New developments in micro technology will eventually make it possible for patients to use portable dialysis machines in their own homes, reducing the need for three-days-a-week transport to dialysis centers: http://www.eurekalert.org/pub_releases/2004-02/osu-pkd020204.php. In the meantime, more dialysis centers made possible by newer technology are opening all the time, with two expected in Hillsboro by October 2005 and two in Fairfield in the near future. These new facilities will reduce the distance patients will need to travel for treatment.
Some of the problems in coordinating transportation services involve government rules that cannot be overcome without regulatory changes or government assistance as in the following examples:
Private service-providers may not meet the minimum requirements for insurance coverage and drug/alcohol screening.
The Contract for Title 19 Medical Transportation dictates the schedule for doctor appointments, and all other transportation must work around that schedule. Appointments are made at remote call centers by persons unfamiliar with local conditions.
Following are questions asked of transportation directors and other knowledgeable persons in the Heart of Texas area during July 2005 along with their responses:
What do you see as the biggest issue facing public transportation?
Fuel costs running 65% over budget and propane fueled vehicles give poor mileage.
Coordination across jurisdictional boundaries is difficult—some providers will not cooperate unless they receive the Medicaid payment.
Coordination is dictated by Medicaid causing too many rescheduled trips and long waiting periods of up to 3 weeks for some clients.
Boundary lines should not dictate who picks someone up—service should be based on client needs.
Dispatch is too scattered and needs to be under one roof. Need a neutral party to handle dispatch and coordination of trips for best efficiency.
The provider makes two trips to drop and pick up a Medicaid patient at a transfer location, but only gets paid for one trip.
Lack of public awareness—need for more publicity.
Some providers give free rides while others don’t, causing confusion for riders. Rules of the different funding sources confuse the public.
Issue of insurance coverage and driver training.
Low driver pay makes it difficult to recruit new drivers.
Accessing transportation is difficult in rural areas.
Lack of availability for persons with disabilities.
What are the strengths of the current public transportation system?
Contractors know their own area and are able to cater to those most in need.
Contractors have experienced, dependable personnel who are concerned with the needs of the riders and will bend over backwards to get them to their destinations.
Contractors have excellent vehicle maintenance.
Very good coordination among the providers in the area.
Providers receive good support from counties and the Council of Governments.
Flexibility to transport family members and caregivers when patients need help.
Provides a good service to the elderly to keep them involved in the community.
The current system is dependable.
What are the weaknesses of the current transportation system?
Difficult to reach remote areas, creating long wait times for riders who need to get to Waco or Temple.
Budgets are maxed out, making it impossible to expand routes or purchase the types of vehicles needed.
Need more flexibility to get rid of worn-out vehicles—have to get estimates and show reimbursement when vehicles are disposed of.
Client addresses in the Medicaid system are very difficult to correct, causing wasted trips and problems with reimbursement. Medicaid needs to verify correct addresses instead of relying on clients to do it.
Conflicts between the rules for different funding sources makes coordination very difficult.
Medicaid constraints—seriously ill customers cannot withstand long waits for transportation.
Long advance notice time to schedule a ride for other riders.
Client has to travel to the provider to obtain passes.
What one thing could be done that would have the greatest positive impact on public transportation?
Improve awareness of services through advertising and public relations.
Create a Networking Reference Guide for coordinating transportation services throughout the state. The Guide would provide information on who to contact and how to transition across jurisdictional boundary lines.
Put all transportation providers on an equal basis, forming a statewide as well as a local network accessible on the internet to facilitate scheduling and transfers across boundaries.
Expand hours of operation.
Increase funds—rural operations are inherently more expensive than urban because of the greater distance between clients.