Featured Articles:
NEMT Providers and COVID-19
Spring 2020
NEMT Billing 101
Big Solutions for Small Businesses
25
5
NEMTAC Board of Directors
Navigating the COVID-19 Pandemic
Opportunity to Serve During COVID-19
After the Crisis, What's Next?
Letter from NEMTAC's Executive Director
NEMTAC Advisory Board Members
45
We All Have More Than One Mission
Emerging Opportunities for NEMT Providers
14
RoutingBox Helps You Serve Your Community
32
3
Working with Ancillary Service Companies
37
46
9
29
18
22
Communicating During a Crisis
Table of Contents
27
TTA Springs into Legislative Action
4
40
Welcome to the spring edition of NEMT Today. I hope that you, your loved ones, and your colleagues are safe and well. I can honestly say that I’ve never experienced an event with such a dramatic impact on how we live and work. During these uncertain times, it is vital to stay connected – connected to your customers, your employees, and your communities. Their feedback is essential to chart the right course to ensure they receive everything they need and to set your organization up for future success. NEMTAC came to life in 2018 to give a voice to NEMT providers within the healthcare industry. Through the leadership of our Board of Directors, our organization has quickly become a valued resource for the industry. It is with mixed feelings that we announce the departure of one of our founding board members, Mr. Stan Sipes. Stan has served NEMTAC from day one and his contribution through the formative stages of the organization have been exceptional. On behalf of myself and our Board of Directors, I would like to wish Stan the best and thank him personally for his contributions. We sincerely hope that we will all be able to go back to normalcy very soon. In the meantime, please enjoy the spring edition of NEMT Today. It is filled with useful information not only related to the crisis but how to best position your organization for growth after this event has passed. Our thoughts are with the providers affected and everyone working around the clock to help those most in need. Everyone at NEMTAC wishes you and your loved ones good health and strength in the days and weeks ahead. Stay safe, healthy and take care!
A Letter from NEMTAC's Executive Director
Melissa Jankowski Executive Director
Chris Kelly Board Member
David Marhoffer, Board Member, not pictured
Peter Hicks Board Vice President
Gail Bauhs Board Member
Eliot Kalter Board Member
Michael Shabkie NEMTAC Founder / Board Treasurer
Board of Directors
Header
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Advisory Boards
Accreditation Michael Shabkie, Co-Chair and Eric Lane, Co-Chair Carlos Ayestas, Priority Transportation Services Dori Boyle, Idaho Department of Health & Welfare Mindy Ginsberg, FR Conversions Stan Gitin, Clarion Medical Sarah Hope, Vertical Identity Background Screening & Drug Testing Melissa Jankowski, NEMTAC Eric Lane, Bankers Insurance Michael Shabkie, NEMTAC Jim Smith, JC Paratransit Solutions Roddrelle Sykes, 3rd Millennium Insurance William van der Linde, Old Dominion Transportation Group Scott West, NEMT Solutions, LLC Compliance and Regulatory Michael Shabkie, Co-Chair and Dan Reid, Co-Chair David Aboudi, Aboudi Legal Group Maggie Adams, EMS Financial Services Michael Adelberg, Faegre Drinker Biddle & Reath LLP Gautam Aggarwal, MD, Arizona Complete Health Laura Fleet, SendaRide, Inc Crystal Ford, Orange County EMS Melissa Jankowski, NEMTAC Martha Kendall, Tennessee Carriers David McDonald, QMAC Consulting Jennifer Place, MAS Mark Porterfield, Careavan Transports Dan Reid, Grove Transit Michael Shabkie, NEMTAC Kevin Teasdale, Secure Medical Transportation Teresa Wilke, Silver Arrow Strategies
Advisory Boards continued ...
Certification Peter Hicks, Co-Chair and Jim Adkins, Co-Chair Kelly Addy, Clear Choice Express, LLC Jim Adkins, SouthStar Emergency Medical Services Howard Berkowitz, H&S Personal Car Service & Consulting, Inc Peter Hicks, NEMTAC Melissa Jankowski, NEMTAC Miriam Manary, Univ of Mich Transportation Research Inst Courtney Muchugu, United Transportation Group Ray Shanahan, CareerCert Cris Sierra, ComfortCare Transportation Resource and Conference Peter Hicks, Co-Chair and Travis Draney, Co-Chair Mike Chatelain, Risk Services of Louisiana, a Leavitt Group Co Travis Draney, Nonpareil Care, LLC Peter Hicks, NEMTAC Melissa Jankowski, NEMTAC Manuel Leon, Alivi Tammy Mihm, State of Tennessee Misti Mills, Two M Insight Group Marcus Norton, Mobility Support Solutions Jason Stempin, VMI Technology Gail Bauhs, Co-Chair and Myron Hammes, Co-Chair Kyle Archer, Passio Technologies Arthur Attal, Via Gail Bauhs, NEMTAC Tony Bradshaw, Bradshaw Consulting Services (BCS) Dominic Buono, UZURV Holdings Inc Sufian Chowdhury, Kinetik Healthcare Solutions, Inc Imran Cronk, Ride Health Myron Hammes, Schedule Viewer Melissa Jankowski, NEMTAC Venkata Marella, HB Software Solutions (HBSS) Brendan McNiff, Roundtrip Anantha Rao, Wellryde Robbins Schrader, SafeRide Health Joe Tovar, TripSpark Medical
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By Gail Bauhs and Kris Lyon, TripSpark Technologies
On March 11, 2020 the World Health Organization (WHO) categorized COVID-19 as a pandemic. Initially this seemed to be a virus that affected China, Europe and large metropolitan areas in the United States. Over the next few days, however, the situation changed. It has spread to all 50 states and significantly altered how people live and interact with each other. “Sheltering in place” is recommended as necessary to slow the spread of the virus and avoid overwhelming our healthcare system. Amid this, transportation to healthcare has become even more important. Questions about providing service, sanitation, and other precautionary measures to keep drivers and members safe is critical for NEMT transportation providers and brokers. What is COVID-19? According to the Centers for Disease Control (CDC), COVID-19 is a novel coronavirus. A novel coronavirus is a new coronavirus that has not been previously identified. The virus causing coronavirus disease 2019 (COVID-19), is not the same as the coronaviruses that commonly circulate among humans and cause mild illness, like the common cold. (https://www.cdc.gov/coronavirus/2019-ncov/faq.html) The symptoms of COVID-19 include dry cough, shortness of breath, and fever. It does not discriminate between age, race, or socio-economic status. At risk groups include individuals with compromised immune systems, older adults, and those with chronic disease including diabetes, and heart or lung conditions. The recommended way to prevent the spread of the virus is to wash hands with soapy water for at least 20 seconds, use hand sanitizer when soap and water are not available, and practice social distancing. Persons typically show symptoms between two and 14 days from the time of exposure, which is why people have been asked to self-quarantine for 14 days following travel to known outbreak areas. With the spread of the virus to the U.S., the probability of exposure in transportation has increased.
NEMT Providers and COVID-19... continued
Transportation Providers Providing good customer service is the goal of anyone operating an NEMT business. In order to meet demand, drivers must be available to operate vehicles in order to transport individuals to and from medical appointments. Many states are declaring transportation an essential service, but that doesn’t mean service levels remain the same. Three concerns for a transportation provider to manage in a pandemic environment are fear, combating driver shortages, and anticipating a loss of revenue. Fear, real or perceived, impacts an individual’s ability to function in the work environment. Drivers and direct service providers risk coming into contact with an infected individual and not realize they have been infected. Fear of COVID-19 exposure could result in an increase in distracted driving, refusing to transport anyone who appears to have a cold or seasonal allergies, or even refusing to come in to work. Drivers play a critical role in the healthcare of the individuals they transport. A rule of thumb, as suggested to healthcare professionals, also applies to NEMT drivers. Make sure to have the most current information available. Use the CDC website (cdc.gov) or reach out to the local Public Health Agency for information that can be distributed. Make sure to have supplies available for drivers to ensure proper cleaning between transports. This means using antiseptic products to wipe down seats, handles, windows, doors, and seat belts in each vehicle prior to arriving for the next pickup. Practicing social distancing may mean passengers sit in the back seat of the vehicle and not next to the driver to minimize the transmission of the virus. Driver shortages may become a new reality as the need to be quarantined, due to self or family exposure or illness, increases. Drivers with school age children who now need child-care and home schooling, may also be unable to work. These are concerns in all areas of transportation but may specifically impact the health outcomes of the NEMT population. But as more companies lay off workers in “non-essential” roles, these workers may be an untapped resource for transportation companies to reach out to and bring onboard, as current drivers are no longer able to provide services. Training, especially on universal precautions and infection control (consistent cleaning and hand washing) will become particularly important to emphasize with any new employee. Declining revenue is another concern for providers. In some areas providers are already experiencing a significant decline in trips due to the increase in alternative healthcare delivery systems, such as the increased use of Telemedicine. Through telephone or video exchange, people can now interact with their healthcare professionals from home. This decreases the number of trips needed to go to and from healthcare offices. While this is beneficial in the current pandemic environment, it results in a loss of income for
providers and drivers. Recently, the U.S. Small Business Administration (SBA) has begun offering low interest federal disaster loans for working capital in areas significantly affected by COVID-19. Information about these loans and areas eligible is located on the SBA website. https://disasterloan.sba.gov/ela/Declarations/Index. Other suggestions to investigate for new revenue streams include: Delivery services for grocery stores, pharmacies, and school districts (schoolwork or meals) Transporting hospital and other medical facility staff Working with hospitals to provide transports for individuals who are positive COVID-19 but do not require hospitalization. This will require following special cleaning and disinfecting protocols. Another way to manage expenses may be to work with insurance companies. As vehicles are not in use, some insurance companies may allow those vehicles to be temporarily removed from policies to save money during the time they are not active. Working with insurance agents could result in savings of hundreds or thousands of dollars depending on the size of the fleet, but the focus is to minimize businesses losses. Transportation Brokers Non-emergency medical transportation brokers are used to arranging transportation to and from medical appointments
NEMT Providers and COVID-19...continued
for people with various medical conditions. However, COVID-19 presents some unique concerns for NEMT operations which differ from other medical conditions. Communications with health plans, clients, and staff all become unique challenges. HIPAA compliance concerns arise when different operating procedures, such as working from home, come into play. Further service risks may also include provider capacity, staff availability, technology, and finances. Communication during a public health pandemic is critical to ensure needed services continue. As with transportation providers, it is important to ensure that the information sent to staff and clients is current and factual. Communicating with clients is key to ensuring that vehicles are not dispatched to homes when in-person appointments are canceled. Telephone systems that have messages regarding available services are important, as well as systems that can send out information updates and process trip cancellations. Keeping the lines open with health plans is important to ensure the broker is providing services as expected, including the kind of transportation needed and not needed. Most brokers and healthcare providers are authorizing only essential services, to include treatments like dialysis and chemotherapy. Other trips for general medical checkups are being postponed until the pandemic has passed. Ensuring compliance with HIPAA protocols remains essential as more individuals work from home. Home networks are typically not as robust as office networks, most of which have VPN (virtual private networks). Operations software that is web-based is more easily available in a work-from-home environment than application-based software. These are concerns that must be addressed to ensure that patient confidentiality is maintained. It is possible that some HIPAA concerns may be relaxed as the push for social distancing increases and call centers are not be able to have staff working 2 to 3 feet from each other. Be sure to check the CMS website for the latest guidance. http://ow.ly/FlvA50zamKd Brokers also have risks in ensuring proper service delivery. This includes provider capacity, call center staffing and keeping track of locations that are open or closed. The declining driver pool experienced by transportation providers also directly affects the ability of the broker to provide needed service to their clientele. If call center staff are not available to answer phones, the software platform does not allow online trip booking and cancellations, or the telephone system does not have the ability to have staff work from home, call times increase, frustrating those who still need service. Brokers also need to pay attention to business closures. In most areas, medical offices and pharmacies are still open. But medical offices may only be providing telemedicine services, meaning that if a patient arrives to see a physician in-person, they may be turned away.
Other types of offices may be completely closed. The broker will need to keep this information updated on a daily basis. Financially, those brokers that are reimbursed on a FFS (fee-for-service) basis may see a reduction in revenue as trip volume decreases, similar to that for NEMT providers. However, those brokers that are reimbursed on a capitated rate basis may not be affected, as long as their contracted capitated rate remains steady. Capitated payments are based on the number of eligible individuals and payment is not tied to numbers of trips. Summary In this new and uncharted public health crisis, medical transportation will be impacted in ways that we can only speculate about today. In the weeks and months to come, a change in the delivery of medical care will impact both transportation providers and brokers. We can best prepare ourselves by staying up-to-date with current public health directives, maintaining open, accurate and frequent communication, and being prepared to pivot to delivery of whatever new model of service comes our way. Once the virus passes, there will again be plenty of work to make up for all the postponed medical appointments, treatments and procedures. Stay safe, wash your hands and maintain social distancing!
Affordable and dependable accessible vehicles. Innovative financing options with affordable—even deferred--payments. Reliable after sales support and service. These are solutions that small businesses need more than ever to conquer what could potentially be the most challenging times ahead. A true partnering supplier will help you rally with effective programs and support. The right partner will collaborate with you so that you have the tools needed to get on track and help you achieve success in business today and for many years to come. The outlook is bright with the right supplier partner. What are some of the solutions available to help a small NEMT operator overcome challenges today and for the long term? An affordable accessible vehicle—CHECK! Purchasing a wheelchair (or gurney) accessible vehicle (WAV) is probably by far the single largest investment you need to make in order to launch or maintain your business. Deciding which vehicle to buy is a critical decision, and the right partner will take the time to understand the clientele you plan to service and help you navigate through the available choices. An expert in the WAV business will conduct a needs assessment with you. For example, will your transportation run typically include multiple wheelchair users or a single passenger at a time? Will you serve clients that depend on government funded payments? Do you expect high volume through a broker or are you targeting your own independent contracts? What will the typical driving environment be like? Those are just some of the questions to ask and answer before purchasing your vehicle. Your answer will drive decisions such as whether you’ll invest in a Dodge, Ford or a Toyota, a rear-entry or side-entry, and if the vehicle must have an ADA compliance package. The bottom line is, a good sales consultant will help you consider the type of vehicle you need to effectively run your NEMT operation. Where to purchase your accessible vehicle is also just as important as what to buy. Private sellers may offer deals that are too good to be true—but you know what they often say about bargains that are too good to be true… Working with a larger volume seller, particularly those with lower overhead such an online retailer, can work to your benefit. They offer expert advice from sales consultants online and on the phone with the ability to offer you a broad selection of vehicles to choose from. A Carvana-like retailer, such as AMS Vans, is most likely able to tailor the best deal for you because it doesn’t have the traditional expense of
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operating showrooms in every city that it serves. Additionally, you can still expect a white-glove service where your vehicle will be delivered to you with the opportunity to review and approve before accepting delivery. Financing options with affordable payments—CHECK, CHECK! Financing is another good reason why you should look to an established retailer. It can offer you solutions that meet your needs in the current business climate and help you utilize it as part of an overall business strategy that’s often overlooked by smaller businesses. Finding a good finance package could help free up your cash flow, especially when you’re dealing with economic uncertainty or want to take advantage of greater purchasing power to shore up the number of vehicles in your operation. As a matter of fact, AMS Vans is currently offering a 90-day payment plan, providing NEMT businesses a 90-day reprieve to make the first payment on all accessible vehicle models purchased that are 4 years and newer, with less than 60,000 miles*. Do you have less than stellar credit? An established retailer like AMS Vans will collaborate with you and help find a solution that will work for your business. *Available to qualified buyers with approved credit applications. Call AMS Vans for details. Reliable service to keep your vehicle(s) running—CHECK, CHECK, CHECK! A long-term partner will support you even after the initial transaction is done. The nature of your business puts miles on your greatest asset and vehicle wear and tear is to be expected. Product warranty is essential so that you may continue serving your community with minimal disruptions. An extended warranty is recommended whenever possible.
Big Solutions for Small Businesses... continued
In addition to warranty, vehicle support goes a long way when your it’s on the road. Not many companies think this far ahead, but a business partner like AMS Vans offers a unique service that every NEMT operator should consider. It offers VMI Assurance, a mobility roadside assistance program. Every one of its vehicles comes with a 1-year complimentary Mobility Roadside Assistance membership, with an opportunity to extend the membership for up to three years. This means that when your vehicle is on the road, your driver and passengers can be assured that assistance is just a call away if the vehicle becomes inoperable. A tow truck will be deployed to take care of the vehicle and a paratransit service will be dispatched to help your passenger complete their journey to doctors appoints, home or wherever they need to go for up to 25 miles. Mobility Roadside Assistance also covers common services such as flat tire repair, fuel replacement and lockouts. As part of the VMI Assurance program, NEMT operators also have access to Wrench Fleet Service where certified auto technicians will perform vehicle maintenance and repairs that range from routine services such as oil changes and tire rotations to more complex repairs. It will also provide service to help maintain the wheelchair accessible ramp system. With Wrench, auto technicians provide the convenience of coming to your place of business to perform the work anywhere where Wrench is available. Find out if Wrench is offered in your city: www.wrench.com/city Wrench offers 20% off first service for AMS Vans customers. Look ahead and know that success is possible with a reliable partner at your side. There’s no room for fair weather suppliers/business partners in NEMT. You have a dream to run a successful NEMT operation, and you can rely on business like AMS Vans with a proven track record to be there with solutions that work for you. For more information on any of the products or services offered by AMS Vans, visit https://www.amsvans.com/wheelchair-vans/commercial or call 800-775-8267. For information on fleet purchases, please contact Jason Stempin at jasons@vantagemobility.com or (314) 396-9322.
The public health impact on society and the economic impact of the novel coronavirus (“COVID-19”) on most businesses and on the entire transportation industry has been nothing short of catastrophic, putting it mildly. This new normal is beyond surreal. Our world in general, and the mobility world, specifically, will never be the same again. In just a few short days, business dropped to a stand-still and most transportation companies have ceased operations, laid-off employees, deactivated drivers, received account and event cancellations or bill collection deferment requests, and parked their vehicles on lots – as they struggle to manage cash flow and reduce costs to a trickle in order to live to fight another day. For non-emergency medical transportation (“NEMT”) operators, business was down by one-half across the nation just two weeks ago, and it has become considerably worse since then. Government contracts have provided some business, but the reduction of non-essential trips has impacted the industry. In addition, national and regional NEMT brokers have canceled shared rides. With the reductions in the number of overall trips, the “pie” has shrunk further and taxicabs and other for-hire vehicles that contract to provide trips have seen their services evaporate. It is possible that NEMT providers that wish to engage in other forms of transport outside the continuing critical services – such as dialysis patients – those opportunities may be coming available as the crisis hits certain hotspots and private and public entities will need such vehicles and services to move around patients, health care and emergency workers (as in now happening in NYC). COVID-19 reactions, facts, policies and the true extent of the threat are a constantly moving target, changing on a daily or hourly basis. Since this is the first time in modern history anything like this has happened, many NEMT companies and their vendors, clients, and suppliers did not have contingency plans in place and everyone is making it up as they go along – often, by reacting to news events and official guidance. In order to fill this information gap, the Transportation Practice Group that I chair at the law firm of Windels Marx put together a comprehensive including the following disciplines:labor and employment, tax, contracts, finance, civil rights, torts and insurance, regulatory and legislative. The webinar was held on Friday, March 20, 2020, entitled “Emergency Webinar on COVID-19 Transportation Industry Risk Mitigation & Resiliency” and can be viewed for free, on demand, at this link: https://bit.ly/3duv3PF Also, the following document were prepared to be used as resources for the coronavirus pandemic, as explained in the webinar:
By Matt Daus, Esq., Partner and Chairman, Windels Marx Transportation Practice Group
COVID-19 Resource Guide for Transportation Companies (https://bit.ly/3bnV9l8); Frequently Asked Questions (FAQs) by Transportation Companies About COVID-19 (https://bit.ly/2WHp43N); and COVID-19 Risk Management Checklist for Transportation Companies (https://bit.ly/39cKRDg). In addition to the above resources which help mitigate risk and assess the duty of care to avoid litigation that may spring-up to hurt NEMT providers, the most important and urgent issues that providers have been dealing with in the last two weeks are the federal, state and local emergency grants and loans that have been released. Below is a brief description of the three (3) Federal programs that were released that NEMT companies should look at to provide some immediate cash relief to retain payroll, pay expenses, and try to get through the next few months. In addition to these programs, many states and localities are developing their own relief programs, so you should check these sources as well. As a courtesy to NEMTAC members, my law firm is providing free advice on answering grant and loan questions and has developed a COVID-19 Transportation Law hotline to answer questions around the country –212-237-1106; or email your requests and questions to mdaus@windelsmarx.com and we will respond promptly. The U.S. Small Business Administration (“SBA”) has funds available for small businesses affected by COVID-19 through the Paycheck Protection Program (“PPP”) and the Economic Injury Disaster Loan (“EIDL”), which includes an Emergency Grant of $10,000. These programs and other benefits are briefly described below, and we have just released FAQs for the CARES Act PPP as well as a Checklist & Worksheets to help NEMT providers apply: Paycheck Protection Program (PPP) Frequently Asked Questions (FAQs) for Transportation Providers (https://bit.ly/3aR78If) ; and Paycheck Protection Program (PPP) Document Checklist & Worksheets (https://bit.ly/3aR78If).
Navigating the COVID-19 Pandemic... continued
CARES Act – Payroll Protection Program The Coronavirus Aid, Relief, and Economic Security Act (the “CARES” Act) enacted on March 27, 2020, included the PPP loan program, which offers up to $2 million in forgivable, low-interest loans to businesses with 500 or fewer employees, including sole proprietorships, independent contractors, and self-employed persons. This loan is designed to provide a direct incentive for small businesses to keep their workers on payroll by providing loans that will be completely forgiven if used to cover payroll costs, payments on interest on mortgages, rent, and utilities for eight weeks after the loan is made provided they maintain or quickly rehire full-time employees and maintain salary levels. PPP loan payments will be deferred for six months, but interest (1% fixed rate) will continue to accrue on the loans during that time. Loans are due in two years. The U.S. Treasury said the loan funds will be issued on the same day the loan application is approved. The PPP loans are available directly through private lenders, who began accepting applications on April 3, 2020. The last day to apply and receive funds—assuming there are still funds available—is June 30, 2020. CARES Act – Extension of EIDL SBA Loans The CARES Act also extended the eligibility for SBA EIDLs, which were part of the first federal stimulus package enacted on March 6, 2020. The EIDLs are loans to businesses with fewer than 500 employees, including individuals operating as sole proprietors or independent contractors. Within three days of applying for an EIDL, applicants may receive an advance of up to $10,000 that does not have to be repaid used for maintaining payroll, paid leave, increased costs due to supply chain disruption, mortgage, utility, or lease payments, or repaying obligations that cannot be met due to revenue losses. EIDLs provide up to $2 million at 3.75 % interest, plus principal and interest deferment for up to 4 years. Unlike the PPP loan program, the EIDL is processed directly through the SBA, and approval is based on an applicant’s credit score. No personal guarantee is required for loans under $200,000, but loans over $200,000 must be guaranteed by any owner who has at least a 20% interest in the applicant. The EIDL program offers emergency grants of $10.000 which will be made through December 31, 2020, and funding is limited. Businesses that received an EIDL between January 31, 2020 and April 3, 2020, can apply for a PPP loan. While using an EIDL loan to cover for payroll costs does not affect eligibility for a PPP loan, the PPP loan must be used to refinance that EIDL loan. Also, proceeds from any advance up to $10,000 on the EIDL loan will be deducted from the loan forgiveness amount on the PPP loan.
New NEMT providers have begun doing business all over the country but are wondering how to directly bill insurance companies for medical transportation services. This article discusses NEMT Billing 101 including what needs to be done to bill regulated payers, commercial payers, facility payers and patient (private) pay. It all Starts Here Working with payers requires an NPI number. The National Provider Identification (“NPI”) is a 10-digit number that is recognized nationally. The NPI is used to submit claims (which are requests for payment) or conduct transactions specified or required under HIPAA (the “Health Insurance Portability and Accountability Act,” a law that governs privacy and security of patient information). An NPI number is needed for the following: Bill any kind of third-party payer (Medicaid, Medicaid managed care, commercial insurance) Submitting information about patients electronically NPI may be used to check a patient’s eligibility for transportation benefits An NPI can be requested online by clicking here. The application process takes 20 minutes. Once the application is complete, it should take approximately 10 days to receive the NPI number. Billing Transport Brokers Many who need transport are on Medicaid. Medicaid will pay for some transport services, but the rules need to be followed. Medicaid is managed by the state where service is provided. Most states have their Medicaid transportation managed by a transport broker. There are numerous transport brokers – LogistiCare, MTM. FirstTransit, etc. It depends where service is provided as to what transport broker covers that area. To learn who to contact, go to your state’s website and look up non-emergency medical transportation. If the information is not easily found on the website, contact your local state representative’s office. The state representative will be a valuable resource to navigate state issues.
By Maggie Adams, President, EMS Financial Services
Scheduling trips is done through the transport broker. The patient may schedule their service directly through the transport broker. In other cases, the facility (nursing home, hospital or dialysis center) may arrange the patient’s transport. But before the trip gets assigned to an NEMT provider, the broker will require the provider enroll in their network. Each transport broker has its own process. Once that process is complete, trips are likely to be given to you. There are many good software programs available to help schedule rides and bill for the transport. These scheduling software vendors have participated with NEMTAC and are committed to the future of non-emergency medical transportation including: Kinetik,WellRyde,MediRoutes,TripSpark and others. Check the NEMTAC website to see the names of companies that are involved with NEMTAC for ideas of the best fit for you. Billing Commercial Insurance Commercial insurers (like Medicare and Medicaid managed care plans) may cover NEMT, but they want to manage the process. In other words, they look for providers to “participate” or be “in network” with them. Network participation with a commercial payer requires a provider to contract with the payer and accept their rates for payment. There is not usually room to negotiate with the payers as their rates are regulated. Commercial payers require the submission of a claim form which must be properly completed. Commercial claims forms can be mailed, but the preferred approach is to submit electronically. If you plan to do a large amount of billing to commercial payers, it would be a good idea to investigate companies that can help with the electronic submission of claims. Patient Billing / Self-Pay Patients There are patients who will arrange transport and want to pay direct. There are options to collect payment at the time of service.Be careful!
NEMT Billing 101... continued
There are state laws that govern when you can bill patients directly for some types of transport. If the law does not prohibit patient payment, then proceed to collecting payment. It is not advisable to send an invoice to a patient. It takes time to invoice, software is needed to create an invoice and track it, and then there is the wait to get paid. There is a risk of never getting paid. Transportation is like catering – once is food is eaten, the caterer has no more “stake” in getting paid. It is better to collect at the time of service. Providers can accept credit cards for payment, but there is a process that must be done through your bank which takes time to establish. Easier might be the options to get paid at the time of service like PayPal (easy to set up). Apple Pay work with Apple devices. Venmo is a quick way to send cash. The same is true of Zelle. Square is a smart-phone app whereby drivers could take the rider’s credit card whereby drivers could take the rider’s credit card information on the spot. Investigate the different routes to payment to see what works for your company. Healthcare Facilities Nursing homes, assisted living centers, schools for the handicapped or dialysis centers may want to contract directly with NEMT services. The facilities need reliable, timely service. When billing the facility, learn what they require on an invoice and do it. It is the best approach to getting paid. Follow-up routinely (at least once a month) for payment. Learn who processes the bills and develop a close working relationship with that person or department. Facilities have been known to delay payment. NEMT providers cannot afford to let that happen. Address prompt payment in your contract with the facility. Compliance Once providers get paid, they want to keep the money. In order to do so, compliance must be maintained. Millions of people use NEMT which is paid for with taxpayer dollars. That means there is federal and state oversight of how those taxpayer dollars are spent. Know the rules and maintain compliance. No provider wants to face a concern about fraud. Doing things right is the best way to get paid and keep those payments! About the Author: Maggie Adams is the president of EMS Financial Services, with over 25 years’ experience as a business owner and reimbursement and compliance consultant. Known for a practical approach and winning presentation style, Maggie has worked with medical transportation providers and billing companies of all kinds to provide auditing services, assess their billing for best practices and support their billing and documentation training efforts. “Like” EMS Financial on Facebook, follow us on LinkedIn or for more info, contact Maggie directly at maggie@ems-financial.com or visit www.ems-financial.com
By Kennedy Petersen, Head of Communications, VectorCare
VectorCare, a patient-care logistics company, and NEMTAC are stepping up and collaborating on a new initiative for COVID-19 services. As the spread of COVID-19 surges throughout the US, there is a marked shift in how to prioritize patient care delivery. Hospitals and healthcare facilities are now becoming infection hot spots, and even routine outpatient appointments pose a risk of infection for patients. To put it simply, the American healthcare system needs to switch to a “hospital-at-home” home health strategy, delivering services to the patient’s residence when possible. We need to collectively slow patient traffic in facilities and turn down the heat of infection hot spots. As the COVID-19 crisis could last upwards of 6-18 months, it’s not going away anytime soon. It’s crucial that our communities work together to re-imagine how we engage with each other, and help patients without overwhelming hospital services. One clear method of bringing healthcare operations to a patient’s home is the home-delivery of COVID-19 tests. Rather than impacting hospitals, NEMT Providers should work with local hospitals to visit patient homes and administer swab tests on-site. VectorCare has partnered with a large nationwide hospital system to begin utilizing this model, with great success since the program launched. Hospital staff take patient calls, use VectorCare to record patient symptoms and triage severity, then broadcast the testing request to local providers who are certified to perform at-home testing and follow safety protocols. Patients are able to receive fast results from their COVID-19 tests, without risking harm to themselves or others by visiting a healthcare facility in-person. However, the “Hospital-at-home” movement extends far beyond COVID-19 testing. NEMT Providers should be prepared to provide a range of at-home patient services: home-health visits, prescription delivery, DME delivery, and more. This new care delivery model prioritizes patient health without sacrificing any of their needed healthcare services.
Opportunity to Serve during COVID-19
Opportunity to Serve during COVID-19... continued
VectorCare is building a network of NEMT providers throughout the US who are willing to help provide COVID-19 testing and auxiliary services to patients. Once providers sign up for a free VectorCare account, they have access to dispatch tools and the ability to receive service requests from local healthcare facilities electronically. As VectorCare builds its national network of providers, we’re working to connect NEMT providers with local hospitals in their area who need assistance. VectorCare will also waive any transaction fees on the platform related to COVID-19 testing. David Emanuel, VectorCare’s CEO and founder, states the reason for starting this campaign: “People are under-prepared. There’s a strong need to think of new ways to coordinate care delivery, and technology can play a huge role. We’re all in this together, and we need to step up and do what we can”. On the hospital side, VectorCare is building a suite of COVID-19 modules which help healthcare facilities manage a surge of COVID-19 patients, and the services they require: a COVID-19 command center which offers a map with bird’s-eye view of all COVID-19 patients in your area (as well as granular patient-specific information), plus remote drive-through testing modules with iOS support, and more. To sign up to be a part of VectorCare’s NEMT Provider network for at-home health services, sign up at www.vectorcare.com. VectorCare will provide free training to all new users, along with free platform usage related to COVID-19 testing. The faster and more widespread we can test for COVID-19, the better we can support our communities, and our local hospitals to halt the spread of this virus.
Boom. Out of nowhere, a crisis hits your company or community. As the leader, everyone’s turning to you. In part to see how you react, but mostly for instruction confirming how they’re supposed to respond. Everyone’s turning to you for answers- but that’s the last thing you should be doing during the first 24 hours of a crisis. Your job the first 24 hours is to ask questions, and to avoid giving answers. The first questions you ask should be directed to your employees. What do they need to deal with the immediate problem? How can you help get them the help they need, quickly? These questions not only demonstrate your support to your team but instructs them to take action. The next set of questions are to gather information. How many people were initially, directly affected by the crisis issue? Follow that with questions about how to prevent new victims from being negatively affected by the same crisis in the coming hours. These questions upfront are necessary to gather the information you need to make strategic decisions and ultimately later, proclamations for the future. Even when talking to reporters, customers or the public, you should still focus on asking questions during the first 24 hours, not giving answers. During the first 24 hours avoid making declarative statements or accusations against others that commit you or your company to certain actions. Avoid giving definitive answers or suggesting long-term solutions that could be considered controversial as your statement will come across as opportunistic instead of as a genuine solution. The only initial statements you should make are holding statements. Otherwise, you essentially should be rephrasing and sharing the questions you asked your staff and the answers you were given. Basically, you’re going to say that your team is still investigating details of the incident to make sure it never happens again, but your immediate priority is to better understand the full impact to those effected and how best, and most quickly to help them.
By Josh Weiss, Owner, 10 to 1 Public Relations
Communicating During a Crisis... continued
It’s only on day two, after more facts are known and cooler heads prevail, that you can start delivering answers and rallying support for specific actions. If there’s a general uproar over the crisis, you can also ask rhetorical questions. For example, if the crisis is a criminal act made against your company, ask aloud who would do such a heinous thing effecting so many. Share in the public outcry and frustration but be careful in pointing blame outwards if you suspect a member of your team might be involved. As the leader, your job when a crisis hits is to ask questions and support your teams in resolving the immediate threat. After the immediate pressure of the crisis subsides, your job refocuses into identifying what caused the problem and initiating a long-term fix to avoid a repeat of the crisis and regain the confidence of your customers and the public. A fantastic example and story of how to deploy the 24 hours of questions before providing answers strategy can be heard in a podcast called Without Fail where in an episode featuring Dayton, Ohio Mayor Nan Whaley talks about the immediate aftermath of the mass shooting outside a Dayton entertainment area called the Oregon District. Here’s a link to the episode, including a transcript of the discussion: https://gimletmedia.com/shows/without-fail/v4h8ow
By Michael Shabkie, NEMT Industry Advisor
This article originally appeared in Transportation Insights These are trying times. In less than three weeks, COVID-19 has changed the way we live and work. NEMT providers, large and small, have had to quickly adjust to unprecedented challenges, including having to dramatically curtail operations or completely shut down. Initially, State and Federal orders were not clear on NEMT transportation being deemed as essential and life sustaining. Fortunately, over the past two weeks, The Transportation Alliance has been hard at work for the industry which is now being seen as an invaluable healthcare partner. COVID-19 came in like a tidal wave and has forever changed our perspective on contagious diseases and the economy, but all hope is not lost for the innovative NEMT provider. There are significant opportunities for providers to thrive during this crisis. NEMT companies across the nation are taking a second look at how they’re best positioned to support their local healthcare system. Owners and operators are looking at how their current operations can be improved upon to ensure the safety of their employees and those in need of medical transportation. Now, more than ever, it’s important for companies to understand the environment they’re living in and adapt quickly to it. These are the organizations that will not only survive during the pandemic but may get ahead of their competition. Many healthcare plans and public health organizations are starting to seek out NEMT companies that can pivot and provide more than just medical transportation services. Services that are currently being sought out include: At-home testing of health plan members Transporting medical personnel between facilities and emergency treatment sites Delivering food and/or groceries to an at risk population Prescription deliveries At home telehealth visits and wellness checks Routine transportation to alternative clinical or testing sites The first step in obtaining these types of alternative transportation requests is to successfully communicate your ability to operate at a high-performance level and instill confidence in the organizations that are seeking out medical transportation partners. The next step is to schedule meetings with the organizations you currently contract with to reiterate your capabilities and share your willingness to partner with them on innovative solutions. Adapting your company to the current situation and marketing your solutions with COVID-19 in mind will ensure your services are relevant as this crisis evolves.
Emerging Opportunities for NEMT Providers... continued
National NEMT Provider Database One of the more important areas that NEMT Providers can help make a difference is by providing teams/individuals to help with at-home testing for COVID-19. Home testing allows for individuals to be tested for COVID-19 without leaving their residence and infecting a wider range of people. VectorCare, a California based healthcare logistics technology company has developed a national NEMT provider database to connect providers with hospital systems that are in need of expanding their transportation services.If your company has the resources to help perform at-home testing or other types of services noted in this article, please fill out this form and a VectorCare representative will be in touch to connect you with your local healthcare providers that are in need of your services. Preparing for the End of the Crisis As unprecedented as this event has become, there will be a day when this crisis is over. The pent up demand for transportation services will be extraordinary. The volume of elective procedures cancelled, medical appointments rescheduled and care facilities resuming their operations will create unparalleled opportunities. Using this time to improve internal processes, connecting with facilities to ensue there is a transportation plan in place once services resume and educating your staff are all great strategies to position your company for a dynamic return to full operations. Business Continuity Loans Finally, as a small business owner it is important to understand the $349 billion Paycheck Protection Program that is meant to "pause" the financial impact of operating in the time of the coronavirus. It’s part of the $2 trillion federal COVID-19 stimulus package, passed last week by Congress. The program is intended to be a bridge loan that covers up to two-and-one-half-months of payroll, rent and utilities. If it used for those purposes the loan will be forgiven. A great overview of the program can be found here: http://ow.ly/hcZ950zb5Ot We Are All in This Together As we are seeing almost daily, the “new normal” is a moving target. As a valued component of the healthcare system, NEMT provides are uniquely positioned to fully integrate into their local communities during this time of crisis. Now more than ever, it is vitally important to support the efforts of the Transportation Alliance. Their leadership is working day and night to ensure the viability of their members and to communicate on a national level as to how “essential” each and every one of their members are to the communities they serve. Stay healthy, stay safe and know that we are all in this together.
Sponsored Content If you've been in this industry for any length of time, you know that NEMT is bigger than transportation. It's about serving your community and helping those in need. RoutingBox was created by people who understand being in this field comes with the responsibility to take care of your community and all the residents who need you. It is part of our mission to make sure all transporters are able to serve their communities to the best of their ability. It is that reason our software has additional features, which not only makes your job as the transporter easier, but are also intuitive and user-friendly for your passengers and those responsible for getting their rides scheduled. Client Link App The Client Link App gives your passengers an unprecedented on-demand experience in the NEMT space. The App helps increase ridership, be more transparent, and streamlines communications. Client Link is RountingBox-powered technology with your company's branding. This means when your clients download the App, they won't be downloading "Client Link from RoutingBox" they'll be downloading "Your Company Name Here." The branded Client Link App is improving passenger relations and streamlining daily operations for transporters across the country.
By Becca Fields-Poniskaitis, Marketing Strategist at BiTS-Creator of RoutingBox
RoutingBox Helps You Serve Your Community... continued
Reduced No Shows and Cancelations: The App sends push notifications and reminders to your passengers, so they don't forget about their scheduled trip. It lets them know when their driver is on their way and how far away they are so that they are ready when the driver arrives. Decreased Inbound Calls: Will Call passengers will no longer have to make a phone call when they're ready for pick-up. They alert dispatchers that they're ready to go by tapping a button on their device. This alert is sent to your dispatcher's RoutingBox, so they can send the best driver immediately. Shorter Wait Times: With the App, passengers can track the vehicle that is coming to get them. This eases the passenger's mind and helps them be ready when the driver arrives to pick them up. This keeps your fleet running smoothly and on time, while also improving your level of customer service. Improved Rider Satisfaction: By simplifying the process for managing their trips, passengers have an effortless and worry-free experience. Your passenger and caregiver experience improves dramatically because the Client Link App give them autonomy and peace of mind while also helping you run your business more efficiently. At the end of the day, the more efficiently you can run your day-to-day, the more effectively you can serve your community. The Client Link App is an extremely popular option for adult children caring for their aging parents. With careers and families of their own, it is difficult to drive parents to appointments and errands. For them, having the ability to schedule their parent's trips on their phone and track them throughout the trip is imperative. While the need to better serve our passengers has always been at the forefront of our minds and businesses, it is impossible to better serve our communities if we aren't considering the best ways to alleviate unneeded stress to our community's caregivers. A common struggle is getting patients home after receiving care. If caregivers cannot easily get a trip scheduled for their patients, their ability to do their job to the best of their ability may be stifled.
Facility Portal The Facility Portal gives hospitals and other care facilities an easy, simple, and seamless way to book transportation for their patients with your transport company. Asking nurses or technicians to step away from treating patients to find your phone number, call , and book a rider for a patient over the phone is a much bigger ask than most realize. By simplifying the experience, healthcare providers will do more business with your company and you will better serve your entire community. Similar to the Client Link App, the Facility Portal is RountingBox-powered technology with your company's branding. The portal will be set up specifically for the facility you're working with and from there login credentials can be set up for facility employees.
Decreased Inbound Calls: Hospital workers will no longer need to call in to book transportation for patients. They book rides for patients through the Facility Portal. A booked ride appears in your dispatcher's system as a Will Call, and they will send the best and closest available driver immediately. Shorter Wait Times: With the Facility Portal, hospital workers track the vehicle as it approaches to pick-up a patient. This eases any patient and the hospital concerns about arrival times. Improved Rider Satisfaction: Being in and out of the hospital is stressful. Getting to and from the hospital should not be. With the portal, Hospital staff can focus 100% of their energy on providing care and keeping patients from being stressed out about a ride home. The Facility Portal helps you do more business with hospitals and other care facilities because of it's simplicity and ease of use. The less we stretch the bandwidth of caregivers, the higher the quality of care patients will receive. If you're like our family of NEMT companies, you got into the business because you have an opportunity to provide a much-needed service for your community. People need to get to their appointments safely and promptly. You also have to run a business efficiently and provide the best possible customer experience. The web-based and mobile tools from RoutingBox are helping meet all these goals for businesses and communities across the nation.
Where does your NEMT business come from right now? It’s probably a mix of: NEMT Transportation Brokers Directly from employers for workers’ compensation providers; Health insurance companies; Referrals from physicians and healthcare facilities, or Customers finding you themselves. Another source of business are third-party healthcare organizations known as ancillary service companies like our company, HOMELINK. Ancillary service companies coordinate numerous services for worker comp and group health insurers, with non-emergency medical transportation (NEMT) being one of them. As a NEMT company owner or operator, ancillary service companies can be a beneficial addition to your current revenue stream. But how do you ensure working with them will be worth your time? We wanted to provide a “how-to” guide for providers to help know what questions to ask an ancillary services provider. Here are some common questions our Provider Relations team is asked by NEMT providers. Credentialing and Provider Expectations You need to understand what the organization requires and expects of you as part of their provider network. A couple of key questions here: What does the credentialing process look like? What specific expectations do they have of transportation providers? Provider Selection Process You also need to understand their process for choosing which provider receives an order. This helps ensure you are doing the right things to receive referrals. Do they choose based only on price? A lot of organizations choose the lowest cost provider, which may be a rideshare service if availability exists in the area. However, rideshare is not always the most cost-effective option for ambulatory NEMT and is rarely an option for elevated levels of transportation such as wheelchair or stretcher services. How much does customer service factor into their choice of provider? Some ancillary service companies, HOMELINK included, are willing to pay higher rates for better service. They see the patient’s experience as the most important factor, that happy patients mean everyone wins. Do they use a quality assurance process to rate or prioritize providers? Again, customer service-focused organizations usually do.
Working with Ancillary Service Companies... continued
For you, that makes the equation pretty simple: Consistently providing great service = more referrals. Providing great service also increases your chances of being used for patients who have multi-trip needs for an extended period of time. For example, a patient may need physical therapy three times a week for four weeks, while another patient may require weekly trips for pain management for months or even years. Do a great job on the first trip and you increase the chance you will chosen to provide services for all the remaining trips. Communication Accuracy is crucial in NEMT, so it’s important to understand how the organization communicates with dispatchers and drivers. When are staff members available to talk? Do they have after-hours or 24/7 staff? Rides can start early in the morning or take place at night outside of “normal” business hours, so being able to communicate directly with ride coordination staff is crucial. Do they have internal benchmarks for communicating with their providers? No one likes to be left waiting or feeling like they’re in the dark. Do you receive patient notes for stretcher or wheelchair transport where detailed information helps you provide better service to the patient? This isn’t always a given; some organizations simply coordinate the ride and give you a name. Do they have bilingual staff or access to interpreters for your drivers or for bilingual patients? This helps prevent situations where communication is difficult because of a language barrier. Additional questions you should ask about communication processes: What channels do they use for communicating with providers? Will you get a real person, or do they make you go through an automated voice system? How quickly can rides be coordinated?
Rates and Payment Terms You have to know how payments will work and how you will be compensated. Your company is providing a valuable service for patients and injured employees. Consider it a red flag if the third party is hesitant to share that information. Do they have contract rates? Once you go through credentialing, you will start to receive referrals. However, you will have to negotiate rates for every trip you provide. The benefit of contracting is that you know exactly what you’re paid every time. This takes less time and makes it easier for you to predict cash flow. How soon after a trip will you receive payment for your services? The timeline usually depends on how quickly the organization is paid by the insurance company. Some companies use “pre-pay”, in which they pay you in a predetermined number of days (30-45 days is reasonable) whether they’ve received payment from insurance or not. Do you still get paid if you dispatch a driver, but the patient/injured employee doesn’t show or cancels the ride? This question is really asking if the organization is willing to do right by the provider. In this situation, you are counting on this revenue, and have already committed resources to provide the trip. It’s a definite red flag if the organization doesn’t have a rate for no-shows or canceled rides. Additional questions to ask about rates and payments: How do they keep rates consistent from order to order if you don’t sign a contract? How are rates negotiated in urgent or unusual situations? And are they honored from that point on? Third parties like ancillary service companies can be great sources for new and recurring business. Thoroughly vetting these organizations helps you make a more informed decision as to whether you join their provider network and integrate them into your transportation business. Contributing Authors: Amanda Bovy, Dir. Of Network Development – Transportation & Language | HOMELINK Alissa Becker, Operations Manager | HOMELINK Abby Lis, Operations Manager | HOMELINK Ryan Longhorn, VP of Operations | HOMELINK
By John Boit, Executive VP, The Transportation Alliance
The world has been disrupted by the COVID-19 pandemic, and with it, the transportation industry. In early March, The Transportation Alliance (TTA) canceled its Spring Conference & Expo for the safety of all of our staff and registrants. This was the first time since 1917, during the gas rations of World War I, that our association had to cancel a conference. Our industry remains especially important in these disrupted times. As an integral component to almost every facet of the American economy, transportation services deserve the same amount of economic safety and categorization as all other essential businesses and critical infrastructure in this challenging and unprecedented time. That is why our team has jumped into immediate action to tackle this pandemic on the legislative front. In a historic first, TTA joined six other major passenger ground transportation trade associations in signing an unprecedented industry letter to President Trump and Congressional leaders asking for $12 billion to save this essential national infrastructure. The letter, sent on March 19 to the White House as well as to Senate Majority Leader Mitch McConnell and House Speaker Nancy Pelosi, laid out an eight-point plan for saving companies who operate a variety of transportation, including non-emergency medical trips, paratransit, taxis, liveries, ride share, buses and shuttles. The eight points are: Deem the industry a national “essential service.” Provide $12 billion in immediate cash grants to fleet operators to provide industry relief. Ensure guaranteed vehicle loan deferment/forbearance for at least 120 days. Declare the industry is eligible for zero-interest SBA loans and ensure such loans are made available within two weeks of application, with no payments due for six months. Mandate that all government accounts with transportation companies be paid within five days of billing. Require insurance companies to suspend auto liability premiums on passenger transportation vehicles pulled out of service, without requiring transportation companies turn in their license plates. Allow operators to postpone real estate tax payments as well as vehicle fuel and utilities payments such as phone, electricity and internet services, without penalty or disconnection. Open a pipeline to cleaning products to ensure vehicles are regularly sanitized, and to help our industry promote the safety of our services. Meanwhile, in an historic move, the U.S. Department of Homeland Security (DHS) has added the for-hire transportation industry to its list of “essential critical
infrastructure workers,” a vital designation for fleet operators amid the COVID-19 pandemic. The designation comes after The Transportation Alliance sent an urgent letter to DHS Acting Secretary Chad Wolf on March 25. “Mr. Secretary, in order for us to fight this invisible threat, all private sector transportation companies are at your disposal,” TTA President Thomas P. Arrighi wrote in his March 25th letter. “Each vehicle represents an essential piece of equipment in our nation’s toolbox as we work together to end this deadly virus.” This is the first time the private sector, for-hire transportation industry has been explicitly named as part of the nation’s critical infrastructure at the federal level. Specifically, the newly added provisions cover: Employees supporting personal and commercial transportation services – including taxis, delivery services, vehicle rental services, bicycle maintenance and car-sharing services, and transportation network providers. Bus drivers and workers who provide or support intercity, commuter and charter bus service in support of other essential services or functions. “We are grateful to Secretary Wolf and his team for this extremely important designation,” President Arrighi said. “To see such swift action means that our affiliated drivers, employees and teams will be on the street when America needs us most.” While the Homeland Security designation does not carry the force of law, it does bear significant weight in making the case to states about what may constitute “essential businesses.” This is of particular importance as more and more states enact stay-at-home orders. As of March 25, nine states had already declared transportation companies as “essential businesses.” In a strategic effort to urge other states to do the same, TTA
TTA Springs into Legislative Action... continued
called upon its members to contact their respective governors to demand action be taken. The letter that TTA drafted for its members included the following key points: The industry continues to provide non-emergency medical transportation (NEMT) to bring those with severe health issues to life-saving doctor appointments. Among these are daily or weekly trips to dialysis centers for people with kidney disease or chemotherapy treatment for cancer patients; the transportation of low-income citizens living in food deserts to grocery stores and pharmacies; transportation for those struggling with substance abuse and mental health issues to the care they require; The industry continues to provide services for the disability community with an ample supply of wheelchair vehicles meeting ADA requirements. Instead of transporting special need students, schools are now depending on the industry to deliver subsidized meals to the homes of low-income children. Taxi and livery services are increasingly being called upon to offer food delivery from grocery stores and restaurants. Given the current trajectory of the virus, ambulance fleets could quickly be overrun with hospital trips. The transportation industry is needed to transport those patients who, while ill, do not require an ambulance. Larger vehicles such as shuttles and buses are already being used to ferry health care workers to the front lines of the coronavirus battle: our hospitals and healthcare facilities. These vehicles offer the ability to safely distance passengers per CDC-recommended guidelines. Airline and railroad crews continue to need transportation services as they move goods and people across the country. As transit services are reduced, the industry helps meet citizens’ unscheduled transportation needs In addition, TTA has sent a letter to the U.S. Department of Health and Human Services asking that the industry be added to the list of the nation’s “critical infrastructure,” a designation that can help direct assistance and allow services to continue during times of crisis. That letter also specifically calls for increased access to Personal Protective Equipment, which is important in order to keep drivers safe as the virus spreads. Meanwhile, believe it or not, the wheels of government have still been turning, and we are pleased to report on movement in our efforts to protect NEMT services from being cut from Medicaid. This bill, H.R. 3935, would guarantee that Medicaid will always fund NEMT trips. The bill has now moved out of the subcommittee in which it was being worked on, and now moves
to the full House Committee on Energy and Commerce. This bill is critical, considering ongoing efforts that seek to take this Medicaid benefit away from millions of people, and allow states to decide for themselves how to meet the NEMT needs of their citizens. Rep. Buddy Carter (R-GA) and Rep. Sanford Bishop (D-GA) have been staunch supporters of this effort to protect Medicaid-funded NEMT. We look forward to their continued leadership on this issue that is so vital to millions of Americans. Our legislative work is crucial to the transportation industry, and now is the time for every company to be involved. Collectively, the transportation industry moves 3 billion passengers a year, approximately the same total number of passengers moved by the equally vital airline industry. Yet the airline industry is dominated by a few major corporations. Our industry is made up of thousands of companies, both big and small. Together, we are part of the essential business fabric that moves America. Let’s learn from one another in these challenging times, and let’s raise our voices together. If you aren’t a member of The Transportation Alliance, I urge you to do so now. Membership gives you access to legislative briefers and timely updates that will help you navigate the assistance packages coming from Washington. It gives you access to some of the brightest minds in the business through our exclusive member-to-member app. And it gives you access to valuable discounts, from our own TTA conferences to special offers on purchases of vendor services. Find out more about how to get involved on our website. I wish you all the very best in these trying times. Our association has been here for 103 years. We are her for you now, and we will be here in the future when this is all over. Be well, stay safe, and let’s get through this together.
While I am quite certain all medical transport programs share the mission of providing safe, quality patient care, I am fairly certain all medical transport programs have MULTIPLE missions. These others missions likely include financial considerations to clients/insurers, supporting the growth and development of their staff, and business development and growth. In order to complete a mission (though they are never really accomplished, are they?), there is a fair amount of behind the scenes work that takes place. The day-to-day focus is that of moving the patient, finding crew, securing a receiving facility & bed, etc. These operational tasks are absolutely vital to the success of the program. However, while focusing on operations, the mission(s) may be overlooked or put on the back burner. There are many reasons why agencies may not have the administrative staff necessary to fulfill the mission, including identifying the best individual from within the organization or difficulty finding the right candidate. Other factors include finding the time, because operations take precedent. One of the missions of my company, Medical Transport Agency Consulting, is “Supporting Patient Care Through Quality.” This is accomplished by ensuring transport professionals’ training and education are appropriate, according to the scope of practice. We provide the backing needed for all transport programs, including commercial airline repatriation and escort companies. This administrative support is meant to assist with putting systems in place to help the transport agency accomplish their mission(s). From quality management programs to relevant education and training, quality can be applied for all missions. Quality translates to your clients and insurers by providing services in the most financially responsible way. Quality becomes evident in business development and growth by making current and potential clients aware of your other missions and the quality involved. Another mission of ours is ensuring clients are supported in ways that make sense for their transport program. Although the end goal of all transport programs is to move patients safely, not all aspects of the industry are one-size-fit-all. Rural transport programs have challenges and may require different philosophies than urban or hospital-based transport programs. At the end of the day, no aspect of this industry is a one-person job. All leaders have a vision and goals, but simply may not have the tools or personnel to accomplish them. It is our mission to provide them. Jessica Peltz, BSN, RN, CFRN, EMT-P is the owner of Medical Transport Agency Consulting. With nearly 20 years of concurrent air and surface transport experience, she has assisted numerous organizations improve their quality and standards, including accreditation. To learn more, visit www.med-tac.com.
By Jessica Peltz, BSN | RN | CFRN | EMT-P
After the Crisis, What’s Next?
I’m a huge fan of musicals. Love them. While I wasn’t fortunate enough to see it live on Broadway, the Hamilton cast recording was a staple in my house for the summer of 2016. I didn’t have kids, my wife and I were newlyweds and we spent our summer evenings outside, jamming to musical theatre. In Hamilton, after the colonists are victorious at the Battle of Yorktown, there’s a brief interlude when King George has been defeated and he asks a critical question: “What Comes Next”? But unlike King George’s thinly veiled threat to the newly freed colonies, NEMT operators aren’t alone in the next stage of life as we know it. Coronavirus’ aren’t new and it’s unlikely this will be the last global pandemic that we face, though I’m hopeful that we are better prepared for the next one, but as the dust settles and the world starts to return to some sense of normalcy, what do those companies that survived do next? What lessons can be learned from a crisis where the threat was invisible? NEMT operators are going to hear a lot of insurance industry buzzwords coming in the next months. Things like “Critical Incident Response” and “Business Continuity Plan” (if you’re lucky you’ll just hear “BCP” like it’s an everyday thing). You’ll hear industry experts postulate that “Fleet Utilization Studies” will be the key to position your business moving forward. These will be made to be post-crisis mission critical items. So, let’s drop the jargon and boil it down to three specific post-crisis tasks: Use the data you have to your advantage. Take a deep dive in to the trips that populated to you, where they were coming from and if they were completed. This data can help you determine where you want to grow and the performance of your contracts. Understanding what your cancellation and completion rates were will help you to determine your fleet management protocol in times of crisis. As an example, the majority of trips that we have seen completed are from standing order dialysis and cancer treatments because deferring this type of care can be fatal to the patient. Knowing the assets required to complete these life-saving transports will be vital information to transportation providers. Assess your ability to function away from the office. There are a lot of cloud-based solutions that are in the marketplace to make working away from your office easier. Everything from document storage to phone systems, routing and dispatch to fleet management, can live in the cloud. One of my clients was able to virtually ride-along with a newer driver and provide coaching on a near-miss rear-end collision due to their use of AI powered cameras
By Eric Lane, Commercial Risk-National Accounts, Bankers Insurance
that upload trip data and video to, you guessed it, the cloud. Knowing that your back-office employees can continue to perform essential functions to keep your business running can alleviate stressors in difficult times. Schedule meetings with the organizations you contract with to reiterate your capabilities. Successfully communicating your ability to operate at a high-performance level when the world feels like its on fire will instill confidence in the organizations you depend on for revenue. This means creating a document that you can pull off the shelf that demonstrates your thoughtful analysis of what your business does that separates you from your competition. I call this document a Capabilities Assessment and offer one to all my clients – most of them have taken up that offer in the past two weeks. I believe that every risk should be treated with insurance and non-insurance techniques and pandemic risk is no exception. Completing the three suggestions for a post-crisis world can help you treat emerging risks using non-insurance strategies. When it comes to purchasing coverage that may become available to you, I would strongly recommend engaging the services of an expert in both risk management and transfer and the NEMT niche. The ability to balance the insurance and non-insurance treatment techniques are critical when facing emerging risks and working with anybody other than an expert in both will result in sub-optimal outcomes for your business. The COVID-19 disease will pass. How we move forward will determine our long-term success. I hope you’ll join me in continuing to practice social distancing as the crisis abates while taking steps to prepare your business for the next potential crisis. Together, we can support the industry we’re committed to and set it on a course that guides us through good times and bad.
After the Crisis, What’s Next?... continued
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