Nonemergency Transports Shift to Rideshare: Boom or Bust for EMS Providers?

By Beth Friedman, Founder and CEO, Agency Ten22
Twitter: @HealthITPR
Twitter: @PayorLogic

It all started in March 2016 when MedStar Health in Maryland partnered with Uber to provide nonemergency transports for their patients. Touted as a practical and affordable way to reduce no-show appointments, the use of Uber and Lyft by health systems has incrementally grown over the past year.

Rideshare partnerships are an innovative solution for hospitals, health systems, physicians and other care providers to secure nonemergency medical transportation (NEMT) for patients lacking funds or affordable EMS access. EMS providers also benefit by eliminating billing paperwork for small-dollar trips and negating the need to contract with local taxi companies. And NEMT providers seem to be willing partners in the shift. LogistiCare, a national NEMT provider, recently announced an agreement with Lyft to offer transportation services to select Medicaid and Medicare Advantage beneficiaries in 31 states.

In most cases, rideshare companies are being used to help patients gain access to medical care. According to the Community Transportation Association of America, roughly 3.6 million patients miss necessary medical care because they can’t get to their appointments. Rideshare partnerships appear to be helping solve this issue.

In fact, even Blue Cross and Blue Shield recently inked a deal with Lyft to help cut down on missed appointments. The nonemergency ride service will be free to Blue Cross and Blue Shield members who lack adequate transportation options. In addition to health systems partnering directly with rideshare companies, a new middleman recently emerged. Circulation, based in Boston, has become the NEMT “platform of choice” for more than 30 healthcare providers.

With so much attention being paid to the Uberization of NEMT, what is the long-term impact to EMS providers? Are there downsides and if so, what are they? Each new story of a rideshare partnership brings new questions for EMS providers.

  • Is the loss of NEMT revenue financially helpful or hurtful to the EMS industry?
  • Are there privacy, security and patient satisfaction risks by going Uber?
  • What is the long-term prognosis for commercial rides versus EMS transports?
  • Will there be negative impacts further down the road?

In this month’s blog post, we’ll explore the pros and cons of the Uberization of NEMT.

Positive Feedback from Patients
The new platform Circulation coordinates Uber rides for some of Boston’s most prestigious healthcare organizations. With on-demand or in-advance bookings, the service company also provides dedicated call center support to help patients schedule Uber rides. Circulation touts a 4.9 out of 5 patient satisfaction rating, 40-50 percent cost savings and only an 8 percent no-show rate compared to the 25-50 percent industry average, according to the company’s website. CareMore Health System, an Anthem subsidiary that partnered with Lyft through its NEMT provider reports a 30 percent decrease in average patient wait times and lower per-ride costs.

These numbers are hard to beat—even for the most seasoned NEMT provider. But some pundits question the privacy, security and clinical support provided by Uber, Lyft and others. Potential downsides, however infrequent, must be considered.

Challenges Create Potholes
Even in the best of situations, Uber and Lyft drivers lack the medical training or clinical expertise to assist elderly, confused or otherwise impaired patients. Escorting patients from door to vehicle is often the most difficult part of a nonemergency trip.

Also, these patients are part of the healthcare ecosystem and are to be protected under HIPAA and other compliance rules. It is unclear how much privacy, security and patient advocacy training these drivers receive before transporting the first patient to a provider’s office.

Finally, continuity of care during patient handoffs to providers is often difficult, even with the best EMS-trained personnel. Rideshare drives would certainly lack the medical terminology or clinical vocabulary to have these important conversations.

While established NEMT providers branching out into rideshare options will likely cover these bases to protect their patients and their reputations, I’m not certain every Uber or Lyft driver will be so conscientious.

Time Will Tell
All great ideas prove themselves over time. There will be kinks to work out and inevitable patient problems ahead. However, the innovation we’ve seen in the past year with rideshares instead of nonemergency transports has definitely caught the industry’s attention.

This article was originally published on Payor Logic and is republished here with permission.