Coronavirus Poses a Risk to Rideshares and Medical TransportationU.S. Senior Care Practice Leader at Marsh Senior Vice President in Marsh’s Sharing Economy & Mobility Group
Rideshare services are emerging as an important tool within health care management, but risk concerns — for health care, transport providers and passengers — should be analyzed and addressed, a fact recently underscored by coronavirus. Indeed, on March 17, Uber and Lyft announced suspensions of the pooled ride component of their services due to COVID-19, though neither has announced a suspension of NEMT.
First, let’s look at some of the risks and precautions already in place for rideshare services in general, as well as those dedicated to health care transport, or nonemergency medical transport (NEMT).
Rideshare Services Address a Costly Trend in Health Care
By some estimates, missed appointments cost the U.S. health care industry $150 billion annually. 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. And when a patient misses an appointment, especially if it’s a follow-up for a recent treatment or illness, they run a higher risk of a negative consequence, such as being readmitted to a hospital. The problem tends to be more prevalent among elderly people and others with mobility problems, a cohort that is more likely to need regular medical care.
Health care providers want to reduce costs and appointment no-shows while also enhancing patient outcomes. The increase in rideshare programs is helping to fill that need. Rideshare options tend to be more cost-effective for health care entities than leasing or buying vehicles and hiring drivers, in addition to simply helping keep schedules on track.
The number of Americans who used an app to hail a ride more than doubled 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 nonemergency appointments. The U.S. government is even starting to express interest at the state level, with some using rideshare services to provide NEMT for Medicaid patients.
Benefits include reliable transportation to clinics and other care sites for patients; fewer missed appointments, which helps health providers reduce costs; and minimizing the potential expense of a nonemergency situation becoming worse — and thus costlier for health payers. At the same time, drivers are often able to help patients with minor mobility challenges to get in and out of vehicles — help that isn’t always available when using public transport.
Rideshare services continue gaining in popularity among the general population, but rideshare companies will need to recognize the risks and take steps to address them.
Rideshares in the Context of Coronavirus
NEMT rideshare platforms run the risk of deterring drivers by virtue of perceived potential exposure to the coronavirus. As coronavirus continues to spread in metro areas, many people will likely grow leery of the crush of public transportation, making NEMT rideshare more appealing. But because NEMT rides tend to be pre-scheduled, we could see drivers begin to shy away from accepting the assignments, fearful of anyone going to a hospital these days. And health care providers are certainly not going to be scheduling rides for patients to come in for COVID-19 testing. Additionally, since drivers are independent contractors, they have the choice to work for whichever rideshare platform they prefer.
On the rider side, there should be some sense of a shared social contract that they will not knowingly use a rideshare service if they suspect they have been exposed to coronavirus or have been in contact with someone who has. In recent days, the major rideshare companies have issued guidance to drivers aimed at helping them avoid the virus, but in terms of forecasting the overall impact, like so much with this new disease, only time will tell.
Take a Safety-First Approach
Beyond the risk posed by coronavirus, the success of a NEMT program depends on passenger safety, making it essential for health care entities to check the track record of the 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. 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.
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. Data on driver behavior can also help NEMT providers identify training opportunities for specific drivers or even decide whether to terminate agreements with drivers with potentially dangerous habits.
Make Service Limitations Known
Transportation services are not an extension of health care facilities. Even when using wheelchair-accessible vehicles, drivers often do not have medical training.
In the event of a possible medical emergency, drivers are instructed 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 rideshare companies recognize the risks and take steps to address them — including, to the extent possible, anticipating and mitigating the risks posed by coronavirus — these services can continue to provide an effective solution for health care providers and the patients they serve.