Health System Specialist: Is ‘Uberization’ of Hospital Transportation a Good or Bad Thing?

Disruptive innovation had begun to drift into the healthcare transportation market. With their new healthcare marketing push, ride-hailing services Uber and Lyft can use their scale and brand identification to give them an edge over cabs and other transportation services that hospitals have traditionally utilized. Plus, their lower prices and convenient payment and scheduling options are as appealing in the healthcare market as they are in the broader personal transportation sector.

However, this new transportation trend can come with its own unique set of challenges, as there can be limits to the types of patients who are serviced by these ride-hailing services, along with concerns about the negative public relations baggage that companies like Uber carry with them.

How Uber, Lyft Approach Hospital Transportation

Uber and Lyft generated significant buzz in March when they officially entered the health transportation sector. Their venture into the medical sector essentially is a repackaging of their standard ride programs paired with efforts to develop partnerships with health providers. The Uber product enables staff members at medical facilities to schedule rides for patients and features a HIPPA-compliant interface. The service includes non-smartphone booking and communication for patients who do not have access to that technology.

Lyft’s product is substantially similar to the one launched by Uber. Lyft allows organizations to book rides for patients through its Lyft Concierge service, and it has formed partnerships with electronic health records provider AllScripts.

Cheaper fares were one reason Saint Francis Hospital in Wilmington, Del., switched to Uber instead of cabs to transport needy patients home from the facility. The average cost for an Uber trips is $11 — well below the cost of a cab ride. Uber also is available when needed and has strong customer service, the hospital says. Saint Francis had made arrangements with the company before the announcement of Uber Health.

However, the service can’t serve all patients, says Annamarie McDermott, director of care management at Saint Francis. “Uber must only be used for patients who can safely and independently get in and out of a vehicle,” she explains. Uber Health has options for wheelchair vans, but they come from the same pool of vehicles that the hospital already has access to, McDermott points out.

Complaints about a lack of access for people with disabilities has landed ride-share companies in hot water. A lawsuit filed in March accuses Uber drivers of denying rides to a woman with cerebral palsy because of her service dog.

Last month, Uber and Lyft, along with smaller industry player Via, took steps to fight a New York City order that the companies make 25% of their vehicles wheelchair accessible by 2023. According to press reports, the companies claim the order, put in place late last year by the New York City Taxi and Limousine Commission, was issued without taking into account demand for these services and would lead to “prohibitive” costs to implement.

These problems have raised doubts about ride-share companies’ ability to provide services for people who might need the most help getting to and from their medical appointments. The non-emergency medical transportation industry has made significant progress in the last few years. So the ride-share companies’ legal troubles serve to highlight other players in the health transportation space that offer similar billing and booking functionality, but also provide a broader range of services pertinent to the medical market.

One example is RoundTrip, a Philadelphia-based startup specializing in the coordination of healthcare transportation. The company launched its service in 2016 and now operates in 15 states, mainly along the East Coast. The company recently secured $1.9 million in seed-round financing, with Johns Hopkins University among its investors.

RoundTrip’s model involves coordinating rides requested by patients or their providers with various transportation partners in a community. The company has a relationship with Lyft, which it uses to provide rides for appropriate patients. But unlike the Lyft and Uber models, RoundTrip has specialized carriers in its network that can provide, for example, wheelchair-accessible vehicles or specialized options for people with particular medical needs, such as the blind.

Mark Switaj, RoundTrip’s founder and CEO, contends the continued development of the health transportation sector holds tremendous potential for both patients and providers.

First, hospitals can provide rides for patients who are ready for discharge but are stuck at the facility, perhaps overnight, because they lack transportation. These patients, often uninsured or under-insured, not only create an unnecessary expense, but also take up scarce bed space that might otherwise be used for more acutely ill patients. By providing affordable rides, typically paid for by either insurance or by the facilities themselves, the service limits expenses for the hospitals and leads to better all around outcomes for patients, Switaj says.

Second, health professionals can schedule follow-up visits and routine exams for patients who might otherwise not be able to take part. RoundTrip’s internal statistics suggest that its service cuts no-show rates for its clients from 17% to about 4%. These additional visits translate into increased revenues for the facilities and more efficient use of specialists’ time.

Industry data has long shown value can be created by improving health transportation. About 3.6 million people in the U.S. miss or delay non-emergency medical visits every year due to transport-related issues, according to a 2005 study by the Transportation Research Board.

No-show rates for medical appointments could run as high as 30% nationwide, concludes research published in 2017 by SCI Solutions, a healthcare software and technology company. Using its 30% figure as a baseline, along with a national average of an empty time slot costing a doctor $200, SCI estimates that the total cost to the medical community of missed appointments was $150 billion a year.

The potential to reduce patient no-shows is one reason ride-sharing companies’ expansion into healthcare, despite their model’s potential shortcomings, likely bodes well for patients and hospitals.

“Transportation remains a major barrier for many Americans getting the health care they need,” says economist David Slusky. “Reducing this barrier with low-cost options would be great.”

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