2.  The trends in health care are evolving. In the early part of the 20 th Century, the doctor had the mobility role making house calls  In the last half of the 20 th century, the patient and the doctor met at the hospital and long hospital stays became common.

3.  Today, the patient is the mobile one › Outpatient surgery › Outpatient treatment › Outpatient rehabilitation

4.  Persons are living longer with more infirmities  The average hospital stay is much shorter  The population is aging  Obesity is becoming epidemic bringing with it many health related issues

5.  Addiction and the need for treatment is increasing  Dialysis treatment is growing  Mental health treatment is more acceptable and therefore increasing

6.  Our troops are coming home with critical mental and physical health issues › Traumatic Brain Injury › Loss of limbs › Stress related disorders

7.  Aging is requiring increased medical care  Aging is requiring increased assistance in transportation

8.  Increased difficulty in travel to seek medical treatment  Increased difficulty in travel to employment in the medical industry

9.  Of 29 rich nations, the United States has the highest rate of ‘amenable mortality’ before the age of 75  The U.S. is falling further behind Nolte,McKee, London School of Hygiene and Tropical Medicine

10.  The emerging transportation need of the twenty first century

11.  Volunteers in Medicine Institute

12.  Older adults  Veterans  Persons with disabilities  Children  Healthcare employees  persons who are “fuel challenged”

13.  One in five persons over 65 does not drive  Compared with older drivers, older non-drivers in America make 15% fewer trips to the doctor  Men can expect to spend the last six years of their lives dependent on others for transportation. For women the time is 10 years.  Lack of transportation was named the No. 3 problem in the lives of seniors, ahead of both Medicare and Social Security issues.

14.  Rising fuel costs have resulted in “fuel challenged” riders  Persons who have never thought of using public and community transportation are new customers

15.  America has some of the best medical facilities with the best medical care in the world.  This is no better than a third world country if the person cannot access the health care.

16.  Total statewide benefit to Florida of more than a billion dollars (number of trips x.1x average cost of one day hospital stay  Florida Transportation Disadvantaged services: Return on Investment Study

17.  Many older adults are not comfortable driving in the metropolitan area  Income and or disability may dictate the need for transportation assistance  Medical community does not consider transportation in land use planning

18.  Across the US › Average distance for medical/dental care was 10.2 miles › Rural trips average 17.5 miles vs. 8.3 miles for urban residents  Nationwide average medical trip took 22 minutes

19. How will people be able to get to the health care they need?

22.  Medical transportation has worked its way to the forefront of public and community transportation  Historically, private transportation has provided medical transportation

23.  Brokerages manage non-emergency Medicaid transportation  Ambulance handles emergency transportation a emergencies and Medicare

24.  Medical transportation need is so great it will require a variety of modes and levels of transportation  Incorporating these modes into coordination plan will take effort

25.  Think outside of the box  Work with new people  Don’t discount volunteers, donated labor  Work with family members of riders to see what they can offer to your system  Create unusual partnerships

26.  Introduce your system to the medical community  Invite the medical community into the transit community › Learn each others language › Identify each others assets › Identify each others needs

27.  Work with state chapters of national medical associations  Work with veterans’ associations to identify their needs  Plan overlapping conferences and share common training

28.  Help them to help you

29.  Educate your transit community about CMS  Follow proposed rule changes  Be educated---Be vocal

30.  When dealing with Medicaid › Keep accurate records › Be able to justify your cost from a third party vantage point › Insure that Medicaid is not paying for any costs not pertaining to Medicaid service

31.  Medical transportation is the new focus › Keep good data on numbers of medical trips, miles, mode of travel

33.  Transportation is the difference between life and living

34.  Community Transportation Association of America  Medical Transportation Specialist  miller@ctaa.org miller@ctaa.org  202-294-2212  www.ctaa.org