Ride Sharing Apps Move to Start Medical Appointment Programs

Part of my job includes working at a practice site and taking last year pharmacy students on rotation. My site focuses on ambulatory heart failure management and associated cardiovascular conditions. Usually, students are responsible for working up patients a few days in advance, discussing them with me, and then we see them the day of their scheduled appointment. At least, in theory, that's how it works. What I feel sorry for is when my students put all their time into a work-up, and the patient doesn't show up. One question I routinely hear from students is "Why didn't they come?" My response is generally, "Life happens."

Indeed, medical no-shows are a common occurrence, and enough to plague any medical office that wants to maximize visits throughout the day to meet profit margins (and needless to say, the possible adverse patient outcomes). You don't make money if no one shows up. So we send reminders, we call them in advance, some practices will charge those that no show a fee. But that doesn't negate that life happens, and for some patients getting to an appointment is tantamount to climbing a mountain, it just isn't going to happen. They can't drive and rely on others to bring them like their friend/child who can't take them that day, the bus is late, or the weather is bad (who wants to wait in the cold rain for public transport), or they just can't do it that day due to other factors.

So, lets all jump on the ride-sharing hype train and have Uber and Lyft to solve all these problems. At least investors hope so, and recent news and programs showcase this is going to be a thing. Last month Lyft announced they were going to team up with Hitch Health to work on helping get patients to their medical appointments.¹ Hitch Health will take care of the scheduling and communication, and Lyft will have their drivers show up to get the patient and bring them to their appointment. Uber likewise announced this past week that they are also getting into this niche with Uber Health.² They are seeking to team up with health systems to also schedule transportation for patient appointments, and have worked on getting all of the HIPAA compliance communication pieces in order.

Sounds awesome right? I mean, I think it's a push in the right direction because this is already informally occurring. The news and internet forums are filled with ride-sharing drivers who have taken patients to the hospital or the doctors. An ambulance bill is enormous, and non-surge transportation is pennies in comparison. But that's the thing; you are paying for the transportation, not the medical personnel. And that is where I think Lyft and Uber are getting on the right track by doing all of this work.

They are targetting the non-urgent medical transportation field and hoping to make it better, and, I hope, less liability for their drivers. But there are some concerns, which I covered in a recent article dealing with studies looking into technology and dealing with medical transportation for patients.

One of the most significant concerns I have is related to disability access. Wheelchair accessible vehicles, for instance, could be a big issue, and I have to imagine that the companies are going to be screening for this one way or another, and making sure their drivers are compliant.

Secondly, cleanliness. I dunno, the thought that these vehicles could be transporting semi-seriously sick patients (think influenza patient to a walk-in or urgent care visit) makes me worried. Again, I am going to have to imagine that the companies will screen for visit types (e.g. semi-urgent vs. non-urgent) and the reason for being seen (e.g., post-surgical follow-up vs. acute illness) and perhaps screen out those patients. At the very least, I am also going to have to hope that the vehicles are cleaned appropriately between rides.

Lastly, as the recent paper in JAMA identified, this isn't going to be a solution for everyone.³ It may help, but there are going to be people that still no show despite even ride-sharing services, and we may have to have another conversation about why and how to address those issues.

References

1. Pennic J. Hitch Health, Lyft Partner to Provide Non-Emergency Medical Transportation to Patients. HIT Consultant. http://hitconsultant.net/2018/02/20/hitch-health-lyft-non-emergency-medical-transportation/. Published February 20, 2018. Accessed March 6, 2018.

2. Hawkins A. Uber is driving patients to their doctors in a big grab for medical transit market. The Verge. www.theverge.com/2018/3/1/17061862/uber-health-non-emergency-medical-transportation-hipaa. Published March 1, 2018. Accessed March 6, 2018.

3. Chaiyachati KH, Hubbard RA, Yeager A, et al. Association of Rideshare-Based Transportation Services and Missed Primary Care Appointments: A Clinical Trial. JAMA Intern Med. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2671405?redirect=true. Published February 5, 2018. Accessed February 28, 2018.