It’s well known that the COVID-19 pandemic has dramatically impacted rural and urban transit systems across the country, but how has it affected agencies where medical trips are their main source of operations? We spoke with a group of non-emergency medical transportation (NEMT) managers about what their experiences have been during this time.
1) How has your NEMT service changed since the onset of the COVID-19 pandemic (example: medical centers moving to telehealth services, etc.)? Have you had to prioritize trips, and if so, how have you made those decisions?
Ready Ride: Our NEMT service has changed some in the way most of the non-essential appointments in our area have been canceled whether from the client or the medical office. This has left the essential rides such as dialysis, treatment center, ect.
Envida: All but the crisis mental health calls have been diverted to telehealth. For all our rides, we are down 70 percent.
VPTA: We are basically only delivering critical care services now. That includes a wide range of trips with the bulk of them being some form of methadone transport. The remainder are dialysis, cancer treatments, and any others that Medicaid deems necessary by referral. So we don’t prioritize they do it for us. Most non-emergency appointments are being handled by telecare service. We do a fairly detailed screening process prior to each trip.
GWTA: We are under a statewide executive order to stay at home, except for essential services. GWTA itself is defined as an essential service and our mission is to be the gateway to life-sustaining trips and access to essential services and essential employment opportunities in our community during this crisis. The Executive Order has significantly reduced demand and ridership for our urban and rural services as people comply with the order. Our total rural coordinated services have reduced by over half, with the NEMT trips making up half of the total trips now provided. Our schedulers will take extra time to re-confirm with medical centers that the customer will be seen for the appointment. We share with our DSS partner the basic health screening questions that we use for our demand response trips, and ask them to refer the customer to our local emergency medical transportation provider should the customer answer yes to any of those questions. We have not prioritized trips, because we believe our partner at DSS is already taking necessary steps before they request services.
Foothills: Physician offices have only seen those who cannot use telehealth, appointment have been postponed, and patients have cancelled their appointment because of their fear of the virus. We continued to only provide services for those on chemotherapy, dialysis, or other life-saving services.
2) If you provide Medicaid NEMT service, how have your existing NEMT contracts been affected?
Ready Ride: Our NEMT contracts remain unaffected at this time.
Envida: Fewer rides in general. New rides to help with prescription calibrations for mental health.
VPTA: Currently, we are not seeing the financial effects as we have a PMPW for 395 days, but we do anticipate a fluctuation in revenue down the road. With NEMT service down approximately 66 percent, we are able to contract with other human service agencies to make up some revenue
GWTA: We continue to work closely with our contracted County DSS department to coordinate essential NEMT services. GWTA is a coordinated and shared ride efficiency service model. The reduction in trip demands from NEMT and other programs has impacted our ability to earn projected revenues and cover costs.
3) How have you handled continuity of care for life-sustaining trips, such as dialysis?
Ready Ride: We are completing all life-sustaining trips, such as dialysis, as needed.
Envida: Continue to deliver these rides. Additionally, helped with a rural dialysis patient in another county, 60+ miles one way get home at 8:30 p.m.nfor several weeks until her chair time could be changed.
VPTA: As long the member can answer our questionnaire and is not showing signs of COVID-19 we are able to provide transportation.
GWTA: We continue to provide these critical life sustaining trips. We partner with social workers at the dialysis center who also help us screen customers and refer them to the local emergency medical transportation service when appropriate.
Foothills: We have fairly significant number of volunteers who will continue and then we also have the family members or neighbors who fill-in to assist.
4) Have you had challenges finding/buying PPE? If so, what are they?
Ready Ride: We have had some challenges finding hand sanitizer and disinfectant wipes to purchase. We are fortunate to have a healthy stock of disinfectant spray as well as gloves and masks currently. We have not been able to find any more masks to purchase.
Envida: Unavailable to purchase new. Had a few boxes prior to pandemic.
VPTA: We have experienced tremendous challenges here in Vermont purchasing supplies. It’s difficult to be deemed part of the essential workforce but not be granted priority access to necessary cleaning supplies, masks, and other essential items. We are fortunate to have support from VTrans who has been able to obtain some mask for us in the short term, we are unsure how long that supply will hold out. Our statewide public transit manager, Ross McDonald actually is driving them around the state today (Saturday) delivering them for Monday’s trips. Most of the drivers around the state are wearing homemade masks because of the lack of supply of anything else. As a state, we have purchased hand sanitizer from a distillery after weeks of begging them to bump us up on a waiting list. We created a google doc to share with all agencies to reduce the duplication of effort in searching for needed supplies, this way when anyone finds needed supplies we can easily share availability, cost, etc.
GWTA: While we do experience challenges with maintaining PPE in stock, we have been supported by our partners. For example, the local county government obtained hand sanitizer and also cleaning solutions for us. We asked social workers from the dialysis centers if they could help obtain additional masks. While they had a shortage of masks, the social worker actually personally made a large quantity of masks for us in response to our request. We haven’t run out of anything we need yet, although it does take some time for the PPE ordered to arrive.
Foothills: Not available for purchase and because we are not considered medical need, cannot get specialized equipment.
5) Have you had challenges with keeping operators due to positive tests, sick leave and/or service changes or reductions? If so, how are you dealing with these challenges?
Ready Ride: We have had no drivers test positive. Due to the reduction in rides we are able to accommodate any drivers that call in sick with little impact.
Envida: We’ve had to ask a driver to socially isolate due to contact with a rider who had been in contact with someone who died from COVID. Another driver diagnosed with pneumonia who is on a two-week paid leave.
VPTA: With a significant reduction in service, agencies across the state have taken a varied approach. Some have reported staff opting out on their own due to health factors of their own or someone in their household. So far, this has not created a shortage of drivers/staff. We have had two drivers statewide test positive so the impact has not been significant. Some agencies have reduced staff hours across the board and others have maintained staff and are using the opportunity to offer training, support the additional cleanings and maintenance projects.
GWTA: We have had a few employees who are in the higher risk group that have begun using their earned leave. We have had a few who were referred to a medical professional because of a positive response to the standard screening questions we use when employees report to work each day. Not every employee was actually tested. In many cases the medical professional will direct people with mild symptoms to self isolate for two weeks. We have been able to maintain service so far.
Foothills: Our cut backs on services are so dramatic, we have had enough volunteers to step up to support the needs.
6) If you are a broker, how have you managed the recent challenges with your subcontractors? Do you have recommendations for providers on how to best deal with these challenges?
Ready Ride: With the decrease in ride amounts we have had a struggle to keep our subcontractors busy on top of our core drivers. We have done our best to provide what we can to our subcontractors but it is significantly lower than the norm.
VPTA: As the statewide NEMT broker, we try to pivot on a daily basis and provide whatever support we can. As you know, things are changing by the hour. We did add a new section to the backend of our website to keep the latest up to date information available. We are trying to coordinate shared information between VPTA and VTrans daily on the COVID-19 information so we are not overwhelming folks and filling their inboxes. Our goal is to just reduce their burden in any way possible while they are out keeping essential services moving. I recommend taking yoga breaks!
7) What are your reactions to the Small Business Administration (SBA) loans, included in the CARES Act? What other funding support do you think should be provided for NEMT providers?
Ready Ride: We are not entertaining the idea of SBA loans at this time.
Envida: We applied for the PPP /SBA and a private foundation
VPTA: VPTA is fortunate to have VTrans providing direct updates and information to all providers around the state on the CARES Act and the PPP loan options.
GWTA: GWTA is a unit of local government and the SBA loans don’t apply for our operation. Covering the unexpected operating deficit created by the pandemic and reduced trip volume would provide a much needed safety net as we take on more expensive trip requests with less opportunity to cost share.
Foothills: I think this is helpful for staffing IF staff can be kept on during what is the slower start-up of reduced services. The staffing is not full-time as services are minimal. It would be helpful to have a 9 month start-up grant.
8) Have you had to transport patients you knew were COVID-19 positive? If so, what challenges did these create and what cleaning protocols did you use?
Ready Ride: Our company has not transported anyone that has tested positive to our knowledge. We have taken multiple clients to get tested. With these rides we are making sure the client as well as the driver are wearing proper PPE (gloves, masks, etc.). We are making sure these are not shared rides and after the transport each driver sanitizes the vehicle with disinfectant spray.
Envida: We are the only transit provider supporting rides for homeless individuals from several homeless shelters and hospitals in the Colorado Springs area, and even Woodland Park, to an isolation center. In 5 days we’ve transported 8 people. We are working with our county public health department and the University of Colorado School of Medicine and under their supervision.
VPTA: We don’t do positive COVID-19 transports, we screen all riders prior to booking trips. If we have provided trips to positive COVID-19 patients we did so without our knowledge. We do transport NEMT patients home once they have tested negative and are being released from the health care facility. We only do this with a signed letter from their physician stating they are safe to be transported on public transportation/rideshare back to their home.
GWTA: To our knowledge we have not had to transport any customers who were COVID-19 positive.
Foothills: We have not.
The Community Transportation Association of America (CTAA) and its members believe that mobility is a basic human right. From work and education to life-sustaining health care and human services programs to shopping and visiting with family and friends, mobility directly impacts quality of life.