Health Care Task Force - Transportation Subcommittee Report

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Assemblyman Green’s Health Care Task Force
Transportation Subcommittee Report

Muhlenberg Regional Medical Center is the only acute care hospital located in the City of Plainfield, a state designated medically underserved community. Although at least seven other hospitals and one federally qualified health center serve the City residents’ health care needs, many families without access to private transportation currently have difficulty accessing these health care providers. Additional public and private transportation services should be provided in the community to provide enhanced access to any of the area hospitals or the federally qualified health center that best fits residents’ health care needs.

The subcommittee concluded that these enhanced services should be prioritized in two ways. At present, the subcommittee and the full Task Force should focus their efforts on supplementing transportation services for residents specifically in need of services created by the pending closure of Muhlenberg Regional Medical Center. However, once those needs are addressed, the subcommittee recommends that the Task Force consider additional options to improve transportation to all area safety-net health care providers.

The Transportation Subcommittee has prepared the following recommendation to Assemblyman
Green’s Health Care Task Force for consideration to supplement transportation services for
residents specifically in need of services created by the pending closure of Muhlenberg Regional
Medical Center.

Emergency Services
The closure of acute care services at Muhlenberg Regional Medical Center is going to place an increasing financial and operational burden on the Plainfield Rescue Squad. Although Muhlenberg will continue to operate a satellite emergency room that will be capable of treating most emergency medical conditions, DHSS regulations warn that persons in need of advanced life support; persons in an altered mental state or intoxicated; and persons over 20 weeks pregnant with symptoms of pregnancy should not be seen at the Muhlenberg satellite ED. The rescue squad will be required to transport these patients to one of the seven other area hospitals that currently serve Plainfield. The additional travel time required to transport these patients out of the City will require the Rescue Squad to add capacity.

The squad currently operates one ambulance to handle over 6,000 annual calls. It maintains a paid staff of EMT’ s during the daytime, and relies upon volunteer services to cover calls on the evenings and weekends. Ninety-eight percent of the Plainfield Rescue Squad’s revenue is generated from billing patients for services provided, however reimbursement from private and governmental payers like Medicare and Medicaid are not adequate to cover the costs expanding capacity to meet this demand and many patients do not have any health insurance to cover this cost.

Recommendations

Several Task Force member hospitals are all licensed EMS providers capable of providing
backup (second call) basic life support services for local EMS providers, including the Plainfield
Rescue Squad. These providers have offered to work with the Squad to negotiate an
arrangement to provide these services. This will ensure that the closure of Muhlenberg Regional Medical Center does not have an adverse impact on the availability of basic life support ambulance services to the City residents.

NOTE: The Plainfield Rescue Squad and Somerset Medical Center EMS have met to discuss this upcoming challenge and have agreed to work towards strengthening their current mutual aid agreements. (Somerset Medical Center EMS currently provides primary daytime basic life support coverage to South Plainfield and Green Brook — both municipalities are part of Plainfield’s mutual aid plan). The agencies will maintain open lines of communications and look for ways to work together to meet the needs of their communities.

Ambulatory Non-emergent Transportation
According to Solaris Health System, at least 2,700 patients access Muhlenberg Regional Medical Center each year by taxi or public transportation. Although many of these trips were to the emergency room, which will remain open at the medical center following the closure of acute care services, the Medical Center currently offers dozens of services that will be relocated to JFK Medical Center and other area hospitals post-closure.

Currently, Plainfield residents can access Somerset Medical Center via train on the Raritan Valley Line for a cost of $10.25 round trip and 20 mm travel time (including $4 cab ride from the Somerville Train Station to the Medical Center). Muhlenberg Regional Medical Center is accessible via NJ Transit Bus #819 from Downtown Plainfield for $2.70 and 15 mm travel time. Trinitas Hospital is accessible via NJ Transit bus #59 from Downtown Plainfield for 45 minutes a fair of $6.40 round trip. Although helpful, these limited public transportation options should be expanded to accommodate Plainfield area residents.


Recommendations

The subcommittee proposes to address these issues through the expansion of existing public
transportation services and through offering a new shuttle service to transport patients from the
Muhlenberg Regional Medical Center campus to the next closest hospital, JFK Medical Center in
Edison.

Public Transportation:
New Jersey Transit should reroute Transit bus #819 to JFK Medical Center (located less than 1 mile off its existing route) and to the Neighborhood Jealth Center Plainfield (located several blocks from the existing route). This route alteration would create a non-stop, reliable and inexpensive public transportation service between downtown Plainfield, the Neighborhood Health Center Plainfield, the SED at MRMC and JFK Medical Center.

Furthermore, the subcommittee recommends that NJ Transit alter the route of bus #59 to stop at to the Neighborhood Health Center Plainfield currently located several blocks from a stop on that route) to provide enhanced access to the Neighborhood Health Center Plainfield and Trinitas Hospital for Plainfield area residents.

Private Shuttle Service
Following the closure of acute care services at MRMC, Solaris will operate a free continuous loop shuttle service to and from the SED at Muhlenberg and JFK Medical Center. The shuttle will operate seven days a week from noon until 8 pm (coinciding with JFK Medical Center’s visitation hours). However, Solaris Health System plans to closely monitor utilization of this service and will adjust hours of operation as necessary to meet demand. This service will accommodate both patients who require non-emergent services at JFK Medical Center and individuals who wish to visit family members and friends who have been admitted to that hospital for care. No appointment will be necessary to ride the shuttle.

On-demand Transportation
Increasing public transportation access to area health care providers and the Solaris shuttle will provide city residents with new options to access safety-net providers following the closure of acute care services at Muhlenberg Regional Medical Center, but public transportation is often not an attractive or appropriate option for some patients. Expended public bus service and Solaris Health System’s proposed shuttle will help patients access services at JFK Medical Center and Trinitas hospital, but the subcommittee recognizes that many patients currently utilize taxi services to travel to area hospitals or the Neighborhood Health Center Plainfield when their condition is not serious enough to call 911 for an ambulance. A taxi ride from most areas of Plainfield to Muhlenberg Regional Medical Center currently costs about $20. However, taxi service ftçj surrounding municipalities or to other area hospitals can cost as much as $70 round- trip — a major expense for many families. The subcommittee proposes that the Task Force seek to establish a medical taxi service for Plainfield Area Residents to travel to and from any of the area’s safety net providers for non-emergency health care services.

The Tn-County Red Cross currently provides a medical taxi service for patients who require a ride to and from scheduled doctor and non-emergent hospital appointments. The service is the only one of its kind in the region that: trains drivers and dispatchers in first aid and CPR to respond to ambulatory patients in an emergency; offers low-cost services; crosses county lines based on patient need; and is operated by a well-known non-profit entity. However, the Red Cross does not currently have the resources to expand capacity for the service.

The Red Cross has prepared a preliminary cost estimate to add the necessary capacity to expand this program to meet the needs of Plainfield residents to access all of the area’s hospitals and the Neighborhood Health Center Plainfield; roughly $70,000 per year per vehicle plus capital costs for vehicle purchases and driver training. However, the subcommittee did not have the expertise to estimate the number of cars that would be necessary to meet the demand for the program and recommends that the Task Force request assistance from DOT or an independent transportation consultant to assess projected demand for the program and better estimate costs.

We recommend that the Task Force seek start-up funding for this program from Governor Corzine’s proposed Hospital Stabilization Fund, which is intended to help prevent hospital closures or fund services or programs that will meet the healthcare needs of communities affected by hospital closures. Ongoing operations could be funded by a patient cost-share, government or private grant funds or contributions from task force members.

Note: Solaris Health System has agreed to contact with the Tn-County Red Cross to provide this service free-of-charge to patients seeking non-emergent transportation to JFK Medical Center following the closure of Muhlenberg Regional Medical Center.

Conclusion

The Transportation Subcommittee members voted unanimously to support this transportation plan, which we believe will meet the transportation needs of residents of the City of Plainfield and surrounding communities following the closure of acute care services at Muhlenberg Regional Medical Center.

Transportation Subcommittee members also agreed that Assemblyman Green’s Health Care Task Force has presented unprecedented new opportunities for the region’s hospitals, the Neighborhood Health Center Plainfield, Union County, Union County College and other task force members to work collaboratively to address our community’s needs beyond those created by the pending closure of one hospital. We recommend that Assemblyman Green remission the Transportation Subcommittee to begin to address larger transportation needs in the City of Plainfield. We also recommend that the Assemblyman invite a representative of the New Jersey Department of Transportation in join this effort.