Dialysis Transportation: The Intersection of Transportation and Healthcare (2019) / Chapter Skim
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Pages 79-122
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From page 79... ...
Chapter 6 -- Initiatives on the Transportation Side 6.1 Introduction This chapter responds to the second of the two stated objectives for the TCRP research project -- to identify effective practices and new strategies for providing and funding transportation for dialysis. Chapter 4 described a number of projects and programs directly or indirectly related to dialysis transportation that have been initiated on the healthcare side, such as the pilots under way through CMS's Center for Medicare and Medicaid Innovation.
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From page 80... ...
6.2 Dialysis Transportation: The Intersection of Transportation and Healthcare Policies Fare Policy Encouraging Trips to Closest Dialysis Facility -- Senior Citizens United Community Services, Audubon, NJ Transportation Agency Background Senior Citizens United Community Services (SCUCS) is a non-pro�it agency serving older adults and persons with disabilities in Camden, Burlington, and Gloucester counties, New Jersey.
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From page 81... ...
Chapter 6 -- Initiatives on the Transportation Side 6.3 The adopted policy requires a $3.00 fee for each dialysis center that is passed should the rider's scheduled trip go beyond one or more dialysis centers when traveling to the rider's selected dialysis center. Before implementation of the policy, the agency met with the staff at the dialysis centers to explain the new policy and reasons behind it.
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From page 82... ...
6.4 Dialysis Transportation: The Intersection of Transportation and Healthcare An important secondary bene�it to the implementation of the fare policy was the start of coordination with the dialysis facilities. Staff realized that cooperating with SCUCS would result in better service for their patients who rely on public transit.
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From page 83... ...
Chapter 6 -- Initiatives on the Transportation Side 6.5 Photo courtesy of Intercity Transit. Description Intercity Transit's ADA paratransit service -- known as Dial-A-Lift -- provides door-to-door service for riders whose disabilities prevent their use of the transit agency's �ixed route service.
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From page 84... ...
6.6 Dialysis Transportation: The Intersection of Transportation and Healthcare Photo courtesy of Intercity Transit. • For the rider, setting up the 3-day-per-week transportation requirement as standing order rides eliminates one area of stress for someone new to dialysis.
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From page 85... ...
Chapter 6 -- Initiatives on the Transportation Side 6.7 Education ADA Paratransit 101 -- Omnitrans, San Bernardino, CA Transportation Agency Background Omnitrans is the public transit agency serving the San Bernardino Valley in Southern California. The transit agency's service area covers 15 cities and portions of the unincorporated portions of San Bernardino County, an area of 480 square miles.
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From page 86... ...
6.8 Dialysis Transportation: The Intersection of Transportation and Healthcare Photo courtesy of Omnitrans. riders' use of taxis and Lyft up to $40.00 per month.
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From page 87... ...
Chapter 6 -- Initiatives on the Transportation Side 6.9 may have received the education may have moved on and are no longer at that particular center, taking their new understanding of ADA paratransit with them. Summary and Transferability ADA paratransit is not the one-on-one, taxi-type service that many unfamiliar with public transit expect it to be, so it is important that dialysis center staff understand what the service can do, given the mandated federal requirements.
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From page 88... ...
6.10 Dialysis Transportation: The Intersection of Transportation and Healthcare Graphic courtesy of Ride Connection. The non-pro�it agency shares an important relationship with the region's public transit agency -- TriMet -- with much of Ride Connection's funding coming from the public transit agency.
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From page 89... ...
Chapter 6 -- Initiatives on the Transportation Side 6.11 Photo courtesy of Ride Connection. Second, Ride Connection reached out to educate the dialysis clinic social workers about transportation, so they would understand the challenges faced by transportation providers and could then help problem-solve when necessary.
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From page 90... ...
6.12 Dialysis Transportation: The Intersection of Transportation and Healthcare Regular Meetings with Dialysis Centers -- Jacksonville Transportation Authority, Jacksonville, FL Transportation Agency Background The Jacksonville Transportation Authority (JTA) is an independent state agency serving the City of Jacksonville and Duval County since 1971.
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From page 91... ...
Chapter 6 -- Initiatives on the Transportation Side 6.13 Photo courtesy of JTA. Photo courtesy of JTA.
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From page 92... ...
6.14 Dialysis Transportation: The Intersection of Transportation and Healthcare resulting in open and direct lines of communication with the centers' staff, which include, among other information-sharing, updates on patients' status that directly affect trip scheduling. Other transit agencies facing growing demand for dialysis trips might consider such a practice: • Regular meetings with dialysis centers provide an ongoing opportunity to address and seek solutions for the inevitable issues and problems that arise with dialysis transportation, bene�iting the transit agency as well as the dialysis centers and their patients.
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From page 93... ...
Chapter 6 -- Initiatives on the Transportation Side 6.15 Operational Strategies Taxi-Based Dialysis Transportation Program -- Phoenix, AZ Transportation Agency Background Public transportation in metropolitan Phoenix is a hybrid operated primarily by two entities: the regional authority called Valley Metro and the City of Phoenix Transit Department. Light rail service is operated by Valley Metro.
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From page 94... ...
6.16 Dialysis Transportation: The Intersection of Transportation and Healthcare Dialysis Transportation Program Voucher. Courtesy of City of Phoenix.
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From page 95... ...
Chapter 6 -- Initiatives on the Transportation Side 6.17 The FY 2017 cost for the program's taxi trips totaled $260,000. The management fee charged by the city's contract administrator adds another 15% to the total.
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From page 96... ...
6.18 Dialysis Transportation: The Intersection of Transportation and Healthcare o Patients' treatment times may be adjusted on the day of treatment, so the time for the trip home must then be adjusted; and o Dialysis patients may need extra time after treatment before it is medically safe to leave the facility. • Trips are provided on a one-on-one basis rather than a shared-ride basis, which is helpful particularly for the trip home when the rider is tired and depleted after treatment.
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From page 97... ...
Chapter 6 -- Initiatives on the Transportation Side 6.19 who are using wheelchairs or other mobility devices and who are not able to transfer to a sedan vehicle. Using taxis speci�ically for dialysis trips can be a successful strategy, as such trips are often dif�icult for public transit agencies to provide with ADA paratransit service.
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From page 98... ...
6.20 Dialysis Transportation: The Intersection of Transportation and Healthcare Photo courtesy of Flint MTA. To address the challenges, the transit agency now uses its mobility management function to coordinate trip scheduling for the dialysis riders directly with the 14 dialysis facilities in the service area.
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From page 99... ...
Chapter 6 -- Initiatives on the Transportation Side 6.21 Photo courtesy of FACT. the agency's menu of services -- whether it is accessible �ixed route, ADA paratransit, or some other specialized transportation service.
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From page 100... ...
6.22 Dialysis Transportation: The Intersection of Transportation and Healthcare Photo courtesy of FACT. transportation option.
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From page 101... ...
Chapter 6 -- Initiatives on the Transportation Side 6.23 rider may phone FACT to inform the non-pro�it to reschedule the return trip for a later time, saving RideFACT an unnecessary trip. Another result appears to be a moderation of dialysis demand.
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From page 102... ...
6.24 Dialysis Transportation: The Intersection of Transportation and Healthcare Graphic courtesy of Ride Connection. Through experience over the years, Ride Connection recognized the challenges and problems with dialysis transportation -- from its perspective as a transportation provider but also from the perspective of patients.
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From page 103... ...
Chapter 6 -- Initiatives on the Transportation Side 6.25 return trip. Ride Connection could then schedule another trip for that later time.
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From page 104... ...
6.26 Dialysis Transportation: The Intersection of Transportation and Healthcare rides home. The parameters are not numerical, but rather the scheduler and dedicated dispatcher are to use their judgment so that the trips are "reasonable" given the objective.
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From page 105... ...
Chapter 6 -- Initiatives on the Transportation Side 6.27 Summary and Transferability Building on �indings through its planning process and tested through the pilots, Ride Connection found several operational strategies effective for dialysis trips: a �lexible wait time after treatment; a dedicated dispatcher for dialysis trips, minimizing wait time and shared riding that result in long travel times; and more personalized trips with familiar drivers who are educated about dialysis treatment. When using a contractor, Ride Connection also learned the importance of using a contractor willing and able to ensure quality service for the dialysis riders.
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From page 106... ...
6.28 Dialysis Transportation: The Intersection of Transportation and Healthcare Coordination with Dialysis Facilities Develop Rapport and Coordinate with Dialysis Facilities -- Washington County, MD Transportation Agency Background Washington County -- the �irst county in the United States to be named for President George Washington -- is located in western Maryland, known as the state's panhandle. The county's Transit Department operates Washington County Transit (WCT)
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From page 107... ...
Chapter 6 -- Initiatives on the Transportation Side 6.29 Photo courtesy of KFH Group. knows many of their regular paratransit riders and works with those riders on dialysis as appropriate for their dialysis trips.
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From page 108... ...
6.30 Dialysis Transportation: The Intersection of Transportation and Healthcare patients. The approach is perhaps best summed up by the paratransit manager who said, "We all work together as a team to provide transportation." Establishing such cooperative relationships with dialysis centers might be easier in a smaller community, where there are fewer dialysis centers.
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From page 109... ...
Chapter 6 -- Initiatives on the Transportation Side 6.31 Graphic courtesy of Ride Connection. information from the different parties involved, including dialysis patients, and developing improvement strategies.
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From page 110... ...
6.32 Dialysis Transportation: The Intersection of Transportation and Healthcare Transit agencies may �ind it worthwhile to approach the dialysis clinics they serve with an offer to work with clinic staff to coordinate transportation and treatment. While the response may not always be positive, such coordination may improve service from both the transit agency's perspective as well as that of the dialysis clinic and its patients.
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From page 111... ...
Chapter 6 -- Initiatives on the Transportation Side 6.33 Photo courtesy of Mountain Empire Transit. The trips require special attention and often receive one-on-one exclusive ride service, particularly after treatment.
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From page 112... ...
6.34 Dialysis Transportation: The Intersection of Transportation and Healthcare Volunteers Mountain Empire Transit recruits volunteers from the community to support its transportation service, to serve as both drivers and aides on the vehicle. Finding volunteers to serve as aides is considerably easier, as the training period is much shorter.
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From page 113... ...
Chapter 6 -- Initiatives on the Transportation Side 6.35 • Build and maintain a cooperative relationship with the dialysis center. • Recruit volunteers to support the transit agency's service.
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From page 114... ...
6.36 Dialysis Transportation: The Intersection of Transportation and Healthcare Funding Funding from the National Kidney Foundation -- TRPTA, Idaho Falls, ID Transportation Agency Background Targhee Regional Public Transportation Authority (TRPTA) , based in Idaho Falls in southeastern Idaho, is a regional public transit authority established by Idaho Code.
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From page 115... ...
Chapter 6 -- Initiatives on the Transportation Side 6.37 The transit agency also reports that it provides �lexibility for return trips from dialysis. For example, the dialysis facilities will typically communicate with TRPTA when they know that a patient will not be ready for the prescheduled return trip.
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From page 116... ...
6.38 Dialysis Transportation: The Intersection of Transportation and Healthcare Photo courtesy of KFH Group. TRPTA explained that such passes are typically used for a transitional period until the patient is eligible for subsidized transportation, usually Medicaid.
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From page 117... ...
Chapter 6 -- Initiatives on the Transportation Side 6.39 CountyRide is operated by the county's Department of Aging, serving seniors and people with disabilities in the urbanized portion of the county and the general public in the non-urbanized northern portion. This distinction re�lects the funding sources received from the state, including FTA and state transit funds.
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From page 118... ...
6.40 Dialysis Transportation: The Intersection of Transportation and Healthcare Photo courtesy of KFH Group. CountyRide recognizes the support in several ways: • Extending its service into Baltimore City speci�ically to serve the participating medical facilities located within the city limits.
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From page 119... ...
Chapter 6 -- Initiatives on the Transportation Side 6.41 United Way Funding for Dialysis Trips -- KVCAP, Waterville, ME Transportation Agency Background Kennebec Valley Community Action Program (KVCAP) is a non-pro�it community action agency serving Kennebec and Somerset counties in Maine.
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From page 120... ...
6.42 Dialysis Transportation: The Intersection of Transportation and Healthcare Graphic courtesy of KVCAP. Results To meet the identi�ied needs, the United Way began donating $3,000 to KVCAP speci�ically for senior transportation.
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From page 121... ...
Chapter 6 -- Initiatives on the Transportation Side 6.43 The United Way supports community-based and community-led interventions that strengthen communities, focusing on education, income, and health. A transit agency might consider approaching its local United Way of�ice to explain the transit agency's role in providing transportation access to healthcare and to request funding support.
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