By Keith Gushardand Eric Scicchitano
CNHI News Service
Geography, combined with the economic and physical limitations of patients, can hinder the availability of reliable transportation to medical appointments across Pennsylvania.
A lack of transportation can limit a patient’s access to appointments and impact the ability to coordinate health care to maintain his or her well-being, according to a report released in January by the Medicaid and CHIP Payment and Access Commission, or MACPAC.
The nonpartisan MACPAC provides policy and data analysis and recommendations to Congress, the secretary of the U.S. Department of Health and Human Services, and states on a wide array of issues affecting Medicaid and the State Children’s Health Insurance Program (CHIP).
The report found nonemergency medical transportation is used extensively by a small number of beneficiaries. Seniors and persons with disabilities are the most frequent users. Those with intellectual or developmental disabilities and serious mental illnesses also use transportation more frequently than those with none of those conditions.
The most common transportation destinations are to a physician’s office or back home, the report said.
The problems range from a lack or severe limits on the accessibility of transportation, to the length of time of some appointments and distance from medical facilities.
Residents in rural counties across Pennsylvania who may benefit the most from the transportation services often struggle to get appointments even though bus service has expanded within the past few years.
“There are still a lot of individuals out in the county who have no way to get to their medical appointments,” Cindy Hall, Meadville Medical Center’s program manager for medical transportation in Crawford County, said. “There are a lot of individuals who live in areas where public transit is just not accessible.”
Geography is a factor in Crawford County. It is about 50 miles from east to west and 26 miles from north to south with the majority of the population living within a 10-mile radius of Meadville in the center of the county. Meadville also is where the county’s main hospital and most medical offices are located.
“We have a lot of people that go for four-hour or longer medical treatments – some might need to be in Meadville at noon and not get out until 5 or 6 at night,” Hall said. “Those are the things that a person can’t depend on a drop-off service because they don’t know when they’re going to finish with their appointment.”
Crawford Area Transportation Authority has on-demand door-to-door service, but can’t serve everyone due to scheduling and the large geographic region, according to Tim Geibel, its executive director.
In the past few years, CATA has been able to add some routes on a limited basis to and from smaller communities within the county to Meadville and Titusville, where medical facilities are to supplement on-demand bus service.
“Unfortunately, we can’t provide Monday through Friday service to all points of the county,” Geibel said. “We just don’t have the resources to do that.”
Also, the on-demand bus service time is limited to about 8 a.m. to 5 p.m. Monday through Friday due to distances needed to travel.
“We try to group trips on a certain day – two, three days a week at certain times so we can bring in more than one individual,” Geibel said.
Transportation options are limited in the Susquehanna Valley of Central Pennsylvania.
The Lower Anthracite Transit System operates a limited fixed-route system in the Shamokin-Mount Carmel area in Northumberland County. Stops along the route bring riders to or within a short walk of smattered health care providers in the region including the Geisinger-Shamokin Area Community Hospital.
Shared-ride service is offered by rabbittransit in Montour, Northumberland, Snyder and Union counties. It is a door-to-door service, but hours and travel areas are limited and riders must apply for the program and book reservations.
Fares vary, but with transportation subsidies supplementing the service, affordability is high for senior citizens and persons with physical, mental and intellectual disabilities.
Dr. Ayn Kerber, who practices with Family Medicine of Evangelical-Lewisburg, spoke of the pandemic and how it closed off people from others including relatives. Many patients who are elderly or disabled rely on family and friends for rides to medical appointments. Kerber said it became harder for patients in these situations to maintain this setup.
“People with more risk factors are having fewer interactions with their younger, more exposed family members,” Kerber said. “These are the people who would often take them to appointments.”
Winter weather also was another factor that would limit their ability to come to doctor visits, Kerber said.
Geisinger Medical Center has a limited transportation program for door-to-door service at its main hospital in Danville, Montour County.
Stacey Staudenmeier, associate vice president of behavioral health and health choices at Geisinger Health Plan, said community health assistants who work with patients in their homes find themselves tapping into emergency funding to help patients get to appointments.
“It is such a barrier for our patients and members,” Staudenmeier said. “We’re seeing that happen more and more.”
There is a bit of a bright spot though in Crawford County.
There is a volunteer medical transportation program with a pool of about 15 volunteer drivers, Hall said.
The volunteer drivers are not paid any wage, but use their own vehicles and are reimbursed mileage for volunteering, Hall said.
“But it doesn’t serve everyone it could,” Hall said as volunteers may not be available to transport a patient to an early morning appointment. “We’re always accepting new volunteers.”
Keith Gushard is a reporter for The Meadville Tribune and Eric Scicchitano reports for The (Sunbury) Daily Item.