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Wow! I thought these presentations were very informative. Hope to have more events like this.

It's interesting that Medicaid is the only federal program that guarantees transportation, and that it does so not because of how it was written but because court cases determined that it was not actually operating as an entitlement if only those with resources – transportation – could access the care. You have to wonder whether policy changes currently underway would move towards making healthcare an entitlement and then making medical transportation part of that. But since it is administered by states it depends on states to have and dispense the resources that make the entitlement a real entitlement. On the other hand, the brokerage system in Washington seems to both integrate and keep separate a long of services. It is interesting to think about how, firstly, changes in health care policy that tend towards seeing health care as an entitlement might make room for expanding the idea of nonemergency medical transportation as an integral part of the provision of services. And secondly, with the brokerage systems and the different states and possibly a different federal role in health care sometime in the future, how services might coordinate going forward – whether technology might have a role to play in that, for example.

The Medicaid eligibility floor is extremely low! Can it be increased without bankrupting the system?

I thought one of the more interesting things he brought up was how changes in care have made transportation more important. People live longer, survive accidents, survive cancer and serious illness, and they go home sooner and go back for regular therapy more. Doctors, he pointed out, don't make house calls. And this trajectory is continuing, and it means transportation is really part of providing health care in a way that it wasn't in the old days.

A very interesting discussion of the history of the government’s involvement in public health.

This website from the Department of Health and Human Services http://healthreform.gov/index.html addresses a few of the issues he discussed and talks about the past and future of various programs.

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Hospitals are interesting because they have very unique transportation needs. Great video!

That one clinic where they were able to calculate the cost of using the medical transportation versus the financial benefits it provided in terms of preventing cancellations and determine that they broke even provided an interesting sort of statistic. It would be interesting to see whether that cost/benefit, in purely financial terms, was fairly standard. In cases where public officials create budgets for transportation – or don't create those budgets – it could be significant, because the cost of not providing transportation is a much softer cost. This study - http://onlinepubs.trb.org/Onlinepubs/tcrp/tcrp_webdoc_29.pdf - also points out that it is much harder to estimate the costs of medical transportation than the benefits.

A hospital took over all aspects of transportation in Marshall? This is really a fascinating idea. Rural transportation could be greatly improved if this were more common!

In general this presentation focused on mobility for elders, but a lot of the discussion was about using volunteers. Since Medicare does not guarantee nonemergency medical transportation it seems to make sense that so many people were relying on volunteers for non-ambulance trips. Since a lot of the elders seemed to need help getting in and out of the house or in and out of the facility, and help while in the doctor's office or at the pharmacy, it seems like one-on-one rides were more efficient, because you didn't have a situation where a driver had to help somebody in or out while everybody else using the transportation had to wait. At the same time, there are a lot of issues with using volunteers: training them, retaining them, relying on them, etc. And I wonder if there were any cases where a volunteer had to be fired, and how to handle that. It looks like there are quite a few programs for volunteer medical advocacy for older adults – like this one in Maine [http://www.smaaa.org/volunteer_medical_advocates.php] – but as many people mentioned, transportation is an issue that involves liability and it is also a technical skill. It would be interesting to know whether defensive driving and similar types of training were also part of the volunteer training. Coordination was also a big issue: coordinating with different agencies and nonprofits. But in light of some of the other panel discussions, it seems like it might be worthwhile to ask what kinds of collaboration was working best. Did resource sharing – things like vehicle maintenance – work well? Or trip coordination? What kinds of coordination were the most helpful with this population of elders? It seemed like Tri-Met did a lot of that resource coordination while in Massachusetts the coordination was largely trip coordination. What circumstances dictate which kind of coordination will work better?

Having a medical advocate partner with a senior to assist them in keeping track of their health is a great idea! I think this extra training is essential to being a partner in the senior’s health.

A lot of this brings to mind something the keynote addressed: how much health care has moved towards treating people by using ongoing therapeutic systems that involve frequent visits for an extended period. All the presenters noted that dialysis and cancer treatments often leave people in a weakened state, where it really isn't feasible for them to drive themselves or take public transportation. In Kansas, it was pointed out, some people are driving themselves home from dialysis but this causes real concern because people who have just undergone these treatments may not always be fit to drive. So in these cases nonemergency transportation really had to be available, and in these rural areas it is difficult to manage. It seemed, across the board, like coordination was the work of time. Transportation providers in rural areas especially had to show that they were reliable and would continue to be available and providing service in the long run before they could really get hospitals and other centers to buy in. And patients in these rural areas, who were unused to the idea of public transportation, needed to be convinced that this really was something they could depend on for these critical treatments. Showing the value of the service couldn't be restricted to quantifying how much money was saved by reducing missed appointments or cancellations, it also had to involve providing a service that really took the worry and trouble out of transportation. And it also meant handling blocking in a productive way: getting patients into appointments in a way that meant they could share rides without making them wait for really extended periods in the facility before or after their appointment and then taking a really long trip home.

American cancer society is very forward thinking in assisting patients, this kind of modeling is great in the face of larger hurdles in transportation.

It seems obvious that Medicaid transportation should allow other children to travel with the parent and the sick child, this must deter a very large number of parents from getting treatment for their children.

Yes, you can download a PDF of the transcript for each presentation located under Supplemental Downloads. You can also download a PDF of the slideshow and other info from there.

I like the closed captions under the videos. Is there a way to download the transcripts of the videos?

This is excellent. I am definitely attending this event next year. Do you plan on holding it next year?

Sharing the cost and increasing efficiency seems the only way that these programs will survive, is this possible in many cities?

Wow! 85% is fixed route transit in Allengheny County, and only 15% of the trips are taken on ADA paratransit. Also, it is interesting to see that transportation costs grew at 4 times the rate of inflation.

I had no idea that Medicaid transportation could gain more flexibility by being an administrative service. This may improve transportation in my state.

Health care reform this year would be great, but shouldn’t be done near elections!

Since MRSA has become so prevalent, it seems that all transportation services would spend a large portion of their budget on cleaning.