TCRP Report Research Report 203: Dialysis Transportation - Intersection of Transportation and Healthcare is a primer for understanding both the medical and the transportation aspects of dialysis treatment. It includes perspectives from dialysis treatment centers, social workers, transportation services, medical insurance programs, and individuals with ESRD.
Dialysis presents a perfect storm of challenges for supplying efficient transportation -treatments administered a few times a week at a particular location; uncertain timing that makes planning difficult for any individual patient, particularly in terms of arranging the return trip home; and physically weak patients who are often unable to handle travel independently. "For public transportation agencies, dialysis transportation has become a critical concern as increasing numbers of individuals with end stage renal disease (ESRD) turn to their community's public transit service for their three round-trips each week for dialysis." Inadequate transportation to and from dialysis treatments has major health consequences and high costs. "The adverse relationship between hospitalization and missed/shortened dialysis treatments is unequivocal."
The difficult intersection of Medicaid transit-benefit administration and lack of compensation to for expensive trips, whether through paratransit or otherwise, is examined in detail. Two promising practices identified are home dialysis, which reduces the number of trips, and ridehailing programs - with both telephone call center and app-based on-demand transportation - to and from dialysis.
The report presents a Community Data Tool, which is an Excel-based data computation mechanism that incorporates data from each state and county, and entry of population numbers, to provide estimates of (1) current and projected demand for public sector trips to kidney dialysis facilities, (2) current and projected costs for this transportation, and (3) potential decreases in the demand for, and cost of, public sector trips if home dialysis increases. The tool employs data from national renal disease and health service area databases.
This post originally appeared in NCMM's August 2019 newsletter