Transportation Insecurity as an Operational Barrier to Care: Impacts on Appointment Adherence and Discharge Efficiency at Mercy Hospital Northwest Arkansas

Abstract

Transportation insecurity is a persistent social determinant of health that directly affects patients’ ability to access care and creates downstream operational challenges for healthcare systems. This capstone project examined transportation insecurity as an operational barrier to care at Mercy Hospital Northwest Arkansas, with specific emphasis on its impact on outpatient appointment adherence and inpatient discharge efficiency. Using a retrospective descriptive analysis, administrative and clinical data from 2021 through 2025 were reviewed, including outpatient scheduling records, cancellation reason codes, payer mix data, work relative value units (wRVUs), documented transportation assistance, and discharge-related workflows. Results demonstrated a substantial increase in transportation-related appointment cancellations concurrent with rapid growth in clinic volume. Although transportation-related cancellations represented less than one percent of total visits, the absolute number increased sharply and was associated with an estimated $462,215 in lost clinic revenue and 4,879 lost wRVUs over the study period. Transportation barriers were observed across all major payer groups, indicating a systemwide access issue rather than a challenge limited to Medicaid beneficiaries. In the inpatient setting, transportation-related discharge delays were historically under-documented; however, recent implementation of standardized transportation screening by Case Management represents a critical advancement toward proactive discharge planning. Findings suggest that transportation insecurity contributes to inefficiencies in access, throughput, and resource utilization and is currently addressed through largely reactive and fragmented interventions. This project underscores the need for healthcare administrators to integrate proactive transportation risk identification, hospital-coordinated transportation supports, and transportation metrics into operational and population health strategies to improve access, efficiency, and equity across the continuum of care.