For many individuals, especially those living in rural communities, a trip to the hospital can be compounded by the inability to access needed transit services home once they’re ready to be discharged.
While a lack of transportation can prevent at-risk patients from receiving critical medical services, limited transit options can also force patients receiving care to needlessly extend their hospital stays. This can increase their medical expenses, take up beds and rooms from other patients in need of medical attention, and prevent them from being speedily transferred to other healthcare facilities.
To help ensure that individuals can safely travel to their homes or rehabilitation centers after leaving the hospital, Monument Health in South Dakota entered into a contract with public transit provider Prairie Hills Transit to provide rides to recently discharged patients. This partnership has benefited both the hospital system and the transit provider by giving discharged patients a safe and reliable way to get to their destinations, while also helping the hospital system better streamline its medical services.
Decade-long partnership allows discharged patients get to their destinations
Launched in 1989, Prairie Hills Transit is a public transit provider that works to give South Dakotans access to the transportation services they need to live their lives. After working with a number of nursing homes and health centers in the state, Prairie Hills Transit was approached by Monument Health in 2011 with an offer to provide the hospital system with contracted transportation services for discharged patients. Headquartered in Rapid City, Monument Health’s network includes five hospitals and 38 specialty centers and medical clinics across South Dakota. Since Prairie Hills Transit operates in the same communities as Monument Health, they are able to handle transportation for discharged patients—particularly those with special medical needs—from all of the hospital system’s facilities when called upon.
Brad Haupt, Monument Health’s vice president of supply chain and contract management, said the hospital system entered into the contract after noting the number of patients who couldn’t find a reliable way to get back home. Haupt said that, while the hospital system also uses local bus and taxi services for discharged patients, individuals who need to travel long distances or those with special equipment couldn’t easily access transportation.
“We had patients who were ready for discharge but didn’t have rides, so they were waiting for a family member to get off work or someone to come from 300 miles away to pick them up,” Haupt said.
In order to better facilitate transport for discharged patients, Monument Health initially purchased Prairie Hills Transit a dedicated bus to carry out its work. As the service became more successful, however, Monument Health purchased two ADA-compliant vans for Prairie Transit to use. Barb Cline, Prairie Hills Transit’s executive director, said that they’re looking at adding a third vehicle and driver in the near future.
“We’ve seen a marked increase in use over the decade,” Cline said. “We started off doing around 10 trips a week, and we’re now averaging about 300 trips a month under this contract.”
Since Prairie Hills Transit is a general public transit provider, in addition to providing medical-related trips, Cline said that they haven’t found it necessary to receive any specialty medical insurance coverage, adding that their current coverage is “very decent.”
To streamline the trips, Prairie Hills Transit receives a host of information from the hospital system about the discharged patients that they pass along to their drivers, including if the person has a wheelchair or oxygen tank, where they will be going, and how far they will be traveling. Trips for discharged patients are also not limited by state barriers, with discharged patients being taken as far away as Omaha and Minneapolis. And while drivers do receive some special training, patients in fragile health are often transported along with a medical escort from Monument Health—known as a patient care champion—in the vehicle to attend to their needs.
“One of the real benefits we also receive from Prairie Hills Transit is that, since a lot of patients come to us in an emergency situation, they require a higher level of care once they’re discharged,” Haupt said. “And since space is limited at these facilities in our section of the state, sometimes we have to take them 350 miles across the state—and that’s where their drivers have really helped us.”
Measuring outcomes for success
In order to maximize the effectiveness of this partnership, Monument Health added two dedicated transportation coordinators to their care management department to work with Prairie Hills Transit’s dispatch team. To ensure that transit services are being directed to the most relevant discharged patients, the hospital system also uses an algorithm to determine whether or not a discharged patient can rely upon local transportation, paratransit services, or a family member to get to their destination. Distance traveled, access to alternative means of transportation, and the medical condition of the discharged patient all factor into the algorithm.
If a trip is within the Rapid City limits, or within 10 miles of the health facility, for example, then Prairie Hills Transit is generally not needed. If a discharged patient is traveling a long distance, requires special medical equipment, and does not have any alternative means of reliable transportation from the hospital, then the hospital system generally relies upon Prairie Hills Transit to take them to their destination.
“Our biggest medical facility is in Rapid City, but Prairie Hills Transit covers all of the communities that we serve,” Haupt said. “And since they also have buses and vehicles in some of the smaller towns around us—in addition to the two dedicated vans that they operate for us—Prairie Hills Transit’s fleet of drivers across the state can be used at times for other transport as well.”
Each month, Prairie Hills Transit also sends along statistical data to the hospital system to help report back on their services. Cline said this includes information on where trips started, ended, and how long they took—information that the health system uses in heat maps to get a visual picture of where patients in the Rapid City area are picked up and taken.
Haupt said the partnership is a positive for the hospital system, since it allows them to treat more patients and “direct them to the right level of care where they can be appropriately treated and reimbursed for.” And Cline added that patients also benefit from the service as well, since it gives them faster access to the care that they need.
“If a hospital is full and they have folks that could be discharged but can’t leave, then it means another family is diverting someone to another hospital,” Cline said. “That can result in an added financial burden, additional travel costs, and other issues that could affect the health of someone diverted from the hospital.”