Using Transportation to Improve Health Care in the Susquehanna Valley

1
Using Transportation to Improve Health Care in
the Susquehanna Valley

• September 20, 2005
• Jon E. Burkhardt
• Susquehanna Valley Rural Health Partnership
• Jersey Shore, Pennsylvania

2
Study Group Participants

• Advisory Committee
• State and local health care and transportation
  agencies
• Local transportation providers
• Local and regional planning agencies
• Pennsylvania State University
• Community Transportation Association of America
• Westat

3
Major Tasks Accomplished

• Household survey of travel needs (rural
  residents)
• Transportation provider survey
• Medical provider survey
• Review of Emergency Department utilization and
  costs
• Review of communities with similar issues

4
Summary What We Know Now

• Between 5,000 and 15,000 persons in the 3
  counties have medical transportation problems
• Excess Emergency Department and ambulance
  expenses are nearly 1.5 million per year
• Persons lacking medical transportation are low
  income, in poor health, disabled, older, and
  alone
• At risk population is growing
• Other communities are addressing this issue

5
Summary What We Dont Know Yet

• How many days of excess hospital stays?
• Excess hospital costs
• Excess costs of preventable / treatable illnesses
• Total cost of lack of medical treatments
• Who pays which part of these costs?

6
Major Susquehanna Valley Issues

• 56 Emergency Department visits are for
  non-emergency reasons
• Excess ED medical costs 500,000 per year
• Excess ambulance costs 900,000 per year
• Citizens and Doctors report problems obtaining
  enough transportation to medical services
• Cancellations or delays in health care negatively
  affect patients health, employability, quality
  of life

7
Household Survey Summary Census

• 27,000 persons 65 and older in these 3 counties
• 20,000 persons in poverty
• 30,000 persons with disabilities
• 11,000 persons living in no-car households
• 16,000 have mobility limitations
• 4,500 I cant get a ride so I miss appointments
• 8,700 I use ER because I cant get to doctor
• 15,000 I could see doctors more w more transp.
• 57,000 transportation here is fair or poor

8
How We Know (1) Household Survey

• Mail survey by SVRHP with follow-up to 4,500
  rural households in Clinton, Lycoming, and
  Sullivan Counties
• Conducted October November, 2004
• Good statistics /- 4 _at_ 95 level for each
  county /- 1 _at_ 95 level for all 3 counties
  combined
• 1,822 respondents in these 3 counties
• Clinton 628
• Lycoming 626
• Sullivan 568

9
Household Survey Highlights (continued)

• Evidence of medical transportation problems
• 3 miss medical or dental appointments because
  they cant get a ride
• 5 use emergency room services because they cant
  get to the doctors office
• 1 use an ambulance because it is the only way
  that they can get a ride
• 9 could visit doctors and other health care
  providers more often if there were better
  transportation services in this area

10
Household Survey Notes

• Survey is of rural households only, but in
  Williamsport there are higher percentages than
  the rest of Lycoming in terms of
• persons 65 and older
• persons in poverty
• persons with disabilities
• persons living in no-car households
• persons living alone
• minority populations

11
Conclusions re Urban / Rural Differences

• Statistics indicating transportation needs are
  greater in Williamsport, so
• Use total population figures for all 3 counties
• Applying percentages from rural households
  probably underestimates the total problem level
• Our overall problem estimate is conservative

12
(2) Transportation Providers Survey

• In-person interviews with major providers in
  Clinton, Lycoming, and Sullivan Counties
• Conducted by Penn State April May, 2005
• Interviews completed with the 4 major providers
  public transit, rural transit, specialized
  services, and 1 taxi company
• 2 other providers declined to be interviewed (1
  taxi company and the intercity bus carrier)

13
(3) Medical Providers Survey

• Mail survey by SVRHP with medical providers in
  Clinton, Lycoming, and Sullivan Counties
• Conducted October November, 2004
• 87 respondents from 365 surveys sent to medical
  providers in these 3 counties
• Clinton 11
• Lycoming 59
• Sullivan 2

14
Medical Providers Survey Highlights

• 78 said patients cancelled appointments or did
  not show up for appointments because of
  transportation
• 63 said this happened less than once a month 7
  said more than twice a month
• 44 said cancellations and no shows were a major
  problem
• 41 rated local transportation services as Fair
  or Poor 21 gave Excellent or Very Good ratings
• Need to increase and improve transportation
  services
• Need to be able to schedule trips with less than
  24 hours notice for urgent or acute conditions

15
Demographic Trends You Need to Know

• Therell be many more seniors in the future
• And more of the oldest old (85 )
• More persons with disabilities and reduced
  mobility
• Seniors will be more often living alone
• Greater expectation of high-quality services
• More seniors and persons with disabilities will
  be residing in suburban and rural homes beyond
  the reach of standard public transportation
  services

16
The 3 Counties vs. Pennsylvania and the U.S.

• Population change 1.3 loss, vs. 3.3 gain
• 65 higher percentage of 65
• in poverty higher percentage
• Median HH income 15 25 lower
• Persons w disabilities higher percentage
• Population density more rural

17
Whats Working Elsewhere -- A Brief List

• Wheels of Wellness Philadelphia
• Medical Motor Service Rochester, NY
• Virginia Health Care Foundation 5 Virginia sites
• Privately financed senior trips Portland, Maine
• Volunteers assisting public transit Portland,
  Oregon
• Connecting kids to health care Hoover, AL
• Long-distance medical trips Fort Morgan, CO
• NEMT HealthLink Medi-Van Redlands, CA

18
Major Choices

• 1 hospital day 3 months of trips
• 1 ambulance ride 30 STEP / EMTA rides
• 1 Emergency Room visit 3 primary care visits
• Higher health care costs Lower health care costs
• Health care costs ?? Transportation costs ??

19
Future Options

• BAD STRATEGY
• Do nothing Incur excessive costs
• GOOD STRATEGY
• Spend a little Save a lot

20
Future Directions Whats Next

• Develop regional medical transportation Action
  Plan
• Coalition building develop partnerships that
  focus on addressing consumers travel needs
• Obtain more funding for transportation services
• Offer a greater variety of services and pricing
• Provide more transportation by volunteers
• Improve quality of services

21
Contact Information

• Susan Browning
• Executive Director
• Susquehanna Valley Rural Health Partnership
• 904 Campbell Street, Suite 205
• Williamsport, Pa. 17701
• Phone [phone] Fax [phone]
• sbrowning_at_shscares.org
• Jon Burkhardt
• Senior Study Director
• WESTAT
• 1650 Research Blvd
• Rockville, Maryland 20854
• 301/294-2806
• JonBurkhardt_at_Westat.com