A 70-year-old man is discharged from a hospital after being treated for pneumonia. He has a follow-up appointment with his physician to ensure that his recovery is smooth and to identify potential complications. But the appointment location is not easily accessible from the patient’s home, and he doesn’t want to ask his son to take time off work to drive him. Instead, he misses the appointment. A week later his health deteriorates and he is readmitted to a hospital.
Missed appointments are all too common within the US health care continuum, costing the industry an estimated $150 billion each year. And a lack of transportation is a major cause of missed appointments – one study found that only a third of patients had access to either private or public transportation to get to their medical appointments. The problem tends to be more prevalent among the elderly and others with mobility problems, a cohort that is more likely to need regular medical care.
As health care providers seek to reduce costs and appointment no-shows while also enhancing patient outcomes, rideshare programs are offering a less expensive way to get patients — and even staff — to sites of care.
Addressing a Costly Trend
Rideshare services have dramatically increased in popularity, with the number of Americans having used an app to hail a ride more than doubling between 2015 and 2018. And some rideshare companies, like Uber and Lyft, have established specific services to transport patients to and from specific sites of care — including hospitals, ambulatory care centers, physician offices, and senior care facilities — for non-emergency appointments.
Even states are starting to express interest, with some using rideshare services to provide non-emergency medical transport (NEMT) for Medicaid patients. In addition to simple scheduling, rideshare options tend to be more cost-effective for health care entities than leasing or buying vehicles and hiring drivers.
The benefits are multifold: Patients do not have to worry about finding ways to get to clinics and other care sites. Fewer missed appointments help health providers reduce costs. Health payers minimize the potential expense of a non-emergency situation becoming worse and thus more costly. And drivers are often able to aid patients with minor mobility problems to get in and out of vehicles — help that isn’t normally available when using public transport.
Still, while rideshare services are emerging as an important continuum of care management tool, risk concerns — both for health care and transport providers — should be analyzed and addressed.
Take a Safety-First Approach
The success of a NEMT program depends on passenger safety, making it essential for health care entities to check the track record of rideshare companies they are considering and to review the safety measures these companies have in place — for example, the criteria used for driver background checks. Additionally, agreements between health care providers and rideshare companies should specifically delineate who is liable in case of a collision or misconduct by a driver.
Because NEMT rides tend to be scheduled well in advance, sometimes at the same time a medical appointment is made, the risk of drivers ignoring safety precautions and driving at excessive speeds tends to be minimized. But there can still be exceptions, and it is imperative for transportation companies to keep tabs on the drivers they engage. Many NEMT companies have recently begun implementing telematics solutions to alert them if a driver is speeding or exhibiting other unsafe driving practices, such as stopping abruptly. Data can help NEMT providers identify training opportunities for specific drivers or even decide whether to terminate agreements with drivers with potentially dangerous habits.
Health care providers should ensure that if a third-party is being used — for example, to provide wheelchair-accessible vehicles — they have all necessary information about that subcontractor and are able to view safety records.
Ensure Data Safety
In an era of heightened cyber and privacy threats for businesses, health care providers should have confidence in the data privacy and cybersecurity measures taken by vendors, including NEMT service providers. Although rideshare companies generally do not collect or possess sensitive medical data regarding passengers, they might still receive information that associates individual patients with specific health care providers and may be in possession of protected information about the patients they transport. Health care providers should extend the same privacy and cyber controls they use with other vendors and discuss the data protection procedures rideshare companies have in place and the measures they take to protect against and recover from data breaches, including the purchase of appropriate cyber insurance.
Explain Service Limitations
Transportation services are not an extension of health care facilities. Even when using wheelchair-accessible vehicles, drivers often do not have medical training. Instead, drivers are instructed that in the event of a possible medical emergency they are to stop their vehicle as soon as it’s safe and call emergency services. This information should be clearly communicated to patients to ensure they are aware that NEMT services are limited to getting them to health appointments and back. Some rideshare companies emphasize this through messaging or signage inside of vehicles.
Rideshare services continue gaining in popularity among the general population. And as long as they recognize the risks and take steps to address them, these services can provide an effective solution for health care providers and the patients they serve.
