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{ timecode: 0, handler: 'blob', id: 1, data: {text: 'DAVE WHITE: We have a great panel for the afternoon and it is going to be led by Valerie Miller of the CTAA staff. You guys all met Valerie earlier this morning and many of you probably know her for her '}},
{ timecode: 16, handler: 'blob', id: 2, data: {text: 'work over the last year or two as the medical transportation specialist with CTAA. Of course, she is near and dear to my heart because she is pushing many of the things that are so important to me and'}},
{ timecode: 36, handler: 'blob', id: 3, data: {text: 'my organization. She has been helping all of us really keep track of what has been going on with medical transportation and many of the changes that have been occurring, are occurring, and will be '}},
{ timecode: 53, handler: 'blob', id: 4, data: {text: 'occurring. She is going to moderate this next panel on some of the major generators in the medical transportation business. I am just going to go ahead and turn it right over to Valerie and her panel'}},
{ timecode: 72, handler: 'blob', id: 5, data: {text: 'VALERIE MILLER: Thank you, thank you very much. Thank you to all of you who stuck it out for the day and stuck it out with us for the afternoon; we appreciate that. We have some interesting panelists '}},
{ timecode: 86, handler: 'blob', id: 6, data: {text: 'and we have a variety of sizes of systems here that we are talking about, so we are going this afternoon from the large urban to the very small rural systems that we are going to be talking about. We '}},
{ timecode: 102, handler: 'blob', id: 7, data: {text: 'have tried to offer something for everybody for every size. First of all, to my far left we have Dan Dirks as our panelist. Dan is the Urban Transportation Specialist for CTAA, also the immediate and '}},
{ timecode: 119, handler: 'blob', id: 8, data: {text: 'newly past president of the Board of Directors of CTAA. He retired in 2007 as the General Manager of SMART, the regional transportation systems of Detroit. So, he is well versed in transportation,'}},
{ timecode: 137, handler: 'blob', id: 9, data: {text: 'especially in transportation in the Detroit area, and he will be talking about that. All of their extended bios are on your flash drive too, so I encourage you to look at those. Then we have Scott '}},
{ timecode: 151, handler: 'blob', id: 10, data: {text: 'Kosky with OATS transportation. OATS is in “Missoura” or to some, Missouri, depending on what side of the state you are on; we are a bilingual state. Scott is in charge of all phases in '}},
{ timecode: 167, handler: 'blob', id: 11, data: {text: 'service provisions in OATS Southwest region since April, 1986. He is charged with all phases of transportation service delivery within a 17-county region of OATS Southwest region. He is responsible '}},
{ timecode: 183, handler: 'blob', id: 12, data: {text: 'for an 84-person staff and an 88-vehicle fleet. He is the author of Performance Evaluation for Rural Transit Systems for the Federal Transit Administration Rural Transit Assistance Program. Scott is a '}},
{ timecode: 198, handler: 'blob', id: 13, data: {text: 'National Safety Council defensive driver course instructor and he is a CCTM. Tracy Walkup is with OATS and she is in Missouri. She is with OATS transportation. She has worked 9 years in City '}},
{ timecode: 227, handler: 'blob', id: 14, data: {text: 'Administration and Economic Development and then she came to work for OATS. She is the Midwest Regional Director and she came to work for OATS in 2007. She has a BS in Business Management and '}},
{ timecode: 241, handler: 'blob', id: 15, data: {text: 'International Business, and an MBA from William Woods in Missouri. I am from “Missoura”, so that makes it hard for me. She is also a CCTM with CTAA. Dan, I am going to start with you. You '}},
{ timecode: 270, handler: 'blob', id: 16, data: {text: 'deal with the largest system and the largest hospital system, so I am going to have you talk a little bit about what the project you started. DAN DIRKS: About a year and a half ago, no not even a year '}},
{ timecode: 286, handler: 'blob', id: 17, data: {text: 'and a half ago, it was late last fall; I was contacted by the largest hospital consortium in the Detroit area. It is approximately 5 hospitals with one of those being a rehabilitation unit, and it is '}},
{ timecode: 334, handler: 'blob', id: 18, data: {text: 'the Detroit Medical Center. The DMC had gone through a financial crisis and they were able to, in about 3 years, get themselves out of it. One of the ways they would do it was by trying to be as '}},
{ timecode: 348, handler: 'blob', id: 19, data: {text: 'creative as possible with their employees, quite honestly. Problems were identified and they really looked to their employees for ways of solving it. Transportation was one of them. The initial reason '}},
{ timecode: 361, handler: 'blob', id: 20, data: {text: 'they contacted me was really because of their employee shuttle. It was really more than an employee shuttle; it was a shuttle among the 5 hospitals in the rehab center that was fairly inefficient. One '}},
{ timecode: 374, handler: 'blob', id: 21, data: {text: 'of the reasons was because there was a conflict with outpatient discharges. A second was because of their valet parking. They had way too many stops. The CEO of the DMC happens to be one of my former '}},
{ timecode: 389, handler: 'blob', id: 22, data: {text: 'bosses and he had the transportation folks contact me to see if I could give them a hand. We made some initial recommendations about how to improve it, like reduce the number of stops and operating '}},
{ timecode: 405, handler: 'blob', id: 23, data: {text: 'some express service during peak employee travel times, but it also gave us an opportunity to look at a couple of other things. One is in the immediate area of the DMC or Detroit Medical Center, was '}},
{ timecode: 418, handler: 'blob', id: 24, data: {text: 'Wayne State University, which is a large university with 30,000 students who go there every semester, as well as the Henry Ford health systems, which is a 1,000 bed hospital. What I did when I gave '}},
{ timecode: 458, handler: 'blob', id: 25, data: {text: 'them the recommendations on how to improve their shuttle was I said they really needed to partner with other organizations in the area, even if it was only in fuel purchasing like with Wayne State and '}},
{ timecode: 467, handler: 'blob', id: 26, data: {text: 'their shuttle and Henry Ford. They had also indicated to me that they were looking at setting up their own transportation service to get, in particular, older adults and people with disabilities to '}},
{ timecode: 481, handler: 'blob', id: 27, data: {text: 'some of their clinics in their hospital program, so we made some recommendations in that regard. Relative to the coordination, Wayne State University, Henry Ford health systems and the DMC all '}},
{ timecode: 498, handler: 'blob', id: 28, data: {text: 'operated shuttles. They all more or less came close together to one another, but they really did not link, and they were not sure if a linkage was possible. They were able to get all three of them '}},
{ timecode: 510, handler: 'blob', id: 29, data: {text: 'together and initially what they were doing was looking at ways or if there was reason to have the shuttles meet. This was done probably about a month and a half ago; a survey went out to all the '}},
{ timecode: 526, handler: 'blob', id: 30, data: {text: 'Wayne State University students, to Detroit Medical Center and Henry Ford hospital employees, and a sampling of patients to see if there was a need to have linkage amongst the three. Once that survey '}},
{ timecode: 544, handler: 'blob', id: 31, data: {text: 'is completed, they are going to determine if they should have a combined shuttle, if they should operate three separate shuttles with coordinated transfers, if they should have better linkage with the '}},
{ timecode: 556, handler: 'blob', id: 32, data: {text: 'existing public transportation systems, etc. The one thing that really surprised me that came out of it was the discussion of possibly doing a joint RFP for the transportation service itself. Meetings '}},
{ timecode: 574, handler: 'blob', id: 33, data: {text: 'have been held about developing an RFP, initially among Wayne State University and the DMC, so that they could get economies of scale by linking their transportation services together. Henry Ford '}},
{ timecode: 589, handler: 'blob', id: 34, data: {text: 'health system, which currently operates the service on their own with their own employees is very much interested to see what kind of deal that the Wayne State University gets and the DMC with the '}},
{ timecode: 603, handler: 'blob', id: 35, data: {text: 'idea of them eventually trying to link with them. The first group to really go to a contracted service was the Detroit Medical Center, and they were able to reduce their cost by about 30%. There are '}},
{ timecode: 617, handler: 'blob', id: 36, data: {text: 'some discussions now that by doing this larger coordination that they might be able to save well over 50%. The other thing they are looking at, as I mentioned, is possibly joint maintenance '}},
{ timecode: 629, handler: 'blob', id: 37, data: {text: 'opportunities. The DMC is a very creative place. One of the things they do, although it is not transit related, for employee recruitment, they will, if a hospital employee has car trouble, they will '}},
{ timecode: 648, handler: 'blob', id: 38, data: {text: 'send their own towing company out to pick up the vehicle, take it to the garage, which is literally at the DMC facility, they will get the maintenance of that vehicle done and only charge them at cost '}},
{ timecode: 660, handler: 'blob', id: 39, data: {text: 'what it is. They have offered to bring the shuttle service from Wayne State University and Henry Ford as part of that whole network. I think the issue is that they try and identify problems and they '}},
{ timecode: 675, handler: 'blob', id: 40, data: {text: 'try to go over and above what has never been done before. That is what has made it successful. The third area that they are looking at is setting up, initially they wanted to set up their own service '}},
{ timecode: 689, handler: 'blob', id: 41, data: {text: 'to get from senior and disabled housing units in the immediate area within about a 4 or 5-mile area of the Detroit Medical Center to their clinics and facilities. We had an interesting meeting and I '}},
{ timecode: 706, handler: 'blob', id: 42, data: {text: 'happen to know from my previous job working for the transit authority, that there were a number of faith-based groups that had their own vehicles. Quite honestly, they use them on Sundays to get their '}},
{ timecode: 717, handler: 'blob', id: 43, data: {text: 'folks to and from church and they might use it for some social service activities during the week. It was suggested that instead of putting $100,000 to $200,000 into setting up their own service, and '}},
{ timecode: 733, handler: 'blob', id: 44, data: {text: 'I think they would find out very quickly that is not going to get them as much service as they wanted, by working with the faith-based groups in the area they would do two things; 1) From a public'}},
{ timecode: 744, handler: 'blob', id: 45, data: {text: 'relations value, the Detroit Medical Center giving a number of churches donations for their transportation service would just, you know, really pump up their positive view in the community. 2) The '}},
{ timecode: 759, handler: 'blob', id: 46, data: {text: 'private non-profits can probably do it a lot cheaper than DMC, even contracting that service out. So, meetings are being scheduled, literally as we speak, with a number of faith-based groups in '}},
{ timecode: 771, handler: 'blob', id: 47, data: {text: 'farmer\'s market their encatchment area to see if they would be interested. Again, the meetings have not been scheduled, but after initial discussions the churches in the area are really excited about '}},
{ timecode: 771, handler: 'blob', id: 48, data: {text: 'farmer\'s market their encashment area to see if they would be interested. Again, the meetings have not been scheduled, but after initial discussions the churches in the area are really excited about '}},
{ timecode: 782, handler: 'blob', id: 49, data: {text: 'it. The lesson is that yes, public transit is an option, but one of the things that is going on or can go on, especially when you have medical institutions and you have like partners in the area, if '}},
{ timecode: 800, handler: 'blob', id: 50, data: {text: 'you can get through the barrier of just trying to work with folks in the area, it is amazing what you are going to be able to do. Again, DMC has found that they are going to be able to save about '}},
{ timecode: 813, handler: 'blob', id: 51, data: {text: '$30/hour, they believe, by doing this joint RFP with Wayne State University. That is a quick and dirty summary of my activity since last fall in that area. VALERIE MILLER: Very interesting. So, in '}},
{ timecode: 827, handler: 'blob', id: 52, data: {text: 'your work with them, what role does the local transit system play in this, and are their opportunities for the public transit? DAN DIRKS: One of the things that has happened is, one other project that '}},
{ timecode: 845, handler: 'blob', id: 53, data: {text: 'I am working on, I am doing some consulting work with the Detroit Department of Transportation. We have kept the whole line of communication open between what we are doing with the DMC and with the '}},
{ timecode: 858, handler: 'blob', id: 54, data: {text: 'Detroit system, and I think that it compliments it in a way. The service that the DMC would provide, even through the faith-based groups, is over and above ADA service. It is over and above the '}},
{ timecode: 872, handler: 'blob', id: 55, data: {text: 'paratransit service that the Detroit system can operate. These are clearly folks that if they can use a fixed route bus, it is not going to be a convenient trip. It is probably going to mean a '}},
{ timecode: 884, handler: 'blob', id: 56, data: {text: 'minimum of a couple of transfers, so the likelihood of that person that would need that clinic service would not be as great. In terms of the shuttle service that operates - we\'re talking about - between the three,'}},
{ timecode: 897, handler: 'blob', id: 57, data: {text: 'about 10 years ago the Detroit system did operate a shuttle, but it was not viewed as being very efficient. In one of their first rounds of cutbacks; you know, in the Detroit area we have had this '}},
{ timecode: 910, handler: 'blob', id: 58, data: {text: 'economic crisis for quite a while, that was one of the things that was initially cut. So, again, I think there is a realization on both the part of the Detroit Department of Transportation and the '}},
{ timecode: 925, handler: 'blob', id: 59, data: {text: 'DMC. They want to keep each other involved. As they develop the shuttle service, they want to make sure that it coordinates with the city service as well as suburban service, so that is very much '}},
{ timecode: 936, handler: 'blob', id: 60, data: {text: 'going on, I mean, there is awareness at this point. VALERIE MILLER: Okay, Scott, you do a smaller locality than that. Tell us about what you do in your area. SCOTT KOSKY: Okay, yea, Springfield and '}},
{ timecode: 956, handler: 'blob', id: 61, data: {text: 'Joplin are the two bigger cities in my area. Springfield, Missouri; and I am from “Missoura”, is also known as Branson North, and it is in the southwestern part of the state. It is right '}},
{ timecode: 975, handler: 'blob', id: 62, data: {text: 'now at about 250,000+ in the metropolitan Springfield area. The other town that is a major population center for us is Joplin, which is right along the Oklahoma/Kansas boarder, and they are running at '}},
{ timecode: 991, handler: 'blob', id: 63, data: {text: 'about 80,000 population now. So, two of the things that we are doing there, we are working with the largest hospital in Springfield on a one-on-one basis and at St. John’s hospital, which also '}},
{ timecode: 1010, handler: 'blob', id: 64, data: {text: 'is the #1 integrated health care system in the nation, and that is according to the SDI, whoever they are, but I was required to say that since my wife is a nurse there. Anyway, we work with them and '}},
{ timecode: 1029, handler: 'blob', id: 65, data: {text: 'what we do with them is Springfield has a public transit system. Springfield also has some service by OATS for those people over 60 and those people who qualify under the area agency on aging, but '}},
{ timecode: 1045, handler: 'blob', id: 66, data: {text: 'what we do with St. John’s is involved with their cardiac rehab and with their clinics, mainly. This is an 866-bed hospital, so it is fairly good sized hospital for our part of the country. They '}},
{ timecode: 1064, handler: 'blob', id: 67, data: {text: 'have over 200 physicians in their local Springfield clinic, so it is a pretty good operation, an operation that actually has over 400 doctors throughout southwest Missouri. The other areas of '}},
{ timecode: 1085, handler: 'blob', id: 68, data: {text: 'southwest Missouri are usually handled by us with our rural general public system, but in the city of Springfield and surrounding area, as I say, we work with other cardiology and oncology departments '}},
{ timecode: 1099, handler: 'blob', id: 69, data: {text: 'mainly. The other major hospital in Springfield also works with us and they are a 665-bed hospital with about 150 doctors. What they use us for is mainly transport of the people. They have a '}},
{ timecode: 1121, handler: 'blob', id: 70, data: {text: 'wholly-owned nursing facility, but they do not keep a fully-staffed, handicapped accessible vehicle, so they use us to take care of transport for doctor appointments for that. Historically, those two hospitals in '}},
{ timecode: 1142, handler: 'blob', id: 71, data: {text: 'Springfield have been competitive in nature as, I am sure, a lot of you have seen in hospitals throughout the country, but now we are starting to see some collaboration as the realities of the world '}},
{ timecode: 1159, handler: 'blob', id: 72, data: {text: 'we live in are starting to hit home. Hopefully, as they move along they will work towards integrating a lot more of their services. They have done that in terms of some of their ambulance services and '}},
{ timecode: 1176, handler: 'blob', id: 73, data: {text: 'in terms of some of their emergency room services already, so they are moving towards some integration there. Thirdly, the third hospital that we do business with is the St. John’s facility in '}},
{ timecode: 1192, handler: 'blob', id: 74, data: {text: 'Joplin, Missouri. Again, it is much the same. It is used on more an intermittent basis. At one time, we operated three vehicles full-time for that one hospital and clinic; it is a 392-bed hospital in a '}},
{ timecode: 1212, handler: 'blob', id: 75, data: {text: '76,000 population city, so it is a large size for that area also. About 10 years ago, the city of Joplin got a public transportation system of their own, and it is a curb-to-curb, on-call type system, '}},
{ timecode: 1232, handler: 'blob', id: 76, data: {text: 'so that picked up a lot of the transportation needs for the hospital and clinic there. We do some of the discharge work and also clinical usage. The fourth hospital that we have helped out in '}},
{ timecode: 1249, handler: 'blob', id: 77, data: {text: 'southwest Missouri is also in Joplin. They underwent a 5-year expansion program here a while back and their greatest need was in terms of having the ability to get their employees from the parking '}},
{ timecode: 1266, handler: 'blob', id: 78, data: {text: 'lot, which was moved down the block while they were building the new building. We ran a 7-day, 6 in the morning to 11:30 at night shuttle bus from the parking lot to the hospital for all the hospital '}},
{ timecode: 1284, handler: 'blob', id: 79, data: {text: 'employees. There you have four different hospitals, four different ways that they approached what they needed OATS service for, and as things go on, it will be interesting to see how, with the new '}},
{ timecode: 1303, handler: 'blob', id: 80, data: {text: 'realities we are dealing with, if they can in fact start to integrate some of those services and work on a more cooperative basis. VALERIE MILLER: With all different kinds of trip generators and '}},
{ timecode: 1314, handler: 'blob', id: 81, data: {text: 'revenue generators. SCOTT KOSKY: Exactly. All kinds of generators for revenue and trip purpose. VALERIE MILLER: And, what kind of reporting was there involved with all of this with all of the '}},
{ timecode: 1326, handler: 'blob', id: 82, data: {text: 'different contracts? Were all of these under contract? SCOTT KOSKY: All of these were under contract. In the case of the two St. John’s clinics, they were the ones who organized and actually '}},
{ timecode: 1343, handler: 'blob', id: 83, data: {text: 'routed the vehicles for us. They made a determination as to which of their clients they would service and which ones they wouldn’t. So, we would just report back to them a delivered trip. With '}},
{ timecode: 1357, handler: 'blob', id: 84, data: {text: 'the Freeman hospital in Joplin on their employees, they just counted the units of service we provided in transporting their folks back and forth. It was very simple in terms of their requirements. It '}},
{ timecode: 1376, handler: 'blob', id: 85, data: {text: 'is also interesting that the thing to note that they had different areas of the hospital contact us to determine what services they wanted. The employee shuttle service, it was the safety and security '}},
{ timecode: 1396, handler: 'blob', id: 86, data: {text: 'department. In the clinics, it was the social services department. So, when you are contacting hospitals, probably social services is the place to start, but you never know who is really going to be '}},
{ timecode: 1412, handler: 'blob', id: 87, data: {text: 'in charge of who moves the wheels. VALERIE MILLER: So, safety and security was an option for the employees. SCOTT KOSKY: Right. Safety and security department because they wanted to make sure that '}},
{ timecode: 1426, handler: 'blob', id: 88, data: {text: 'they were going to have reliability and be able to get their folks there. VALERIE MILLER: Okay. Tracy, tell me a little about yours. You have the small rural areas and the smaller hospitals. TRACY '}},
{ timecode: 1440, handler: 'blob', id: 89, data: {text: 'WALKUP: Yes. When they talk about these large hospitals with hundreds and hundreds of beds, the largest one I am going to talk about has 84. The population centers that I am servicing under these four '}},
{ timecode: 1451, handler: 'blob', id: 90, data: {text: 'contracts range from a population of approximately 10,000 to 20,000 people. I would like to thank Dale even though he is not here this afternoon; he gave me a wonderful lead-in to start talking about '}},
{ timecode: 1463, handler: 'blob', id: 91, data: {text: 'this. As he was going through his timeline, he talked about Hillary Care in 1993 and 1994 and how it disappeared without anything really being accomplished. Well, there was something that happened in'}},
{ timecode: 1473, handler: 'blob', id: 92, data: {text: '1994 and that was a round of rural hospital grants came down to provide rural transportation for hospitals, and that is where two of these contracts originated. The oldest of the contracts is with '}},
{ timecode: 1488, handler: 'blob', id: 93, data: {text: 'Fitzgibbon hospital in Marshall, Mo, which has population of approximately 12,000 people. It is a 60-bed facility. This is perhaps the most interesting of the contracts that we have because the '}},
{ timecode: 1501, handler: 'blob', id: 94, data: {text: 'hospital in Marshall decided that they were going to take over all the public transportation from the City of Marshall. The City of Marshall provided a bus and Fitzgibbon provided all the routing and '}},
{ timecode: 1515, handler: 'blob', id: 95, data: {text: 'administration and scheduling, and OATS provided the service and the trained driver. Another of the older ones that we have originated thorough that same grant, and that is Nevada, Nevada Regional '}},
{ timecode: 1528, handler: 'blob', id: 96, data: {text: 'Medical Center, and it has a 63-bed facility. They also took over a portion of the public transportation from the City of Nevada, though they did not take over all the public transportation, just that '}},
{ timecode: 1540, handler: 'blob', id: 97, data: {text: 'portion that they felt was the most important to them. We currently have two busses that run in the City of Nevada and OATS now provides those busses. Although, when the program started, there was a '}},
{ timecode: 1553, handler: 'blob', id: 98, data: {text: 'leased vehicle that we started the program with. The next one that I have is Bates County Memorial Hospital in Butler, Mo, which has a population of approximately 8,000 people. This is a 60-bed '}},
{ timecode: 1568, handler: 'blob', id: 99, data: {text: 'facility. We also run the bus for them while they do all the routing and scheduling. That is the one thing that all four of these contracts have in common and it is one of the rare things they have in '}},
{ timecode: 1581, handler: 'blob', id: 100, data: {text: 'common. They are so diverse in the way that they have been set up, but we always provide a trained driver and they always provide the routing and scheduling; everything else is different. Last but not'}},
{ timecode: 1591, handler: 'blob', id: 101, data: {text: 'least, in 2006 we started a new hospital contract with Golden Valley Memorial Hospital in Clinton, Mo. It is the most recent of our contracts and the one that has, perhaps the most data, because they '}},
{ timecode: 1604, handler: 'blob', id: 102, data: {text: 'are still trying to track their data and try to figure out how this program is working for them. Whereas, with the older contracts, they have just decided at this point that they are working out '}},
{ timecode: 1613, handler: 'blob', id: 103, data: {text: 'really well and they do not track a lot of information anymore that we would find important. One thing that I asked all of these administrators and schedulers as I was visiting with them about what we '}},
{ timecode: 1627, handler: 'blob', id: 104, data: {text: 'are doing for them is any advice that they would give to a transportation company or a hospital that was trying to set up this type of transportation system. They had very very different responses. '}},
{ timecode: 1641, handler: 'blob', id: 105, data: {text: 'Fitzgibbons, since they took over the general public portion for the entire city, their response was don’t bite off more than you can chew. At this point, they are overwhelmed with trying to '}},
{ timecode: 1653, handler: 'blob', id: 106, data: {text: 'provide service to Wal-Mart and the grocery store as opposed to getting people to the doctor’s office and the hospital. Nevada, their program has worked out so well that they had a very very '}},
{ timecode: 1666, handler: 'blob', id: 107, data: {text: 'hard time coming up with any one thing that they would tell you that they had learned that you needed to avoid. Finally, the one thing they came up with was once you have set your rules, be sure that '}},
{ timecode: 1677, handler: 'blob', id: 108, data: {text: 'you stick to them. You know, you may drive Mary back and forth to the doctor’s office every Friday, but don’t drop her by the grocery store because she needs to pick something up because '}},
{ timecode: 1688, handler: 'blob', id: 109, data: {text: 'if you do it for Mary, then you are expected to do it for everybody. They have learned that lesson the hard way. Golden Valley, the most interesting comment I think I got was the dispatcher there; she '}},
{ timecode: 1701, handler: 'blob', id: 110, data: {text: 'said “that bus is running around town, it has that 800 number emblazoned on the side of it.” So, people don’t just call her for trips, that 800 number is called for everything that '}},
{ timecode: 1714, handler: 'blob', id: 111, data: {text: 'anybody needs for that hospital because that is the number they know. So, she said that she is almost more of a switchboard then she is a scheduler at this point. The best comment, and I told Kelly '}},
{ timecode: 1726, handler: 'blob', id: 112, data: {text: 'Phillips at Bates County Hospital that I was going to use this when I got here, was he said the one piece of advice that he would give you is call OATS. Just a little plug. His stance was not '}},
{ timecode: 1740, handler: 'blob', id: 113, data: {text: 'necessarily just OATS but whatever public transit provider you have in your area. He wanted something that took no effort on their part. They needed the transportation but they did not want to be a '}},
{ timecode: 1751, handler: 'blob', id: 114, data: {text: 'transportation company. He said that this has worked out wonderfully for them. He said that their administration is basically nil on this program because we came in with the experience and the '}},
{ timecode: 1764, handler: 'blob', id: 115, data: {text: 'knowledge and the vehicle, and we just did it. So, for those of you who are looking to find transportation for a medical facility, I would suggest that you do call whoever your public transportation '}},
{ timecode: 1776, handler: 'blob', id: 116, data: {text: 'provider is in your area because that is a good start. Last but not least, there was a gentleman over here who had asked a question earlier about the cost benefit of transportation, and I did ask all '}},
{ timecode: 1789, handler: 'blob', id: 117, data: {text: 'of these hospitals about the cost benefit of this. The older hospitals had a very very tough time quantifying it; the ones that have been doing this for 15 years, because they don’t necessarily '}},
{ timecode: 1802, handler: 'blob', id: 118, data: {text: 'track it anymore. They decided that it was wonderful and it was a benefit. The closest that we got was the controller at Nevada Regional tried to pull some numbers together for me, and she finally '}},
{ timecode: 1813, handler: 'blob', id: 119, data: {text: 'just said, well intuitively we just know that it is working out really well. Golden Valley reported that their outpatient clinics had had a 20% cancellation rate prior to providing this transportation '}},
{ timecode: 1828, handler: 'blob', id: 120, data: {text: 'and they had decreased that by 5% over the three years that this transportation has been provided, so they definitely saw a benefit to that. Bates County had the best numbers for me. They had '}},
{ timecode: 1844, handler: 'blob', id: 121, data: {text: 'determined that their per-unit trip cost was between approximately $13 and $18 per unit of service over the lifetime of the program, and that the benefit to them of having the appointments not be '}},
{ timecode: 1857, handler: 'blob', id: 122, data: {text: 'missed is approximately $15 to $20. They basically determined it was a wash, but their board of directors decided that it is a very important part of their mission to provide medical service and '}},
{ timecode: 1871, handler: 'blob', id: 123, data: {text: 'health care to their constituents. Therefore, even though they didn’t lose or make money on it, they felt that there was a true value to providing this service. VALERIE MILLER: Excellent, '}},
{ timecode: 1882, handler: 'blob', id: 124, data: {text: 'excellent, that is very good to know. That is glad to see that somebody realizes that, I think that is exciting. In your overall service, I guess for both you and Scott, what is the percentage of '}},
{ timecode: 1901, handler: 'blob', id: 125, data: {text: 'hospital transportation for your area? SCOTT KOSKY: For me, right now we are running at about $100,000 a year in hospital contracting service on a $3 million budget. VALERIE MILLER: What about you '}},
{ timecode: 1924, handler: 'blob', id: 126, data: {text: 'Tracy? TRACY WALKUP: I am running just almost exactly the same. I am running right at $100,000 a year and my revenues are about $3 million. Kind of an interesting side note to that, we do a lot of '}},
{ timecode: 1939, handler: 'blob', id: 127, data: {text: 'medical trips that are not necessarily generated by that hospital contract, but under a Medicaid service. My region will run approximately $1 million in Medicaid service this year as opposed to the '}},
{ timecode: 1952, handler: 'blob', id: 128, data: {text: '$100,000 in hospital contracts. VALERIE MILLER: So, with these hospital contracts, are you on those vehicles, are they solely used for hospital use? Do you put any other people on those vehicles? Or, '}},
{ timecode: 1973, handler: 'blob', id: 129, data: {text: 'does it vary? TRACY WALKUP: In theory, they are for hospital use. In reality, OATS is a general public transit provider. We may have 2 hospital busses in Nevada, but we also have an area Agency on'}},
{ timecode: 1992, handler: 'blob', id: 130, data: {text: 'Aging bus running through Nevada. We have 4 Medicaid vehicles running through Nevada. We may have an Area Aging bus that is doing area wide service in the Nevada area. Just kind of as an interesting '}},
{ timecode: 2005, handler: 'blob', id: 131, data: {text: 'story, as I was visiting with them, we know that there are times when the hospital bus drops somebody off at the hospital and then something happens and one of our busses goes and picks them up. Well, '}},
{ timecode: 2016, handler: 'blob', id: 132, data: {text: 'I should have realized on the flip side of that, some of the clients that we drop off on the area wide bus may forget which bus dropped them off because they all say OATS on the side of them. So, they '}},
{ timecode: 2027, handler: 'blob', id: 133, data: {text: 'will get confused and they will call the hospital and the hospital will come back and pick them up. Also, one of the things that we have done to decrease the per-unit cost to Bates County Memorial '}},
{ timecode: 2038, handler: 'blob', id: 134, data: {text: 'Hospital is there was a little bit of excess capacity within that system, so any time that we have excess capacity within the system and we have an opportunity to put a Medicaid rider on that bus, we '}},
{ timecode: 2050, handler: 'blob', id: 135, data: {text: 'will put a Medicaid rider on that bus and bill Medicaid for that time instead of Bates County. So, we do our very best to coordinate the service and take up whatever capacity we can with one bus. '}},
{ timecode: 2064, handler: 'blob', id: 136, data: {text: 'SCOTT KOSKY: Whereas, mine is a little different because we are a little larger and since our hospitals are the ones responsible for the dispatch and the scheduling and the routing of the busses, it '}},
{ timecode: 2080, handler: 'blob', id: 137, data: {text: 'goes through, again, their safety and security system, so ours are dedicated hospital vehicles when they are on service to the hospitals. Again, you do what fits your own particular situation in your '}},
{ timecode: 2100, handler: 'blob', id: 138, data: {text: 'community. TRACY WALKUP: I think it is maybe a little different being in a small community of 8,000 to 10,000 where everybody knows everybody. The hospital when they get a phone call and they realize '}},
{ timecode: 2111, handler: 'blob', id: 139, data: {text: 'that it was actually a different bus that dropped them off and not their bus, they don’t care because they are a small, tight-knit community and they will just send the bus to go get them. '}},
{ timecode: 2125, handler: 'blob', id: 140, data: {text: 'VALERIE MILLER: Dan, has the downturn in the economy helped or hurt the attempts by DMC to coordinate with the partners or with the faith-based community? DAN DIRKS: Well, there is no question with '}},
{ timecode: 2142, handler: 'blob', id: 141, data: {text: 'the hospitals and Wayne State University trying to save every penny they can. I think attempts at trying to coordinate 5 years ago didn’t get anywhere. Part of this started with vice presidents '}},
{ timecode: 2156, handler: 'blob', id: 142, data: {text: 'of each of the institutions getting together and not only talking about how they can coordinate from a transportation prospective, but from the three institutions themselves. Clearly, the economy has '}},
{ timecode: 2167, handler: 'blob', id: 143, data: {text: 'helped, and I think that a lot of times you can take a negative and turn it into a positive. People are more acceptable to change when there is a crisis developing, so I think that’s clearly '}},
{ timecode: 2181, handler: 'blob', id: 144, data: {text: 'what has happened in this case. It has been a real opportunity for all three and again, I think where all three of the groups approached this very tentatively, what tends to happen when you get groups '}},
{ timecode: 2195, handler: 'blob', id: 145, data: {text: 'together, friendships start developing, trusts start developing, and you are more than willing to try something that you wouldn’t when you first started it. I think that is clearly an example of '}},
{ timecode: 2207, handler: 'blob', id: 146, data: {text: 'what has happened in the three institutions. If we were to get together next year, I think I could report on even more successes than they are having already. VALERIE MILLER: Are the faith-based '}},
{ timecode: 2218, handler: 'blob', id: 147, data: {text: 'vehicles, or most of them, accessible vehicles, or do they tend not to be accessible vehicles? DAN DIRKS: I think it is a catch-can depending on the faith-based group. I think some of the larger '}},
{ timecode: 2235, handler: 'blob', id: 148, data: {text: 'churches in the area have accessible vehicles. I think some of the smaller ones don’t. That is part of putting this whole process together. I think they are going to have to be aware of that. '}},
{ timecode: 2248, handler: 'blob', id: 149, data: {text: 'You know, one of the other things is that the regional transit system typically will go out to auction on their paratransit vehicles because the system I worked with had close to 350 paratransit '}},
{ timecode: 2262, handler: 'blob', id: 150, data: {text: 'busses that they were operating, so about every 6 months they would auction off vehicles that were ready for retirement that, where you can’t use them 40 hours a week, some of them were decent '}},
{ timecode: 2278, handler: 'blob', id: 151, data: {text: 'enough and a lot of those faith-based groups purchased those vehicles. There are a couple of ways to skin a cat. Again, a lot of this is the cup half-full or the cup half-empty. You can always find '}},
{ timecode: 2292, handler: 'blob', id: 152, data: {text: 'barriers on how not to make things succeed, but you can always find ways of solving a lot of the problems. You know, one of it is funding and partially, we have had success in the Detroit area, but if '}},
{ timecode: 2308, handler: 'blob', id: 153, data: {text: 'you can prove to hospitals the benefit that you are bringing to them, they will provide dollars. Although, that matter tied into the Detroit Medical Center, some of the suburban community based '}},
{ timecode: 2319, handler: 'blob', id: 154, data: {text: 'organizations showed the hospitals how many people they were bringing in to their clinics. They were able to get University of Michigan to identify the approximate benefit to that health institution. '}},
{ timecode: 2334, handler: 'blob', id: 155, data: {text: 'If you are asking for a grant of $10,000 to $15,000 and are bringing $0.5 million dollars of billables to them, you are darn right they are going to be a lot more amenable to you. You know, again, '}},
{ timecode: 2348, handler: 'blob', id: 156, data: {text: 'there are different ways of trying to find anything. I think the key is listening to what people need, listening to what the problems are, and don’t be afraid to try something that has never '}},
{ timecode: 2363, handler: 'blob', id: 157, data: {text: 'been tried before. I mean, to me, it was kind of amazing that we had a hospital and a university trying to merge a private nonprofit and a public institution merging their request for proposal for '}},
{ timecode: 2378, handler: 'blob', id: 158, data: {text: 'transportation services. You know, I had not heard of that before. Not that I was cautioning them, but I urged them as they started discussions to bring not only their procurement people but to bring '}},
{ timecode: 2389, handler: 'blob', id: 159, data: {text: 'their attorneys together because they didn’t want to get far enough along the way where they had to stop it. They are finding reasons to make it work. VALERIE MILLER: I think you were correct '}},
{ timecode: 2399, handler: 'blob', id: 160, data: {text: 'because it is always appropriate to have the right people at the table when you begin so you don’t get part way down the process and find out that it is not going to work or you haven’t '}},
{ timecode: 2414, handler: 'blob', id: 161, data: {text: 'had the right people at the table. DAN DIRKS: That’s correct. VALERIE MILLER: I know in the last session Michelle and Ron were talking about having several hospitals sort of competing with each '}},
{ timecode: 2427, handler: 'blob', id: 162, data: {text: 'other and a little bit of jealousy, and you have talked about Detroit Medical Center and Henry Ford Hospital. So, has that been an issue or are they working together? DAN DIRKS: Well, they are working '}},
{ timecode: 2452, handler: 'blob', id: 163, data: {text: 'together but there is definitely competition between the two. Not only from the, actually the Henry Ford does not know anything about this faith-based project that the Detroit Medical Center is going '}},
{ timecode: 2466, handler: 'blob', id: 164, data: {text: 'after. VALERIE MILLER: After they see it on the web, they will. SCOTT KOSKY: I was just going to say. DAN DIRKS: Well, you know, yea, there you go. Or, if Lori reports to them. Again, they listened to '}},
{ timecode: 2481, handler: 'blob', id: 165, data: {text: 'what their patients needed. They tried to identify solutions. It’s that whole creativity that has existed there. One of the other things the Detroit Medical Center will respond within, I think '}},
{ timecode: 2497, handler: 'blob', id: 166, data: {text: 'it is 30 minutes on any emergency, and that’s one of their marketing schemes that if you go in for any emergency it will be 30 minutes. One of the others was 31 minutes, so you’re right, '}},
{ timecode: 2511, handler: 'blob', id: 167, data: {text: 'there is big competition that exists among health care providers, especially in the same encatchment area. VALERIE MILLER: So, with any of you, in approaching a hospital or a medical center for about'}},
{ timecode: 2530, handler: 'blob', id: 168, data: {text: 'transportation, who did you contact? Who was your contact person? It wasn’t a physician, most likely, so who was the contact person? TRACY WALKUP: Well, to be perfectly honest, these contracts '}},
{ timecode: 2549, handler: 'blob', id: 169, data: {text: 'all pre-date me. I have only been in this position since 2007, but I do know that the most recent ones were contacted by outpatient services. We are doing non-emergency transportation and the '}},
{ timecode: 2569, handler: 'blob', id: 170, data: {text: 'outpatient services are the ones that are basically dealing with the issues that are arising with these contracts, so that would be my recommendation if you are looking to do non-emergency '}},
{ timecode: 2581, handler: 'blob', id: 171, data: {text: 'transportation. SCOTT KOSKY: In my instance, one of the contracts was through one of the hospitals has an over-60 club and they organize events for them. They found that a lot of the people who belong '}},
{ timecode: 2599, handler: 'blob', id: 172, data: {text: 'to that over-60 club were asking about, now that I am over 75, how do I still keep going to my doctor? As I mentioned earlier, with the construction project that came through safety and security, so '}},
{ timecode: 2615, handler: 'blob', id: 173, data: {text: 'it just depends on where the hospital is at a particular time. Social Services, any time you can meet with a social service person in a community setting, that’s a good thing. Right now, in '}},
{ timecode: 2634, handler: 'blob', id: 174, data: {text: 'Springfield, there is an active community partnership where myself and Diane Gallion who is out here who is going to talk tomorrow from City Utilities, which runs a public transit system in '}},
{ timecode: 2647, handler: 'blob', id: 175, data: {text: 'Springfield, and many of the social service agencies all get together, including the hospitals and clinics, those are good contacts. If they are not the people who ultimately make the decision, they '}},
{ timecode: 2661, handler: 'blob', id: 176, data: {text: 'can be the people who can get you into the door. When they see the other things you are doing in the community, and I think that’s real important. VALERIE MILLER: So, um. DAN DIRKS: Can I jump '}},
{ timecode: 2673, handler: 'blob', id: 177, data: {text: 'in? VALERIE MILLER: Sure. DAN DIRKS: I think the social service worker at the hospital is absolutely one of the ways to go, but if you are looking at getting overall support in the hospital, I mean '}},
{ timecode: 2684, handler: 'blob', id: 178, data: {text: 'you also need to look at the hospital administration, the board of directors and the CEO. Most hospitals on their website list who those CEOs are. Just do a Google search, in many cases, and it is '}},
{ timecode: 2698, handler: 'blob', id: 179, data: {text: 'amazing how much you are going to find out about the boards of directors and their contacts and whatever. Often times, a lot of the folks that you are serving will have a relationship to that board '}},
{ timecode: 2710, handler: 'blob', id: 180, data: {text: 'member or whatever, so there is nothing better than having Aunt Mable talk to somebody on the board of directors about the transportation service that they have to see if you can get more tie ins that '}},
{ timecode: 2724, handler: 'blob', id: 181, data: {text: 'way. Don’t underestimate the use and the importance of your customers in trying to network, it is just absolutely wonderful. VALERIE MILLER: We have a question back here. She’s got it. '}},
{ timecode: 2741, handler: 'blob', id: 182, data: {text: 'AUDIENCE MEMBER: I am just curious if the contracts are annualized and if they are based on an hourly rate or a per-trip rate. SCOTT KOSKY: My contracts are on an hourly rate basis. Again, with the '}},
{ timecode: 2756, handler: 'blob', id: 183, data: {text: 'hospital in my instance being the scheduler, they control that aspect of it, they know what the hourly rate is, and they can dispatch the bus 10 hours a day if that’s what their needs are, or '}},
{ timecode: 2772, handler: 'blob', id: 184, data: {text: 'they can dispatch it 6 hours a day, and we just track the hours and invoice them monthly. They know who they have taken and it is just very simple. I like it simple. TRACY WALKUP: I would like for '}},
{ timecode: 2789, handler: 'blob', id: 185, data: {text: 'mine to be simple too, but it’s not. Mine are quite different from that. I have one that is on a flat hourly rate. I have two that are on a per mile and per hour. And then I have one that is on '}},
{ timecode: 2810, handler: 'blob', id: 186, data: {text: 'an hourly rate not to exceed x amount. If there were any way to make it more complicated, I would. VALERIE MILLER: So, for all of this, who determines how rides are provided? Who determines who gets '}},
{ timecode: 2826, handler: 'blob', id: 187, data: {text: 'the rides and how are they paid for? Does the rider ever pay for any of these rides or do the hospitals bear the full cost for the ride? SCOTT KOSKY: In my instance, the hospital pays the full cost of '}},
{ timecode: 2843, handler: 'blob', id: 188, data: {text: 'the ride. TRACY WALKUP: And that couldn’t be simple for me either. Let’s see. In Nevada, the hospital pays most of the cost of the ride. They do request a donation. They don’t really '}},
{ timecode: 2863, handler: 'blob', id: 189, data: {text: 'care whether they receive the donation or not. Their goal is to serve their constituents, but it is always nice to have that little extra to offset the cost of it. Golden Valley does have a fare that '}},
{ timecode: 2875, handler: 'blob', id: 190, data: {text: 'they require of their clients, especially the clients that they pick up outside the county. I believe that fare is $2.50/ride. It is not a lot but just enough to help offset the cost of service. '}},
{ timecode: 2889, handler: 'blob', id: 191, data: {text: 'Fitzgibbon has a requested donation of $2.00 and my understanding is that approximately 2/3 of their clients give that donation. Bates County is the one where I said that Kelly just said that he '}},
{ timecode: 2904, handler: 'blob', id: 192, data: {text: 'didn’t want anything to do with administering this program. They don’t look for reimbursement from anything; they don’t want donations, they don’t want fares, they just want us '}},
{ timecode: 2912, handler: 'blob', id: 193, data: {text: 'to go get their clients, get them on the bus and take them to the hospital. As far as who sets up the rides, all of these are set up through the hospitals. We don’t do any of their scheduling or '}},
{ timecode: 2923, handler: 'blob', id: 194, data: {text: 'any of their dispatching. AUDIENCE MEMBER: With the trips that you are running, are you running paratransit trips in addition to ambulatory trips in these contracts? If so, what percentage are you '}},
{ timecode: 2939, handler: 'blob', id: 195, data: {text: 'talking about being paratransit? SCOTT KOSKY: In my instance, mine are mainly paratransit trips, that’s what they use me for. Like I said, post-cardiac and oncology, anywhere that they have the '}},
{ timecode: 2962, handler: 'blob', id: 196, data: {text: 'situation where there’s a need for either a door-to-door type transit where you just have to be there; they are weakened from an operation, they are weakened from their surgery, they are '}},
{ timecode: 2978, handler: 'blob', id: 197, data: {text: 'weakened from their heart attack, or they are coming in from one of their nursing facilities and they are wheelchair bound. That is the great majority of mine. TRACY WALKUP: I cannot tell you how many '}},
{ timecode: 2992, handler: 'blob', id: 198, data: {text: 'of mine are ambulatory and how many are paratransit because the hospitals do all the scheduling for us. I know that we do a significant number of wheelchair clients and every one of the busses that we'}},
{ timecode: 3005, handler: 'blob', id: 199, data: {text: 'have one these routes is wheelchair capable. VALERIE MILLER: Tracy, you mentioned that during the Clinton administration that there was money that was being given to rural hospitals for '}},
{ timecode: 3016, handler: 'blob', id: 200, data: {text: 'transportation, and it sounded like those grants are still continuing. Can you clarify that? TRACY WALKUP: No, those grants are not continuing, but they did get these contracts started. I am not sure, '}},
{ timecode: 3030, handler: 'blob', id: 201, data: {text: 'I believe they were only available for 2 years, but it was enough to get the program started and show the value to the program. A lot of the funding for these programs now is coming from a very '}},
{ timecode: 3043, handler: 'blob', id: 202, data: {text: 'diverse number of sources. In Missouri, we have what is called the Elderly and Handicapped Transportation Assistance Program and METAP puts money into these programs for these hospitals. I know that '}},
{ timecode: 3058, handler: 'blob', id: 203, data: {text: 'some of the hospitals go through the United Way and get donations from there annually to help support their programs. The hospitals each have a foundation where people have made contributions and '}},
{ timecode: 3071, handler: 'blob', id: 204, data: {text: 'donations to the hospital, and they are using some of those funds to fund these programs. Like I mentioned earlier, some of the hospitals request donations, some of them have fares and that helps fund '}},
{ timecode: 3083, handler: 'blob', id: 205, data: {text: 'the programs. They also go to their county commissioners and request annual funds to help with these programs. Like I said, no one of these programs is set up exactly the same and none of their '}},
{ timecode: 3098, handler: 'blob', id: 206, data: {text: 'funding is exactly the same. They all just go and find it wherever they can. AUDIENCE MEMBER: My question kind of bridges the previous session and this one, so I open it up to the panelists or anyone '}},
{ timecode: 3116, handler: 'blob', id: 207, data: {text: 'in the room, and it has to do with dialysis. You talked a lot about the long distance trips in the previous session. I am in Buffalo, NY. In the urban area, there are access to centers, but the next '}},
{ timecode: 3131, handler: 'blob', id: 208, data: {text: 'question is if there is an opening at that center. In some cases, people just go where the opening is whether that’s the center located in closest proximity to their residence or not. They might '}},
{ timecode: 3142, handler: 'blob', id: 209, data: {text: 'not be going 60 miles, but they could be going an additional 20 or 25 miles 3 times a week because there is an opening at that particular center, and that certainly would add up over time. Once they '}},
{ timecode: 3155, handler: 'blob', id: 210, data: {text: 'are assigned to a center to the extent that they change, I am not really…I don’t see a lot of that happening, so I was curious if there was any organization or company in the room that '}},
{ timecode: 3167, handler: 'blob', id: 211, data: {text: 'had worked with dialysis centers in recognizing there\'s competition among them. There is also freedom of choice issues where there is coordination in the assignment to where people receive '}},
{ timecode: 3179, handler: 'blob', id: 212, data: {text: 'treatment closest to their residence on kind of a significant scale at all, or had heard of a particular program or anyone involved in that type of an effort. Before the transportation even happens, '}},
{ timecode: 3195, handler: 'blob', id: 213, data: {text: 'essentially, is there any kind of partnership with some of the dialysis centers to better coordinate where people are receiving treatment or? SCOTT KOSKY: We have a program similar to that in Rhode '}},
{ timecode: 3207, handler: 'blob', id: 214, data: {text: 'Island where according to the Department of Elderly Affairs, folks are supposed to go to the closest health care center, which of course applies to dialysis, but we do have folks who do choose to go '}},
{ timecode: 3220, handler: 'blob', id: 215, data: {text: 'to a different center because their doctor may be there. In that case, they generally go as ADA passengers and pay a fare. We generally try and group to the closest center in order to get the best '}},
{ timecode: 3233, handler: 'blob', id: 216, data: {text: 'bang for our buck. Most of the time we have a very good relationship with the social workers and they usually will try and work out the closest center, but of course, there are exceptions to that. '}},
{ timecode: 3245, handler: 'blob', id: 217, data: {text: 'Plus – on the Medicaid, that’s not possible. This is under our senior transportation that we have. DAN DIRKS: Under the senior transportation program I worked with, we would call the '}},
{ timecode: 3256, handler: 'blob', id: 218, data: {text: 'facility and try and negotiate with them. You know, up front. Sometimes we were successful and sometimes we weren’t. It’s particularly maddening, as you say, when you have somebody that '}},
{ timecode: 3268, handler: 'blob', id: 219, data: {text: 'lives a mile from a dialysis center and then another person that lives a mile and you can’t switch them. Part of it is their doctor, part of it is their health care program they are at, but we '}},
{ timecode: 3279, handler: 'blob', id: 220, data: {text: 'have had some success in initially calling because sometimes if we can group the trips; if you have one person going at 7, one at 8 and one at 9, to try and group them together, that saves you that '}},
{ timecode: 3293, handler: 'blob', id: 221, data: {text: 'way. Again, not a foolproof answer, but you know, take what you can get. TRACY WALKUP: I haven’t found in my region that it is a matter of the clients not having a choice. When we find that we '}},
{ timecode: 3307, handler: 'blob', id: 222, data: {text: 'are traveling further than we probably should with a client; for instance, I have one client that lives just outside of Warrensburg and there is a dialysis clinic in Warrensburg, but she has been '}},
{ timecode: 3321, handler: 'blob', id: 223, data: {text: 'going to the dialysis clinic in Clinton for the last 10 years and she doesn’t want to change. So, she has a 45-minute ride to go to dialysis 3 times a week. That is her choice if that is what '}},
{ timecode: 3337, handler: 'blob', id: 224, data: {text: 'she chooses to do, but I have not found that people are being forced to go places they don’t want to go in my region. I would also mention that we seem to have dialysis clinics popping up '}},
{ timecode: 3348, handler: 'blob', id: 225, data: {text: 'everywhere over the last 5 to 10 years. So, they are capable of getting in because there are openings close to home. AUDIENCE MEMBER: I actually now have two questions. Does anybody operate on '}},
{ timecode: 3367, handler: 'blob', id: 226, data: {text: 'weekends, or are you just basically around office hours? My second question was referring to the paratransit trips, are you all saying just wheelchair accessible vehicles? Is that what you are meaning '}},
{ timecode: 3380, handler: 'blob', id: 227, data: {text: 'when you say “paratransit trips”? TRACY WALKUP: I think that was what the gentleman was asking was wheelchair. Paratransit means more to me than that, but I answered what I thought he was '}},
{ timecode: 3389, handler: 'blob', id: 228, data: {text: 'asking. Basically, OATS is a Monday through Friday operation, but yes ma’am, we do operate Saturdays and Sundays now too. As I mentioned earlier, I have a 13-county area and my entire 13-county '}},
{ timecode: 3404, handler: 'blob', id: 229, data: {text: 'area is rural. I have no big cities. My biggest city is approximately 25,000 people in that 13-county area. There I a dire need for dialysis clients that go on Tuesday/Thursday/Saturday. So, you know '}},
{ timecode: 3420, handler: 'blob', id: 230, data: {text: 'part of that $1 million in Medicaid that we are running, a big part of it is those dialysis clients, so we have a full schedule for dialysis on Saturdays. Occasionally, we will have something pop up '}},
{ timecode: 3431, handler: 'blob', id: 231, data: {text: 'on a Sunday with a hospital admit or discharge that we will run, but we do have a very limited Saturday and Sunday schedule. SCOTT KOSKY: The same is true in my operation currently. We had 7-day '}},
{ timecode: 3445, handler: 'blob', id: 232, data: {text: 'operation for the hospital during their construction phase for their employees, but we pretty much keep the Monday through Friday clinic hours currently. Again, with the Tuesday/Thursday/Saturday dialysis,'}},
{ timecode: 3463, handler: 'blob', id: 233, data: {text: 'which aren’t part of my hospital contracts. VALERIE MILLER: Dan, is yours looking at going…how long? DAN DIRKS: Well, initially, I think we will probably start Monday through Friday I '}},
{ timecode: 3475, handler: 'blob', id: 234, data: {text: 'would guess at this point. Part of it is, what are their customers’ needs going to be. Clearly, if there is a Tuesday/Thursday/Saturday, then I think they will try to address that. There again, '}},
{ timecode: 3489, handler: 'blob', id: 235, data: {text: 'at this point, especially with faith-based groups with that finding; getting commitments. AUDIENCE MEMBER: I have a question on cost. From an operating cost standpoint, what is the metric that this '}},
{ timecode: 3502, handler: 'blob', id: 236, data: {text: 'hospital model cost? Is it per trip or per mile and do you know what that amount is? DAN DIRKS: For me? Yea, they are looking at somewhere around $52/hour and that is from when they were operating it '}},
{ timecode: 3517, handler: 'blob', id: 237, data: {text: 'themselves, it was close to $90/hour, so they are very excited about it. They are hoping as they link with the university of getting it down even under that $52/hour. AUDIENCE MEMBER: Do you have a '}},
{ timecode: 3532, handler: 'blob', id: 238, data: {text: 'per-trip mile cost? DAN DIRKS: I don’t have their number of passengers that they have put together. I am sorry; I can’t help you with that. SCOTT KOSKY: I don’t have that data with '}},
{ timecode: 3551, handler: 'blob', id: 239, data: {text: 'me. I can get it, but I don’t have it with me. TRACY WALKUP: I can get close. I am just under $24/hour right now. That doesn’t just include the hospitals though, that’s my entire '}},
{ timecode: 3567, handler: 'blob', id: 240, data: {text: 'operating cost for all the different types of contracts that I run is just under $24/hour. VALERIE MILLER: Wait a minute, we have one up here and then we will go to you. AUDIENCE MEMBER: Um, my '}},
{ timecode: 3587, handler: 'blob', id: 241, data: {text: 'question was related to that as well because I was a little confused when you said you charge an hourly rate to the hospitals and then your trips are mostly paratransit. Well, with paratransit, you '}},
{ timecode: 3597, handler: 'blob', id: 242, data: {text: 'can only charge twice what a fixed route rate is, you know. So, you know if you are paying $1.75 on the bus, you can only charge $3.50, so I am a little confused. Or with paratransit you can also '}},
{ timecode: 3612, handler: 'blob', id: 243, data: {text: 'charge an "agency rate", so is that how you are doing that? DAN DIRKS: Part of it is that you are looking at fixed route service, which is comparable to ADA. That is, in order to get ADA '}},
{ timecode: 3625, handler: 'blob', id: 244, data: {text: 'service, a fixed route has to operate there. Where there is no fixed route service, you can charge whatever you want, so I am willing to betcha there is no fixed route service, so that’s where a '}},
{ timecode: 3638, handler: 'blob', id: 245, data: {text: 'lot of that comes in. TRACY WALKUP: That would be a very good bet. In a town of 10,000, you very often don’t have a fixed route running around town. VALERIE MILLER: Okay. We had the gentleman, '}},
{ timecode: 3652, handler: 'blob', id: 246, data: {text: 'okay. AUDIENCE MEMBER: We haven’t talked much about primary care doctors or preventative cares. I was wondering if any of your communities or anybody here do any…our community is thinking '}},
{ timecode: 3676, handler: 'blob', id: 247, data: {text: 'about doing like a wellness on wheels where you can go out and do preventative kinds of things. SCOTT KOSKY: Can I ask where you are from? AUDIENCE MEMBER: Cedar Rapids, IA. SCOTT KOSKY: Iowa, Okay. '}},
{ timecode: 3690, handler: 'blob', id: 248, data: {text: 'TRACY WALKUP: I would love to answer that. I didn’t get into a lot of detail. I did submit a paper to Valerie that should be on your zip drive on this. My hospitals don’t just transport to '}},
{ timecode: 3702, handler: 'blob', id: 249, data: {text: 'the hospitals. Take for example Nevada Regional Medical Center transports not only to the hospital but they also transport to any doctor offices who are affiliated with their hospital, so the clients '}},
{ timecode: 3716, handler: 'blob', id: 250, data: {text: 'can go anywhere. Golden Valley not only brings people into the hospital but they have clinics around town, they have a wellness center and an aquatic center and they transport people to those areas. '}},
{ timecode: 3731, handler: 'blob', id: 251, data: {text: 'Bates County Memorial Hospital even transports to unaffiliated medical appointments and pharmacies. As I mentioned earlier, Fitzgibbon took over the general public transportation from the City of '}},
{ timecode: 3747, handler: 'blob', id: 252, data: {text: 'Marshall, so they will transport you anywhere. If you would look at the zip drive on that paper, it gives you a lot more detail on what they are doing. VALERIE MILLER: Go ahead. DAVE WHITE: I just '}},
{ timecode: 3760, handler: 'blob', id: 253, data: {text: 'would add that the state of Connecticut is in the process of introducing primary care case management model where its Medicaid, well it\'s called its Husky Group, and it\'s basically '}},
{ timecode: 3778, handler: 'blob', id: 254, data: {text: 'a young adults and kids Medicaid group. There are about 340,000 covered individuals in the state of Connecticut. Very small introduction and they are rolling it out over the next year. It is going to '}},
{ timecode: 3798, handler: 'blob', id: 255, data: {text: 'be less than probably a couple of thousand people, but essentially it is interesting that you bring it up because it is going to be run through physicians’ offices and the physicians that enter '}},
{ timecode: 3814, handler: 'blob', id: 256, data: {text: 'the program are going to have to hire or have someone on staff be a case manager. Under the Medicaid, since it is part of the traditional Medicaid program, they are going to have to manage or '}},
{ timecode: 3830, handler: 'blob', id: 257, data: {text: 'interface with the Medicaid transportation program. It is going to be an interesting…they will in fact have to interface with one of the state’s transportation brokers to get their '}},
{ timecode: 3851, handler: 'blob', id: 258, data: {text: 'transportation for their customers for their patients. We are seeing that now—that has popped up over the last year. Connecticut is looking at it as a model to significantly—really they '}},
{ timecode: 3870, handler: 'blob', id: 259, data: {text: 'are not looking to control their transportation cost they are looking to control their medical cost through it. TRACY WALKUP: We were talking with the public health department so the things that we '}},
{ timecode: 3882, handler: 'blob', id: 260, data: {text: 'are looking at with mobility have to do not only medical but more the wellness piece, possibly delivering even farmer’s market produce to low-income housing. Then we have—there is several '}},
{ timecode: 3895, handler: 'blob', id: 261, data: {text: 'portable dental chairs that the I Smile programs have that would fit in this thing. Possibly several different features. DAVE WHITE: I think dental might be-I think-we have portable dental'}},
{ timecode: 3913, handler: 'blob', id: 262, data: {text: 'clinics in Connecticut now. We have portable mammography vans in Connecticut. But they are all pushing it all out; you know they are bringing it out into the community again. This is the primary care '}},
{ timecode: 3933, handler: 'blob', id: 263, data: {text: 'case management model is really going back in some ways to your family physician model that was around when we were all growing, at least I was growing up. You know 35 years ago or so. It is going to '}},
{ timecode: 3953, handler: 'blob', id: 264, data: {text: 'be interesting to see how that works. It was interesting. I am glad you brought that up. VALERIE MILLER: Is it like the medical homes? DAVE WHITE: It is the medical home, that’s right, same '}},
{ timecode: 3965, handler: 'blob', id: 265, data: {text: 'thing. Yep. Medical home. VALERIE MILLER: Familiar with the medical homes that it is the primary physician , where one area handles all of your medical care and keeps track of everything. It is a '}},
{ timecode: 3982, handler: 'blob', id: 266, data: {text: 'wonderful opportunity to also be able to have an inroad to talk to those clinics who bill themselves as medical homes about how do your patients get to your facilities. If you are saying that you are '}},
{ timecode: 4005, handler: 'blob', id: 267, data: {text: 'total medical facility, a total medical home providing care, providing this total care, how do you get your patients to this care? Have you thought about that? Because'}},
{ timecode: 4020, handler: 'blob', id: 268, data: {text: 'in a lot of cases that has not been on their horizon and it should be. And I think, in their thinking, it\'s ripe to be in their mind now because there\'s a new, this term "medical home", it kind of fits with what the program is. In this hospital transportation that you are doing, and in your faith based '}},
{ timecode: 4056, handler: 'blob', id: 269, data: {text: 'transportation project, how does coordination fit in here? Or does it? We have talked a little bit about it. Does Medicaid fit in, where does it fit in, and how do you keep it separate? How do you fit it in but also '}},
{ timecode: 4079, handler: 'blob', id: 270, data: {text: 'how do you account for it separately? Do you understand what I am saying? TRACY WALKUP: Yes I do. VALERIE MILLER: Okay. Who wants to go for that? TRACY WALKUP: I will jump right in. VALERIE MILLER: Okay, '}},
{ timecode: 4093, handler: 'blob', id: 271, data: {text: 'Tracy. TRACY WALKUP: We do coordination to the greatest extent that we can. I run, right now I am running approximately 110 vehicles in my 13 counties. Some days it does not feel like it is enough '}},
{ timecode: 4110, handler: 'blob', id: 272, data: {text: 'when we get more trips than we can handle. When we have more trips than we can handle we figure out a way to handle them. The only way you can do that is through coordination. You may have people who '}},
{ timecode: 4122, handler: 'blob', id: 273, data: {text: 'have 2 or 3 different funding sources on the same bus and we track it the best we can. We allocate. That’s all you can do is allocate the cost amongst the passengers for what is going on that '}},
{ timecode: 4136, handler: 'blob', id: 274, data: {text: 'particular vehicle on that particular day. It is not a bad thing to be in a position to be forced to coordinate services because it is so easy to say this bus only does this. This driver only does '}},
{ timecode: 4151, handler: 'blob', id: 275, data: {text: 'this. This bus only does this and this driver only does this. That is not the most efficient way to run your service. So it is good to be in a position of having more clients than we know what to do '}},
{ timecode: 4164, handler: 'blob', id: 276, data: {text: 'it and having to coordinate. SCOTT KOSKY: One of the things we are seeing in Springfield, although we currently are—pretty much hospital dedicated by contract. There is a movement by the '}},
{ timecode: 4178, handler: 'blob', id: 277, data: {text: 'Metropolitan Planning Organization and some other folks including city utilities and OATS to explore the possibility of a coordinated system. We did a study a number of years ago, I still have '}},
{ timecode: 4195, handler: 'blob', id: 278, data: {text: 'yellowed copies of it if anyone would like to see it, but, once again, coordination was important 10 years ago when we made our first attempt at it and it certainly important now if not more so. The '}},
{ timecode: 4214, handler: 'blob', id: 279, data: {text: 'other thing as we have seen Springfield grow from a small midsized little city to a quarter million people plus, the boundaries of the city are constraining and the constraints of the City Charter are '}},
{ timecode: 4236, handler: 'blob', id: 280, data: {text: 'such, I won’t go into all of that because I don’t know enough about to talk about it too much, but there is another movement afoot to look at the possibility of establishing a transit '}},
{ timecode: 4250, handler: 'blob', id: 281, data: {text: 'authority that encompasses the entire metropolitan planning organization area rather than just the city limits of the city of Springfield. Coordination is becoming more important out there also. DAN '}},
{ timecode: 4271, handler: 'blob', id: 282, data: {text: 'DIRKS: When you talk about coordination to me, it is not just trip coordination. I mentioned maintenance. It could be that the Detroit Medical Center might have their maintenance done by private '}},
{ timecode: 4286, handler: 'blob', id: 283, data: {text: 'non-profit in the area, or fuel purchase, or insurance. Coordination is more than just the transportation end of it. People seem to forget that once in a while. In many cases you can save significant '}},
{ timecode: 4300, handler: 'blob', id: 284, data: {text: 'dollars by looking at things that you would not normally connotate with transportation or transportation cost per se. Joint marketing. There is a lot of things you can do. Don\'t limit yourself '}},
{ timecode: 4316, handler: 'blob', id: 285, data: {text: 'to just trip coordination because quite honestly that is the most difficult thing to coordinate that there is. With my experience if you can do the maintenance, the fuel purchase, the joint marketing '}},
{ timecode: 4328, handler: 'blob', id: 286, data: {text: 'efforts, you are going to have a lot easier time moving down the road to coordinate the transportation trips. SCOTT KOSKY: That is an excellent point. Think in terms of coordinating office space. '}},
{ timecode: 4343, handler: 'blob', id: 287, data: {text: 'There is a lot of different ways that you can coordinate not just trip coordination. Sharing software. You can go on and on just don’t limit yourself to that thought. DAVE WHITE: One of the '}},
{ timecode: 4358, handler: 'blob', id: 288, data: {text: 'reasons to do that is because when you start talking about coordinating trips you often times start talking about stepping on other people’s turf. Sometimes you need to work through some '}},
{ timecode: 4373, handler: 'blob', id: 289, data: {text: 'confidence building and trust enhancing steps, some community organizing steps or whatever. Doing some joint purchases together can sort of get you over those humps where you start the '}},
{ timecode: 4392, handler: 'blob', id: 290, data: {text: 'communication—you know the lines of communication open. I think Dan really has an excellent point. TRACY WALKUP: I like that. DAVE WHITE: So you get those elements going and then one day you '}},
{ timecode: 4407, handler: 'blob', id: 291, data: {text: 'might both look at each other and say maybe that group of people, and that group of people and suddenly we can start figuring out the trips. DAN DIRKS: Just to throw an advertisement for CTAA, if you are '}},
{ timecode: 4420, handler: 'blob', id: 292, data: {text: 'a CTAA member and you can coordinate your fuel purchase with a couple of other groups. CTAA has a program where you can purchase fuel at a reduced rate. There is one case where I was talking to a '}},
{ timecode: 4435, handler: 'blob', id: 293, data: {text: 'group, I believe it was Montana or Idaho, they were the smallest of their county, their school district and they were operating a minimal number of vehicles. But because they were a CTAA member, they '}},
{ timecode: 4447, handler: 'blob', id: 294, data: {text: 'could sell, and they had a joint fuel purchase program they could sell fuel for all three at significant savings. There are ways that you can do this. The other pitch is that CTAA offers a lot of '}},
{ timecode: 4462, handler: 'blob', id: 295, data: {text: 'technical assistance. Let me tell you, don’t tell Charlie Dickson not here? Often time it is free. Okay. It is short term technical assistance. If you have some needs, if you need an operational '}},
{ timecode: 4476, handler: 'blob', id: 296, data: {text: 'analysis, if you need somebody to come in and look at what you are doing and give you a 5 page here is what you\'re doing right and here is what you\'re doing wrong, here is how to fix it. CTAA '}},
{ timecode: 4485, handler: 'blob', id: 297, data: {text: 'can step in and help you in many cases. VALERIE MILLER: Often times not that many people apply for it. We are not going to tell you that. So it is not—don’t hesitate to ask. DAVE WHITE: '}},
{ timecode: 4496, handler: 'blob', id: 298, data: {text: 'Right, really if you’re not a member of CTAA and neither Dale or Charlie are here, or Scott. Talk to them about a membership. Come and join the association. It’s well worth the few '}},
{ timecode: 4514, handler: 'blob', id: 299, data: {text: 'sheckles you put out. DAN DIRKS: Actually the Detroit Medical Center is still not a member. That is not costing money—any money. Just call Dave White; he’ll handle it for you. DAVE WHITE: '}},
{ timecode: 4524, handler: 'blob', id: 300, data: {text: 'Or Dan Dirks. Either way we will get you in. DAN DIRKS: Jane? DAVE WHITE: Or Jane Hardin. JANE HARDIN: I think we don’t want to undercut the benefits of becoming CTAA members. I am very pro CTAA '}},
{ timecode: 4542, handler: 'blob', id: 301, data: {text: 'memberships. It is a great deal. But our technical assistance is frequently for the general public. A lot of us have provided technical assistance to providers for a few years and never known whether '}},
{ timecode: 4559, handler: 'blob', id: 302, data: {text: 'they were members or not. DAVE WHITE: That’s right, absolutely. So how do you access the—you just go to the website. CTAA.org. right? Technical assistance is right there. JANE HARDIN: '}},
{ timecode: 4573, handler: 'blob', id: 303, data: {text: 'There is no wrong number at CTAA. DAVE WHITE: That is a great advertisement. JANE HARDIN: If you call Ginger and the right person is Kelly Shawn, she’ll get you to him. If you call me, I will do '}},
{ timecode: 4586, handler: 'blob', id: 304, data: {text: 'the same. And sometimes you hit it. The person will say “yeah I am the person to help you, I am Bob Carlson and I am it.” Any number, seriously, we are a small office. In fact most of the '}},
{ timecode: 4600, handler: 'blob', id: 305, data: {text: 'time I can just shout, “hey Kelly.” I mean you are not entering an impersonal bureaucracy. We work together. VALERIE MILLER: Well, I will tell you. I think we have come to the end of the '}},
{ timecode: 4619, handler: 'blob', id: 306, data: {text: 'day. I want to thank Tracy and Scott and Dan for their presentation. I will turn it back to you Dave. DAVE WHITE: I want to thank Valerie for putting together a great panel. This has been very '}},
{ timecode: 4635, handler: 'blob', id: 307, data: {text: 'educational for me. I will just make one comment that probably I should not—this is not representative of CTAA but I would consider going after those dialysis units. I think they might be well '}},
{ timecode: 4657, handler: 'blob', id: 308, data: {text: 'worth talking to. There is a lot of them around and they are for profit. On that note, it has been a great day. We obviously found out very early this morning that we have a very diverse group of '}},
{ timecode: 4671, handler: 'blob', id: 309, data: {text: 'people representing diverse organizations. Dale got us off to a great start. We had a good conversation on senior transportation, on collaboration, on hospital transportation. We are going to be back '}},
{ timecode: 4687, handler: 'blob', id: 310, data: {text: 'here tomorrow morning at 8:30AM and we are going to start off the day with a great conversation around children’s transportation. I look forward to seeing everybody here a little earlier than '}},
{ timecode: 4703, handler: 'blob', id: 311, data: {text: 'this morning but I am sure that we can all make it. Have a great evening tonight. Thank you again for coming.'}},
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