latter outstrips the former, plus it places stress on your staff.
A modern transportation solution relies on technology to give your assigned team members access to systems that immediately show availability of transportation options and uses analytics to surface the best options. You need to be able to see the position of incoming and outgoing modes of transport in real-time and send messages to these private and public services instantly. In doing, you open up the bottlenecks that inhibit successful and efficient transportation for your patients.
With that in mind, here are two main places you can institute such a policy at your facility.
It’s this stage of the patient’s journey where you’ll no doubt see the most immediate return on investment for a transportation plan.
This is where you can tell the difference between your transportation efforts prior to and after the implementation of a technology-centric tool that works in tandem with your discharge software. By equipping your case management team with the ability to track the locations of suitable NEMT in the area and quickly and seamlessly schedule drop-offs and pickups for your patients, you can streamline your entire transportation process.
Assessing patient needs starts with asking the patient early on, as soon as admittance even, whether or not they’re going to need transportation upon discharge. If they say yes, you can plan this aspect of discharge quickly.
Similarly, if you know ahead of time the likelihood of your patients needing to be discharged to a post-acute environment and if they’ll need special care to get there, you can plan ahead to make sure the appropriate conveyance is available ahead of time. For instance, if a patient is recovering from COVID-19, you'll know that you need to coordinate a pickup with a service that's taken the proper infection control procedures. Whatever technology you use should be able to distinguish between general vehicles that would be readily available to the public, such as cars and SUVs, versus those more appropriate during unique circumstances, such as Medical Transportation Vans, transports with wheelchair lifts and gurneys, and other vehicles that have been modified for infection prevention.
Once you have an estimate of when the patient will be discharged, coordinate with the NEMT services in the area to schedule a pickup. Ideally, this would happen in conjunction with your discharge process, the two happening at almost the exact same time to maximize productivity. Message your post-acute facilities to see who has a bed available and, once the appropriate facility has been chosen, alert the representative of that organization of the method of transport being used. You should both be on the same transportation software program in order to monitor the progress of that patient’s subsequent discharge.
By streamlining the discharge and transportation processes in this manner, you’ll be able to refer your patients where they need to go more quickly than ever, freeing up beds within your facility and enabling your staff to do their best, most productive work.
Post-Acute Care Management
Finally, realize it’s not enough to simply send people on their way with a ride from the hospital to the home or post-acute care setting. In order to truly address transportation needs, you need to extend this service far into the future.
At the very least, a patient discharged from your care ought to have the ability to schedule rides (or contact you for the same) in the 30 days following discharge. 60 days is even better, and 90 is the best yet. The fact is, someone who has trouble making an appointment on Day 7 of their post-acute journey will likely face the same obstacle on Day 85, and a failure to secure transportation at any point could send them back to your facility for readmission.
It’s incumbent upon your organization to create a system where patients have an opportunity to participate in transportation services long after discharge, ideally with no end to the service whatsoever. You could consider a de-escalation of services, i.e. rides to anywhere within the first 30 days, then only to pharmacies and community-based organizations 60 days after that, and then only to clinics and healthcare facilities at any point thereafter.
Whether you partner with a rideshare company to achieve these aims or work with a local ambulatory transportation service will be up to you and your patients’ needs, but it’s important to maintain awareness of the service and to make sure your patients understand utilization procedures and their benefit.
Transporting to a Modern Care Model
Hospital organizations now find themselves entering into brand new territory in the name of care management and patient wellbeing, and transportation is the perfect example of that.
This single social determinant has an effect on so many aspects of patients’ lives, which is why it’s imperative that organizations get a handle on addressing the issue for anyone who suffers from a lack of public or private transportation.
In doing, you’ll find that not only do patients benefit from better health, but your organization will be able to free up beds more quickly, dedicate fewer staff resources to the discharge process overall and even benefit from increased revenue.