Ridesharing programs can be a game changer for patients and providers. Medical offices, healthcare organizations and both inpatient and outpatient facilities can all benefit from the increased appointment attendance that ridesharing makes possible, provided that related risk exposures are evaluated and managed.
Patients are missing appointments and treatment due to challenges with transportation, and providers are missing out on revenue when patients do not show up for appointments and/or treatments. Ridesharing companies like Uber and Lyft or other private transportation services can make transportation easier for patients when coordinated by their healthcare providers.
Studies Reveal Mixed Results on the Effectiveness of Ridesharing
A one-year study examining Lyft found that providing transportation to patients helped them keep more appointments. In this analysis, there was a reduction of more than 25 percent in “no-show” rates and a return-on investment (ROI) of nearly 300 percent.¹
A one-month study of four ambulatory clinics found a 7 percent reduction in no-show appointments, as seen in the table.
| Measure | Value | Commentary |
|---|---|---|
| Scheduled Slot using RideShare provider | 67 patients | Patient kept appointment |
| Monetary outcome/ contribution for slot filled | $50.00 | Value of maintained appointment |
| Gross contribution for study group | $3,360 | Total Contribution to revenue |
| Cost of RideShare, total for all patients | ($1,206) | Total Costs |
| Net Contribution | $2,154 | Benefit to Clinic(s) |
However, a recent study published in the Journal of the American Medical Association Internal Medicine indicated that ridesharing deals featuring Uber and Lyft did not reduce patient no-shows and missed appointments in the population analyzed, which were primary care patients.²
One might say the jury is still out on whether these blossoming programs work.
The Cost and Nature of Missed Appointments
The total cost of missed healthcare appointments (a.k.a. no-shows) in America is estimated at $150 billion per year. Each open, unused time slot costs a physician or provider 60 minutes of a day’s schedule and nearly $200 in lost revenue, on average. Multiple studies suggest that no-show rates are nearing 30 percent in US healthcare.³
Transportation services and travel time are critical barriers to accessing care for many patients, including the elderly. A recent study suggests that transportation is the third most frequent barrier noted by patients who miss appointments with their providers.4
Demographics also play a key role in missed appointments. Populations that are disadvantaged by income, language or age often have more difficulty keeping appointments.
Elderly patients, for example, may no longer drive but may be reluctant to use public transportation, because of inclement weather or fear and unfamiliarity with routes. Such problems are compounded in rural areas, where bus systems, trains and other modes of public transportation are non-existent.
Benefit and Challenges of Rideshare Programs for Healthcare Organizations
Many healthcare systems and organizations suggest there are benefits associated with the implementation of rideshare programs. These benefits include:
- Reduced number of patient no-shows
- Increased patient satisfaction when transportation services are designed, coordinated and paid for by providers
- Increased or stabilized revenue through an improved rate of kept appointments and planned treatments
- Reduced barriers to care
- Minimized likelihood of failing health status and resulting unexpected outcomes associated with missed appointments for treatment and follow-up care
Overall, ridesharing programs can help reduce some costs that healthcare systems experience since the cost of providing transportation is generally much less than the cost of missed care. However, the benefits of ridesharing programs do not come without challenges or concerns, which include the following considerations:
- Need for a “sponsor” of the program at the healthcare organization or medical office with the capacity to manage a rideshare program
- Charges for the services and potential reimbursement
- Need for a formal protocol and/or policy, which addresses processes and criteria (including acuity level of the patient and appropriateness of these services) for patient transportation as well as potential regulatory concerns
- Vetting of and contractual requirements for companies utilized by the healthcare organization
- Assessment of liability generally and while in transit
- Capacity for intervention and follow-up when patients do not keep scheduled, paid transportation services
Risk Management Considerations Around Ridesharing
Risk Management professionals should be involved in the design and analysis of transportation partnerships for several reasons, not the least of which is to assist with managing liability. Due diligence is a key strategy when reviewing options for these services, and such diligence should be conducted on the likelihood of utilization and success rates with patients as well as the risks associated with the partnership. Risk management considerations include:
- Designation of a lead or co-chair of a committee or task force within the organization to vet program options and which includes stakeholders in Legal, Operations, Clinical Leadership and Patient Safety
- Development of clinical criteria for patients to qualify for these services (e.g., patients utilizing oxygen or patients with unstable mobility)
- Development of criteria for patient care settings in which these services would be applicable and appropriate
- Contract review including language pertaining to company and driver qualifications, screening of drivers, CORI and similar data sets
- Contract review including indemnification, state licensing and minimal insurance limit requirements
- Insurance considerations including Auto Liability/Fleet liability, General Liability, Professional Liability/Errors and Omissions and Cyber/Privacy Coverage
- Regulatory review to identify barriers to implementation
While more concerns could be explored, the reality of the need for ridesharing programs to be considered from a risk management perspective is clear.
Conclusion
Time will tell whether ridesharing models will support the investment of time and management by a healthcare organization. Early results suggest, in most instances, a reasonable ROI, an increase inpatient and provider satisfaction, and evidence that patients who keep appointments tend to have healthier outcomes. With risk management concerns addressed, ridesharing programs are worth serious consideration for any healthcare organization that may benefit from them.
¹ No Show Rates in Academic Clinics: And Why We Should Care. The Journal of the Medical Group Management Association. August 2018.
² Viewed online on November 12, 2018. https://jamanetwork.com/journals/jamainternalmedicine/article-abstract/2671405
³ Health Management Technology, Jamie Gier, May, 2017. Electronic Edition.
4 Health Services Research, 2012 Feb; 47(1 Pt 2): 462–485.
