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June 24, 2020
The CDC defines social determinants of health (SDOH) as the “conditions in the places where people, live, learn, work, and play [that] affect a wide range of health risks and outcomes.” These may include factors such as housing stability, education, employment and income, food insecurity, material security, social integration and support, and transportation. With increasing evidence of SDOH’s impact on health outcomes, more and more healthcare organizations are recognizing the importance of both screening and addressing patient’s SDOH to improve results.
One way that organizations are addressing patients’ transportation barriers is through the use of ride-sharing apps for non-emergent transportation to and from their appointments. According to the American Hospital Association, 3.6 million individuals do not obtain medical care because they experience transportation barriers. It is also noted to be the third leading cause of missed medical appointments for older adults across the country, contributing to a cost of over $150 billion annually.
Ride-sharing companies such as Lyft, Uber, and Ride Health have recognized the growing need for transportation solutions in the healthcare industry and launched health divisions, partnering with electronic health record (EHR) vendors to offer HIPAA-compliant platforms for providers to request ride services within their patients’s medical records. National and private payers have also recognized the benefits and costs savings of using ride-sharing services. Some state Medicaid and Medicare Advantage plans may cover costs for non-emergency medical transportation (NEMT) and private insurers may provide some reimbursement.
Not only have these ride-sharing services been shown to decrease costs associated with outpatient transportation and reduced no shows, but they have also been valuable alternatives for patients facing public transportation disruptions caused by COVID-19 to continue receiving care. Some health systems have even used these services for their staff treating COVID-19 patients to travel between their homes or hotels and hospitals to prevent exposure to family members.
Although this technology may have a positive impact on patient access to care, it does not come without some risk.
Keep in mind, ride-sharing drivers are not medically trained or prepared to handle escalating medical emergencies. Therefore, it will be vital to screen and assess that patients are stable, low acuity, and have decisional capacity before utilizing a ride-sharing service. Staff assessment and the patient’s approval to use ride-sharing services should be documented in their medical record.
Not all ride-sharing services can accommodate people with disabilities. If a patient requires assistance to and from the vehicle, they may not be an ideal candidate for using ride-sharing services on their own and require a chaperone to accompany them. Organizations should consider developing a policy and procedure to guide staff on appropriate patient selection for the use of ride-sharing services.
Limit the number of stops and mile radius from the location in which patients can be picked up and dropped off. Suitable pickup and drop-off locations should include a patient’s place of residence and the health clinic or hospital location.
Ensure proper infection control measures are in place, and both driver and passenger are using appropriate PPE. Check with the ride-sharing company to ensure vehicle interiors are properly cleaned between passengers, and there are no restrictions to transporting confirmed or suspected positive COVID-19 patients.
When partnering with a ride-sharing service or purchasing a ride-sharing software platform through an EHR vendor, it is essential to consider how and if protected health information (PHI) can be accessed and whether a business associate agreement is required. It will also be important to inquire about how drivers are insured and the limits available for coverages such as auto, employment practices liability, etc. Partner with your legal counsel and IT department to better understand how patients’ PHI is protected, any system vulnerabilities, and indemnification provisions among the parties.
For more information on the risks associated with using a ride-sharing service for non-emergency patient transportation, please contact an experienced insurance broker.
The views and opinions expressed within are those of the author(s) and do not necessarily reflect the official policy or position of Parker, Smith & Feek. While every effort has been taken in compiling this information to ensure that its contents are totally accurate, neither the publisher nor the author can accept liability for any inaccuracies or changed circumstances of any information herein or for the consequences of any reliance placed upon it.