Healthcare and transportation are moving partners. Literally.
About 3.6 million Americans miss at least one medical trip each year for lack of transportation, according to the AARP. This population, says the AARP, is disproportionately female, older and poorer. They view the number of missed appointments as a growing crisis, since the U.S. has a rapidly aging population. By 2030, the youngest of the Boomers, born in 1964, will turn age 66.
There are different ways to approach the transportation problem, current and ‘booming’. The obvious question is why people are missing these medical appointments. Is there something more systemic, beyond the transportation barrier? But, since our blog focus is on seniors and transportation, we will assume, for the moment, that the self- reported transportation deficiency is the primary reason for missing appointments.
Fortunately, healthcare and transportation are “moving issues”. In the future, when many more Baby Boomers will have this need- there will be options- even if transportation by autonomous car is still a few years away.
OPTION ONE : FOUR LETTERS AND AFFORDABLE TRANSPORT ACT?
The most straightforward transport answer is a four letter word. “Uber”, “Lyft”, and other services like Silver Ride, are a useful for getting to and from medical visits when people cannot drive. Today, very few seniors use these Transportation Network Carriers (TNC’s) but that will change with the aging of the Boomers, a generation becoming more experienced with SmartPhones..
Although it is not widely publicized, many of the TNCs are experimenting with senior-friendly transportation. They are working with drivers that have handicap accessible vehicles- vehicles that can accommodate the likes of a wheelchair, a walker, or a service animal. The TNCs are also improving their driver training- so that the driver who picks up an elderly or disabled passenger can be prepared to provide escort service to and from the vehicle. These refinements are not happening overnight, but they are being tested and refined in key markets.
Meanwhile, perhaps abetting the TNCs, is a revisit by health care administrators of what transportation needs are covered under the rubric of medical transportation. For 2010, the AARP tracks Home Care Based Services (HCBS),a Medicare waiver. ‘Grants’ of nearly $62 million were provided to 65,542 older adults or adults with physical disabilities. The HCBS goal is to provide medical service medical service closer to home, in lieu of longer patient stays in institutions and hospitals. Going forward, transportation, funded by Medicare and insurance programs, might be used to bring more people “home” as well as back and forth.
OPTION TWO: WHOM VISITS WHOM
A different way of addressing the missed medical visits, is to turn the issue on its head. Instead of the patient traveling to the doctor, the physician comes to the patient- a return to days of old. This concept is no longer a concierge service for dignitaries and visitors staying at hotels- it is a viable business model.
In the Bay Area an app called www.urgentmedhousecalls.com advertises urgent care for patients in their home, hotel or workplace. The app notes there are no waiting rooms where patients risk exposure to other bugs or infections. Another at-home provider, called The House Doctor, cheerfully notes that he/she can arrive with Bijoux, a therapy poodle.
There is also a different solution- the doctor does not quite come to you, but the patient, seeking consultation, does not travel so far either. Call it the middleground. Just as Amazon has brought a rethink to the retail industry, a rethink is occurring about the size and scope of medical facilities. One result has been to shift inoculations and wellness to take place in local pharmacies like CVS and Walgreens. Presumably, clients (patients) can walk-in, or drive less, if the store-front is neighborhood based.
This trend brings some serious issues for hospital administrators. Brick and mortar projects are being evaluated alongside more local outpatient care clinics and ambulatory surgery centers. Beckers Hospital Review says that hospitals have been forced to reevaluate their capital investments and reconsider renovation or expansion plans. In 2013 there were 37 ” firm” planned hospital construction projects in the works, estimated to cost $50 million or more. Will they be reevaluated?
OPTION THREE: TELE + HEALTH + PHONE
There is yet a third model which challenges the transportation paradigm, and may bring a change to the 3.8million missed doctor’s visits. It may, paradoxically, expand the number of visits overall.
It’s called telehealth- connecting with a physician or a physician’s assistant using video or mobile phones. It is by no means a new model- the military began using it years ago to serve the armed forces. In FY 2014, the US Army completed 33,000 patient encounters and provider to provider consultations in 30 specialities. overseas populations.
Telehealth is coming to Main Street now that people have SmartPhones and faster video connections.
The Chief Medical Officer for a telehealth app called “Doctor on Demand” describes the advantages: “We’ve (i.e. medical providers) made it really hard to interact with the medical industry, and it’s hard to get appointments. It can often take 22 days to get an appointment and patients typically have to wait to see the doctor for 3 or 4 hours- especially if they are in the emergency room or an urgent care office. The Medical Officer goes on to estimates that 80 percent of ER cases should not be there.
Visitng the ER room when you don’t need to is a good example of where people travel too far…for too little.
A great deal has been written on telehealth….the key issue is when it will begin to substitute or complement trips to the physician. The simple theory is that people will substitute travel for telehealth. The more complex, and probably realistic scenario, is that telehealth will complement other types of medical visits. Perhaps there will be increased, more routine follow up, or visits will be used for more preventative care.A
SUM UP: NEW TRAVEL COMPLEMENTS
In summing up, there will be many new options for medical transportation- and many complements. In a research project for AARP Policy Institute (2012), Nancy McGuckin and Jana Lynott observed that the largest growth in trip making by Baby Boomers was for medical visits. These visits are not going away, but the number of options is increasing.