Transportation  to  Healthcare  Destinations  Resource Guide for Conversations BetweenTransportation and Healthcare ProfessionalsThis resource guide is designed to provide a quick-read for transportation providers as theyseek interaction opportunities with potential healthcare partners. It covers the basic “whoand how” of engaging healthcare providers in a conversation about patient transportation.
For more context on this issue, refer to the National Center for Mobility Management’s“Transportation to Healthcare Destinations: How A Lifeline for Patients Impacts the BottomLine for Healthcare Providers.”Who do you contact?
In a hospital setting, begin your conversations with the appropriate high-level individualwho has control over the hospital admissions and discharge policies (e.g., vice presidentfor operations). This person should be able to refer you to the next level of staff you shouldtalk to: the individual responsible for the discharge planning process in the hospital. Thisperson’s particulars will probably vary by hospital, but will likely be in the nursing orsocial work department. Individuals who interact directly with patients in the dischargeprocess may have titles such as care coordinators, discharge planners, or care managers.
Another good option is to talk with whoever is in charge of community outreach or caremanagement.
Even with this guidance, navigating hospital systems can be daunting. Be sure to tap intoyour own networks to identify individuals who understand the set-up of your local hospitalsystem and who might be able to connect you with the right department and hospital staff.
During your initial conversations with the hospital, you might also want to ask, “Who inyour system is involved in working with the transportation needs of your patients?” keepingin mind that it is likely to be multiple departments (e.g., oncology, discharge, social work,emergency department).In the clinic setting, begin with the office manager or, in larger clinics, with the chiefoperating officer. Another contact might be a practice manager, who often hasresponsibility for multiple primary care clinics.
How do you engage them?
Within the last decade, healthcare facilities have focused on optimizing health systemperformance, guided by the three principles articulated in the “triple aim”: 1) providinghigh quality medical services 2) at a lower cost that 3) also brings about a good patientexperience. Any conversation about transportation will need to be in the context of theseprinciples and how the successful movement of patients to and from healthcaredestinations can help the healthcare field achieve these objectives. Often we talk about anorganization’s “pain points,” meaning those barriers that are standing in the way of theorganization achieving its mission. As pointed out in “Transportation to HealthcareDestinations: How A Lifeline for Patients Impacts the Bottom Line for HealthcareProviders,” the pain points for healthcare provides boil down to their bottom line:•••••the cost of missed appointments from an operational standpointthe cost missed opportunities to improve patient care and outcomesthe cost of penalties for readmissions for Medicare patients within 30 days of theirinitial discharge from hospitalthe cost of penalties to hospitals whose Medicare Spending per Beneficiary,referring to the 30-days post discharge, that exceed the index set by CMSthe cost of diverting patients to other medical facilities when there are no availablebedsLet’s not forget that healthcare providers are also motivated because they care about theirpatients. They want to see them succeed in reaching their health outcome goals.
These are what matter to healthcare providers and where you should be begin yourconversations.
Contexts for interaction with healthcareOne opening for conversations is the community health needs assessment process.
Currently all tax-exempt hospitals, nonprofit organizations, community partners, as well ashealth officials are required to improve the coordination of hospital community benefits.
These assessments are a required starting point for doing so and provide transportationproviders with the opportunity to interact with health system partners.
Other settings in which transportation providers might come into contact with healthcareproviders, care coordinators, community benefit leaders, and others engaged in theprovision of services to the community include population health conferences and housingand economic development meetings. Another opportunity may be social innovationconvenings, such as Philadelphia’s Public Health Management Corporation (PHMC), ahosted meeting to discuss city health improvement with philanthropy, multi-sectorproviders, designers, and academia.
Attending meetings such as these may give transportation professionals the opportunity tolearn from health systems and health providers about their operations, and to ask questionsto help them understand some of the ways they might be of value to them.
Conversation startersBelow are some conversations starters for transportation professionals as they approachhealthcare systems. Note, though, that after you begin your conversation, the direction foradditional questions should be dictated by the conversation. Also, conversations of thisnature may be spread out over several meetings, particularly if the healthcare facilitywishes to first do some research into the extent of missed appointments and relatedtransportation issues.
Conversations with any of the individuals mentioned in this guide may best be started withgeneral questions so you can learn about the general challenges, such as••What are the biggest issues facing your facility now?
What do you perceive as the most troublesome issues that are preventing patientsfrom achieving better health outcomes?

Then turn to more specific questions about issues they may be facing with patientskeeping their appointments, such as••••••How would you describe the incidence of no-shows for patient appointments atyour facility?
What types of transportation do most of your patients rely on?
What kind of approaches have you taken to reducing no-show patients?
How do you attempt to maintain high-quality outcomes for patients who missappointments?
What are the barriers you perceive community-wide with regards to improvingpatients’ ability to make all their recommended healthcare appointments?
At what point in the discharge planning process, or appointment schedulingprocess, is there an opportunity to discuss transportation with patients and/or theircaregivers?

As your conversations with healthcare providers deepen, you will probably be gettingdown to specific data points, such as those listed below. However, note that some of thesequestions may be asking for sensitive or proprietary data that a system is reluctant toprovide. Be flexible in your discussions; a system may be more willing to provide ranges ofdata or bundled data rather than specific data. Also, you may need to view these questionsas ones healthcare systems should ask internally; they do not necessarily need to providethe data to you.
•••••••	  What is the incidence of missed appointments at your facility (numbers andpercentage)? What does this represent in terms of missed opportunities for billingfor services provided?
What percentage of patients are being readmitted within 30 days of the initialhospital discharge? Are you able to attribute any of that to the patients missingfollow-up care appointments? If so, have you surveyed patients to understand whythey missed follow-up care appointments? [Some reasons: lack of convenienttransportation options nearby, lack of ability to pay for transportation or healthcareco-pays, lack of health insurance, lack of understanding of what follow-up care isrequired because of literacy issues, language barriers.]What is the hospital’s goal for reducing missed appointments or reduced hospitalreadmissions? What would they be willing to spend to achieve that goal?
How much does the healthcare facility spend now in transportation assistance forpatients? Where does this funding come from (e.g., general operations, affiliatedfoundation)?
Is the hospital aware of the new ruling from the Office of the Inspector General,Department of Health and Human Services, that carves out a “safe harbor” formedical facilities to pay for patient transportation in certain circumstances withoutviolating anti-kickback/anti-competitiveness regulations (seewww.nc4mm.org/webinars for more information from February 21, 2017 webinarand related documents)?
Do your clients who miss appointments share particular characteristics like zipcode, income or language barriers?
Would the hospital be willing to explore ways to better match the process forscheduling follow-up appointments to better align with patients’ availabletransportation options?