Oregon faces a complex transportation challenge that needs both thorough exploration and decisive action. Here's a breakdown of the issues and my proposed solutions.
The primary concern in Oregon, notably in the Portland metro area, is the shortage of transportation vendors. Instead of expanding non-emergency medical transportation (NEMT) agencies, policies are inadvertently forcing vendors out of business, fostering monopolies. These monopolies then have undue leverage to set arrival times, contributing to prolonged ETAs. With rising demand and minimal competition, these monopolies may engage in practices that lead to inadequate staffing and unsustainable revenue models as new entrants struggle to scale.
Moreover, Coordinated Care Organizations (CCOs) in Oregon wield substantial control with insufficient oversight from Medicaid. While Oregon Administrative Rule 410-141-3860 sets clear operational guidelines for independent CCOs, deviations have occurred, resulting in delayed transport for Medicaid patients. This issue is particularly acute with Trillium/MTM, whose mismanagement necessitates a state investigation for potential Medicaid fraud.
In contrast, Healthshare of Oregon exemplifies operational excellence. I recommend reallocating all Medicaid patients from Trillium to Healthshare to elevate the quality of transportation services.
Furthermore, the NEMT industry monopoly complicates transport for private pay and Medicare patients requiring long-distance travel. Often, providers demand full payment upfront, a significant burden for many. The state must mandate that NEMT vendors provide services regardless of immediate payment to avoid discrimination against the economically disadvantaged.
Additionally, restrictive operational hours at care homes present significant barriers. In an era when continuous care is crucial, it is unreasonable for care homes to refuse new intakes after 5 pm or on weekends. Regulations should mandate 24/7 admissions once authorization is given. This change is vital as some care homes exploit hospital emergency departments for non-urgent cases, only to refuse timely readmission, adding to system inefficiencies and patient distress.
These issues represent broader systemic problems in Oregon’s transportation infrastructure that require immediate resolution. Forming a dedicated state committee to investigate and address these concerns is imperative to ensure efficient, equitable transportation for all Oregonians.
I only require 30 minutes to thoroughly explain everything Becky Hultberg
President and CEO Becky Hultberg recently explained that when patients must stay longer in the hospital because they can't be discharged to a more appropriate care setting, there is an impact to both patients and hospitals.
