Friday, March 7, 2014
By MATT HONGOLTZ-HETLING Morning Sentinel
When an out-of-state company began brokering rides for MaineCare patients in August, thousands of patients began complaining that they no longer could access the medical services they depend on.
Mark Goggins stands next to his KVCAP bus in Waterville on Friday. KVCAP used to provide between 900 and 1,000 rides a day to MaineCare patients.
Michael G. Seamans/Morning Sentinel
While the patient's health is the primary concern when a person can't make a medical appointment, the transportation companies and other medical care providers also pay a price.
When Coordinated Transportation Solutions, a Connecticut firm, won a $28.3 million contract to coordinate rides to most of the MediCare patients in the state, it became the middleman between the patients scheduling the ride and the transportation companies.
While the company has pledged to fix problems, patients continue to complain about confusing and burdensome paperwork and long wait times. At the same time, transportation companies say that continuing confusion has led to rides not showing up for patients who have scheduled them.
Agencies in Maine, many of which are dealing with other financial constraints, are struggling to cope with the effects.
"At a minimum, it's cost us 25,000 bucks in the first month," said Thomas McAdam, chief executive officer of Kennebec Behavioral Health, which provided services to 13,710 clients last year.
It's a significant loss for an organization that was in the black only $60,000 last fiscal year and which recently was forced to close Halcyon House, an emergency shelter for youths in Skowhegan, because of a reduction in state and federal funding.
McAdam said the health agency, which provides psychiatric medication, mental health care, and substance-abuse treatment, among other medical services, from locations in Augusta, Skowhegan, Waterville and Winthrop, is trying to assess the total cost his company has incurred.
By some measures, he said, the problem has gotten better in the last two weeks, but by other measures, it has worsened.
"There are less completely missed appointments than there were before," McAdam said, "but our staff have had to go into almost full-time mode helping people navigate the system. It's still incredibly confusing about what people need to do in terms of the paperwork."
McAdam said the company requires many patients to fax paperwork, which is a significant obstacle, because many MaineCare residents don't own fax machines or have easy access to them.
McAdam said the health agency has responded to the crisis by sending employees to pick people up or by providing cab fare to patients who need to get to key appointments.
The lack of reliable transportation increases an ongoing issue with patient no-shows, the term the medical industry uses to describe patients who miss an appointment without canceling.
At the practices overseen by Inland Hospital in Waterville, transportation issues have grown over the last month, when Coordinated Transportation Services began coordinating the rides, according to Sara Dyer, spokeswoman for the hospital.
Dyer said transportation has always been an issue for patients, but the hospital has been successfully managing the impact by increasing communication with patients, to allow them to reschedule missed appointments quickly.
Hospitals have had complaints about the new obstacle to medical care, according to Jeff Austin, vice president of government affairs and communications for the Maine Hospital Association, which counts all 39 of Maine's hospitals among its members.
"Some of our members did receive calls from patients who said they couldn't make appointments because of transportation issues," he said.
Austin, who is also the association's lobbyist, said the public outcry and the potential for the company to lose the contract have created enough of a motivation for the company to fix the problem, and so it wasn't necessary for the hospital association to take on the issue with legislators.
The national Medical Group Management Association said that it had no statistics on how much patient no-shows cost the industry each year, but a study from the University of Florida found that one clinic alone had 14,000 no-shows in a year, resulting in a loss of more than a million dollars.
Gordon Smith, executive vice president of the Maine Medical Association, said doctors are used to dealing with patient no-shows, sometimes by overscheduling their day because they know a certain percentage of patients won't show up.
Smith said the problems the system is causing for patients is paramount.
He said patients living in poverty or dealing with social or mental issues are already more likely to miss appointments, and that the ride issue compounds the problem.
Jim Wood, the transportation director at Kennebec Valley Community Action Program, said Coordinated Transportation Solutions has given assurances that they are working through the problems, but that now there are continued data-transmission issues that result in patients not getting rides.
Wood said the community action program gets about the same number of referrals it always has -- about 900 to 1,000 per day -- but that it is only able to complete about 750 rides per day. Before the transition on Aug. 1, he said, nearly all of the referrals would result in rides.
There have been times when the program has given a patient in need a ride in good faith, only to find out that the patient's ride was actually scheduled through a local cab company, he said.
Patients continue to report issues with the program.
Carol Penney, a 69-year-old from Waterville who sees her providers regularly, said she has missed several appointments because rides she has tried to schedule have not materialized.
"They never show up," she said. "I'm ready to commit suicide. That's how I feel. What am I supposed to do?"
Donna Cantone, a resident of Augusta, sees a doctor between six and eight times a month for various reasons.
"Tonight I have an MRI in Augusta because they feel that I've torn some muscles in my right shoulder, which could mean surgery," she said.
Unlike many MaineCare clients, Cantone drives herself to her appointments, for which she is reimbursed at a rate of 24 cents per mile.
Cantone said the paperwork, which requires everything from her driver's license number to information only her doctor can provide, has been a major obstacle for her. She said the problem is not being resolved quickly enough for the patients who are suffering immediate and ongoing harm.
"What's going to happen to us?" she said.
Matt Hongoltz-Hetling can be contacted at 861-9287 or at: