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Patients losing patience with non-emergency medical transport services

Posted: 11:44 AM, Sep 26, 2018
Updated: 2018-09-27 00:57:11-04
Patients losing patience with non-emergency medical transport services

KEY FINDINGS

  • Tens of thousands of people in Palm Beach County alone rely on non-emergency medical transportation companies to take them to doctor’s appointments, hospital visits and dialysis treatments.
  • Contact 5 uncovered complaints that show many people who depend on the service don’t find it reliable, or even safe. 
  • Many involved in the system have told Contact 5 cost cutting measures are leaving vulnerable people at times stranded, at wrong locations, or not picked up at all.
  • One county commissioner says he wants to strengthen oversight, and the county's ordinances, to empower patients.

The case of the missing mom

"My mom is a 68-year-old vibrant woman. Unfortunately, she fell down with dementia," says Betty Rowlett, talking about her mom Jacinth.

Jacinth Rowlett relies on non-emergency medical transport to get her to and from an Alzheimer's adult daycare center while her daughter is at work. 

Her insurance company pays a transportation broker, in this case, Logisticare. Brokers, like Logisticare then hire the non-medical transport companies. It could be a different company each day, but Betty Rowlett always has the same rules. 

"They are supposed to come to my door, knock on the door, pick her up and put her in the vehicle. Have to hand her to someone at the center. Make sure she is hand delivered to someone else because she can’t be left alone at any time," says Rowlett.

"Sometimes they (the transport companies) wouldn’t come. They would never show up," says Rowlett. 

During one problem transport in 2017, Betty rolled live on Facebook.

"I was at my house and expecting to see my mother come. They brought my mom home. Only it wasn't my mom, it was a man that they brought home," says Betty.

That man came from the daycare center too. Betty recognized him. He also had dementia.

"These people (the transport company) had no clue who they had and where they were supposed to drop him off," says Betty.

Just one week earlier, the broker had called a taxi to take Jacinth Rowlett to the day center. They dropped her off down and across the street, at the Florida Dental Center. Betty only found out because she went to pick up her mom for a mid-day appointment.

"It really made me mad because anything could have happened. I don't want anyone to feel the frustration and the stress and aggravation of what I felt that day so we have to make a change." 

"They come too early"

Aaron Dess was on his way to work, on his motorcycle in 1988 when "somebody ran him off the road, and left him for dead," says his mother Bette Dess. 

Aaron Dess loves to tell jokes, despite his health.  "Head trauma, spinal cord, a double amputee," says Bette.

But his mother says the treatment from some non-medical transport companies is no joke. 

"There's times when they've shown up too late, there's times when there is miscommunication."

And sometimes they come too early. "If his appointment is in 2 hours, why did you pick him up so early and bring him to the doctor and then they have nowhere to put him," says Bette.

Logisticare says that transport companies "as contractually required, have a pick-up window of 30 minutes." 

Bette says some companies wait at the doctor's with Aaron, but most just take him home if doctor's offices can't put him somewhere right away. 

"A transportation provider is not contracted to wait for the member to finish their appointment. The facilities are responsible for having accommodations and stretchers available to transfer members for appointments," said Logisticare when asked. 

Both Betty and Bette worked with their broker, and use only one company from now on, Pro Transportation.

Robert Perez, the Florida general manager at LogistiCare said in a statement, "We apologize to Ms. Rowlett and Mr. Dess for the difficulties they encountered because of every member and ride matters. Many months ago, we learned about the issues and assigned them to new transportation providers to meet their needs. Since then, the members have not reported any additional complaints to LogistiCare. In addition, we followed up with the transportation providers about the importance of meeting their contractual obligations and have continued to closely monitor their performances."

“99.8 percent of LogistiCare member trips were completed in Florida last year without complaint,” added Perez.

Contact 5 asked if brokers have the ability to discipline transport companies. Perez said, "If any performance guidelines are not met, Logisticare implements a corrective action program, including but not limited to: performance improvement plans, liquidated damages or removal from the network."

"I've never seen it this bad"

"There's an old saying, you get what you pay for. And I think that saying came to be when the insurance companies decided to go to a brokering system," said Alex Castro, CEO of Jolly Transport.

He says the brokering system has lowered standards.

"I can have a brand new truck, I can have the best patient service, be on time, but if I'm charging 12 dollars instead of 10, the broker is going to give it to the 10 dollar guy."

In Palm Beach County, non-emergency medical transport companies report that on average, 60 percent of the revenue they receive comes from contracts with transportation brokers like Logisticare, MTM, Secure and Veyo. Reimbursement rates, or rather what they do or don't get paid, is one of their highest concerns. 

"Brokers are controlling everything, and the more they squeeze the money, the more the companies have to find a way to save," says Castro. "And the way they find a way to save starts with safety, unfortunately." 

Castro is able to afford brand new vans and says he goes above and beyond but that's not the same for everyone.

Like not having a cross body belt to strap someone in, or using one man to transport someone on a stretcher. Whenever you have financial issues, the things that aren't mandated or mandatory, are the ones you make exceptions for.

"The system has gotten so widespread with such little regulation, that even taxis can do these calls, " says Castro.

What will the county do? 

There are 26 registered vehicle for hire companies in Palm Beach County.  "I don't know how they can regulate the brokers, but I do know they (the county) can regulate the license they give out and what we charge in this county for these services," says Castro.

For Palm Beach County Commissioner Dave Kerner, this is personal. "I experienced it with my grandmother. Every time there was a doctor's appointment she had to go to, or be picked up from, it was just a constant delay, a constant headache."

"There is an incentive to drive down the price per trip, cost per trip," says Kerner. "Every corner is cut in this process. The quality or lack of quality of the transport vans, and the equipment within the vans was frightening for me. That's as a layperson."

Kerner says the county must do better. 

"We have broad home rule authority to require certain medical devices and equipment on the trucks and the vans. We have the ability to impose requirements on the drivers, in terms of first aid training, hazardous materials training, how to treat patients," says Kerner. "It forces the broker to offer more money per trip."

Kerner has already had meetings with some of the transportation companies and plans to update the county's ordinance to make rules stronger. 

"For a county with such a large elderly population, our ordinance was very, very basic. We internally need to have an ordinance that requires more inspections by our enforcement officers," says Kerner.

Kerner adds, "We want to make sure there aren't a thousand fly by night companies in PBC and that's how I feel we have right now."

The county has 14 registered complaints about the non-emergency medical system on file. ACHA says they took in more than 4,300 complaints from January 2017- August 2018 related to transport. While the agency couldn't say if they were all non-emergency related complaints, they did say they receive "relatively few complaints regarding emergency transportation." 

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A Q&A with a non-emergency transportation broker Logisticare

Q: Transport companies are vetted to meet certain requirements before working with Logisticare. What are those requirements?

A: Passenger Assistance Safety and Sensitivity (PASS) Basic
PASS Wheelchair
Defensive Driving Course
First Aid/CPR Course
Contract Orientation
Billing Training/WellRyde
Driver’s License Check
County Hack License (Chauffeur License)
Motor Vehicle Report
Level II – County and National Background Screening
Medical Screening
Drug Screening
OIG Screening
 
Q: How are rides determined, meaning which transport companies get which trips, which day? Is there a pecking order, or a bidding process?

A: Transportation providers are assisted by our automated system, which determines the providers’ capacity, operating hours, service area and levels, member preference and other factors and then the system assigns trips accordingly.
 
Q: What do the periodic checks look like for the transport companies? Does a representative come out to the vehicles? What is involved in the on-site spot checks? How often are the checks? Are the transport companies told of the checks?

A: As required by the state, we perform annual vehicle inspections. Also, our field team completes frequent, unannounced vehicle inspections of the transportation providers.
 
Q: How does it work when a member asks for a certain company?

A: If we identify reoccurring service issues, we try to assign a new transportation provider for the member, among other options.
 
Q: When would Logisticare take action against a company? Would they take action for late pick-ups?

A: Transportation providers are required to meet performance guidelines including but not limited to on-time percentage of service. If performance guidelines are not met, Logisticare implements a corrective action program, including but not limited to: performance improvement plans, liquidated damages, reduction in trip volume, or removal from the network.
 
Q: How has Logisticare worked to improve services?

A: We continually track transportation providers’ performance and diligently work to identify any opportunities to correct service deficiencies. As noted above, a corrective action plan will be initiated to drive transportation provider accountability and improvement of services.
 
Q: How does a consumer complain? Do they know where to complain?

A: If any member experiences issues with their transportation provider, we encourage them to contact us immediately. We offer multiple ways by which they can do that: directly on our WeCare form [logisticare.com] online or by calling the phone number [logisticare.com] assigned to their individual health plan. The sooner we are made aware of problems, the more effectively they can be resolved.
 
Q: Are there policies and procedures in place for certain crises, like a wrong drop off or late pick-up. If so, what are they?

A: Yes. We have clearly defined processes and a recovery team in place to successfully manage these situations.
 
Q: How often do you use taxis? Do you have contracts with them?

A: We contract with taxi companies for scheduled and recovery trips.
 
Q: Is your contact with the state, specific insurance companies or both?

A: We are contracted with both.
 
Q: Are penalties imposed on transportation providers reported to the managed care organizations, or ACHA?

A: Yes – penalties are reported to either or both (in some instances). Transportation providers will be assessed penalties based on contractual performance requirements.

Q: Do taxis have those same requirements you mentioned for transport companies?

A: Yes. In-network taxis have the same requirements. However, the state does not require the same for out-of-network taxis. These taxis are only used as a last resort if in-network taxis are not available for a recovery trip.  

Q: Does Logisticare have fixed rates for transport companies, or do they bid?

A: LogistiCare has fair market rates that reflect local market conditions. 

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