A revealing study shows what happens when urban Medicaid patients are offered complimentary rideshares to their primary care appointment.
The association between rideshare-based medical transportation and missed primary care appointments among Medicaid patients was recently evaluated in a new study.
The study, published online in JAMA Internal Medicine on February 5, 2018, found that the missed appointment rate was not significantly different between patients offered rideshare-based transportation services compared with controls.
Conducted between October 24, 2016, and April 20, 2017, the study included 786 Medicaid beneficiaries who resided in West Philadelphia and were established primary care patients at one of two academic internal medicine practices located within the same building. Participants were allocated to being offered complimentary ridesharing (intervention arm) services or usual care (control arm) based on the prescheduled day of their primary care appointment reminder. Those scheduled on even-numbered weekdays were in the intervention arm and on odd-numbered weekdays, the control arm. The missed appointment rate was 36.5% (144 of 394) for the intervention arm and 36.7% (144 of 392) for the control arm, according to the study.
For more on ridesharing for primary care patients, read“Five Things to Know About the Uber and Lyft Provider Partnerships.”
Uber and Lyft have recently announced online platforms so hospitals can provide rides for their patients.
“I think there is an operational reason one might choose to use the new platforms from Lyft and Uber-ridesharing is generally cheaper than transportation vendors and taxis-that might be more of a common sense, financial reason health systems use these platforms to transport patients,” says lead study author Krisda H. Chaiyachati, MD, MPH, MSHP, medical director for Penn Medicine's FirstCall Virtual Care, a VA advanced fellow, and associate fellow at the Leonard Davis Institute of Health Economics at the University of Pennsylvania. “The question about reducing missed appointments and truly affecting long-term health outcomes is still possible, but as our study shows, we shouldn’t think that the majority of all low-income patient need it, or at least we shouldn’t assume they need it all the time.”
The study looked at primary care, and it might be true that missing one appointment out of the five to six appointments some patients have in a year might not really matter, according to Chaiyachati.
“However, we might imagine a different population of patients who need transportation for a short period of time for missing appointments with grave consequences-cancer treatments or dialysis. If these patients are truly missing these appointments, there is some ‘barrier’ to care and transportation may be one of them,” he says. “I support testing the application of these platforms. The next step, though, is how do hospitals or insurers figure out whether it changes healthcare outcomes. That next step requires linking transportation data with claims information.”
“Patients need to know they can access ambulatory or outpatient sources of care; but if it is too difficult to travel to or the wait times are too long, we can imagine they will delay their care or choose more convenient options-urgent care centers and EDs,” Chaiyachati says.
Transportation may be one of the key components, helping patients get a ride for appointments that they believe matter and for the ones they value, he says.
“Another view might be that we should meet some patients’ care needs at home. We might instead try to provide better access through home-based care models for the frail, elderly, and/or home-bound. For those who have minor acute issues or disease management, we might employ telemedicine or telephonic complimentary models. These ‘in-home’ services try to address their needs without the time and travel burdens our healthcare system has traditionally asked of our patients,” Chaiyachati says.
“The next step is coming up with an ‘outpatient’ care program that matches the service delivery to the needs-physical or social-that produce the best patient outcomes at the end of the day and keep them out of the ED or the hospital.”