The trends in health care are evolving. In the early part of the 20th Century, the doctor had the mobility role making house calls

In the last half of the 20th century, the patient and the doctor met at the hospital and long hospital stays became common.

Today, the patient is the mobile one

› Outpatient surgery

› Outpatient treatment

› Outpatient rehabilitation

Persons are living longer with more infirmities

The average hospital stay is much shorter

The population is aging

Obesity is becoming epidemic bringing with it many health related issues

Addiction and the need for treatment is increasing

Dialysis treatment is growing

Mental health treatment is more acceptable and therefore increasing

Our troops are coming home with critical mental and physical health issues› Traumatic Brain Injury

› Loss of limbs

› Stress related disorders

Aging is requiring increased medical care

Aging is requiring increased assistance in transportation

Increased difficulty in travel to seek medical treatment

Increased difficulty in travel to employment in the medical industry

Of 29 rich nations, the United States has the highest rate of ‘amenable mortality’ before the age of 75

The U.S. is falling further behind

Nolte,McKee, London School of Hygiene and Tropical Medicine

The emerging transportation need of the twenty first century

Volunteers in Medicine Institute

Older adults Veterans Persons with disabilities Children Healthcare employees persons who are “fuel

challenged”

One in five persons over 65 does not drive

Compared with older drivers, older non-drivers in America make 15% fewer trips to the doctor

Men can expect to spend the last six years of their lives dependent on others for transportation. For women the time is 10 years.

Lack of transportation was named the No. 3 problem in the lives of seniors, ahead of both Medicare and Social Security issues.

Rising fuel costs have resulted in “fuel challenged” riders

Persons who have never thought of using public and community transportation are new customers

America has some of the best medical facilities with the best medical care in the world.

This is no better than a third world country if the person cannot access the health care.

Total statewide benefit to Florida of more than a billion dollars (number of trips x.1x average cost of one day hospital stay

Florida Transportation Disadvantaged services: Return on Investment Study

Many older adults are not comfortable driving in the metropolitan area

Income and or disability may dictate the need for transportation assistance

Medical community does not consider transportation in land use planning

Across the US› Average distance for medical/dental

care was 10.2 miles› Rural trips average 17.5 miles vs. 8.3

miles for urban residents

Nationwide average medical trip took 22 minutes

How will people be able to get to the health care they need?

Medical transportation has worked its way to the forefront of public and community transportation

Historically, private transportation has provided medical transportation

Brokerages manage non-emergency Medicaid transportation

Ambulance handles emergency transportation a emergencies and Medicare

Medical transportation need is so great it will require a variety of modes and levels of transportation

Incorporating these modes into coordination plan will take effort

Think outside of the box

Work with new people

Don’t discount volunteers, donated labor

Work with family members of riders to see what they can offer to your system

Create unusual partnerships

Introduce your system to the medical community

Invite the medical community into the transit community

› Learn each others language

› Identify each others assets

› Identify each others needs

Work with state chapters of national medical associations

Work with veterans’ associations to identify their needs

Plan overlapping conferences and share common training

Help them to help you

Educate your transit community about CMS

Follow proposed rule changes

Be educated---Be vocal

When dealing with Medicaid

› Keep accurate records

› Be able to justify your cost from a third party vantage point

› Insure that Medicaid is not paying for any costs not pertaining to Medicaid service

Medical transportation is the new focus› Keep good data on numbers of medical trips, miles, mode of travel

Transportation is the difference between life and living

Community Transportation Association of America

Medical Transportation Specialist miller@ctaa.org 202-294-2212

www.ctaa.org