COVID-19 Creativity & the New Normal
As the world continues to cope with the changing landscape from the COVID-19 pandemic, the world of medical transportation has evolved. Not only have we seen fewer trips overall but also seeing a decline in shared rides, increased time for cleaning vehicles, mask mandates, and more. The changing scenery of transportation requires innovation and alteration in how services are delivered.
As a partner in the transportation service industry, TripSpark has seen models changing to include “reverse service” or delivery of things (food, medications, etc) rather than transportation people to the service. We remain focused on ensuring our understanding of the changing needs of our service providers including NEMT Brokers and direct service providers, and offer solutions to meet the needs of providers for scheduling, routing and in-vehicle technology.
NEMT businesses strive to deliver good customer service. Drivers must be available to operate vehicles to transport individuals to and from medical appointments to satisfy demand. Many states have declared transportation an essential service, but that does not mean service levels have remained the same. Transportation providers are facing three concerns in this pandemic environment: fear, mitigating driver shortages, and alleviating a loss of revenue.
Fear, real or perceived, affects an individual’s ability to function in their work environment. Drivers and essential service workers risk coming into contact with an infected individual and not realize they have been infected. Fear of being exposed to COVID-19 could result in an increase in distracted driving, refusing to transport anyone who appears to have cold or seasonal allergy symptoms, or even refusing to report in to work.
Drivers are critical in their passengers' healthcare journey. A rule of thumb, as suggested to healthcare professionals, also applies to NEMT drivers. Use the CDC website to or contact the local Public Health Agency for information that can be distributed to ensure to you are up to date with the latest. Make sure your drivers have ample supplies to guarantee proper cleaning between transports. Using antiseptic products to wipe down seats, handles, windows, doors, and seatbelts in each vehicle prior to arriving for the next pickup is key. Also, passengers should sit at the back of the vehicle, as far away from the driver as possible to maintain social distancing and minimize the risk of transmission.
A driver shortage has become the new reality as quarantine mandates, including self or family exposure or illness, increase. Also, drivers may be unable to work if they have school- age children who require childcare and home schooling. While these are concerns in all areas of transportation, they may particularly impact the health outcomes of the NEMT population. However, as more companies have laid off workers in “non-essential” roles, these workers have been an untapped resource for transportation companies to reach out to and bring onboard, since some drivers have no longer been able to provide services. Emphasizing universal precautions and infection control (sanitizing and frequent handwashing) has become especially important when training any new employee.
Since the onset of the pandemic, providers have also had to contend with a decrease in revenue. In some areas, the increased use of telemedicine and alternative healthcare delivery methods have contributed to a substantial decline in trips. Patients can interact with their healthcare professionals via telehealth (telephone or video exchange) from the comfort of their home, decreasing the number of trips needed to go to and from healthcare offices. While this has been beneficial in minimizing contact and keeping people safer, it has led to a loss of income for providers and drivers. Unfortunately, loans under the Paycheck Protection Program (PPP) of the Small Business Administration closed as of August 8, 2020. Further funding is pending approval in Congress. If your organization has received a PPP loan, there may be opportunities available to have loans forgiven. To find out if your business qualities for PPP forgiveness, please review the application from the SBA website.
Here are some suggestions to consider for additional revenue:
Working with insurance companies can help manage expenses. Since vehicles have not been in use, some insurance companies have allowed said vehicles to be temporarily removed from policies to save money while they are inactive. While the focus is to mitigate business losses, depending on the size of your fleet, this could result in savings of hundreds or thousands of dollars.
Non-emergency medical transportation brokers are accustomed to coordinating transportation to and from medical appointments for those with various medical conditions. However, COVID-19 has introduced some unique concerns for NEMT operations which have differed from other medical conditions. Communications with health plans, clients, and staff have become unprecedented challenges. HIPAA compliance concerns arise when changes in operating procedures occur, such as working from home. Additional risks may include provider capacity, staff availability, technology, and finances.
Staying in Touch
Communication during this pandemic has been critical to ensure essential services remain. As with transportation providers, it is important to make sure information shared with staff and clients is updated and accurate. Regular communication with clients is key to ensuring that vehicles are not mistakenly dispatched to passengers when in-person appointments are cancelled. Telephone systems equipped with messages regarding available services are important, as well as systems that can send out information updates and process trip cancellations, such as TripSpark's Notifications system. Staying aligned with health plans is important to ensure the broker is providing services as expected, including the kind of transportation required and not required. Most brokers and healthcare providers have only been offering transportation for essential treatments, including dialysis and chemotherapy. A number of other trips for general medical checkups have been postponed until the threat of the pandemic has lessened.
Compliance with HIPAA protocols has been essential as more individuals have been forced to work from home. Typically, home networks are not as secure as office networks, most of which have VPN (virtual private networks). Web-based operations software is more readily available in a work-from-home environment than application-based software. These are valid concerns that must be addressed to maintain patient confidentiality.
As social distancing pressures have increased, some HIPAA compliance requirements have been relaxed since call centers are not permitted to have staff working within 2 to 3 feet from each other. For the latest information, be sure to check the CMS website.
When ensuring proper service delivery, brokers also have risks including provider capacity, call center staffing and keeping abreast of locations that are open or closed.
The declining driver pool has also directly affected the ability of the broker to provide necessary service to their clientele. If call center staff are not available to answer phones and the software platform does not allow online trip booking and cancellations, or the telephone system does not have the ability to have staff work from home, call times increase, frustrating those who still need service. TripSpark's NEMT software ecosystem includes a trip management platform, allowing members to book, review and cancel trips, without having to contact a call center.
Brokers must also be aware of business closures. While medical offices and pharmacies have remained open in most areas, they may only be providing telemedicine services, and if a patient arrives to see a physician in-person, they will be turned away.
Financially, similar to NEMT providers, those brokers that are reimbursed on an FFS (fee-for-service) basis may see a reduction in revenue as trip volume decreases. However, those brokers that are reimbursed on a capitated rate basis may not be affected, as long as their contracted capitated rate remains steady. Capitated payments are based on the number of eligible individuals and payment are not tied to numbers of trips.
During this uncharted public health crisis, medical transportation has been impacted in significant ways. As this pandemic evolves, there is unfortunately no insight yet as to when or if things will return to a new normal. The change in the delivery of medical care will has affected both transportation providers and brokers. It is best to stay up to date with current public health directives, maintaining open, accurate and frequent communication, and being prepared to pivot to delivery of whatever new model of service comes our way. Once the virus passes, there will again be plenty of work to make up for all the postponed medical appointments, treatments, and procedures. Stay safe, wash your hands, and maintain social distancing.
TripSpark has decades of experience in the NEMT market. We encourage to explore our comprehensive NEMT product ecosystem. Feel free to reach out to us and learn how we can become your single-source, long-term strategic partner.