For hospitals, patient no-shows are a constant and costly source of frustration. Each year, about 3.6 million people in the U.S. miss or delay medical care because of issues related to transportation like a ride to an appointment falls through or the car will not start. The problem is especially acute for low-income populations dependent on public transportation.
The cost of hospital patient no-shows
According to The Washington Post, the average wait to see a physician is 18.5 days. During that time, patients may decide their concerns can not wait and go to the emergency room, or they may feel better and decide to skip the appointment sometimes without notifying the medical office.
In a retrospective study published by BMC Health Services Research, researchers found that the average no-show rate for community hospitals was 62 appointments daily, at an annual cost of $3 million. At teaching hospitals, the no-show and late arrival rates averaged 25% and 31%, respectively.
The financial toll of no-shows for a hospital can run in the millions of dollars annually, says Jose Lozano, chief of staff and vice president at HackensackUMC in New Jersey.
It is not just a revenue issue. If a patient is on a chemotherapy regimen and can not get to the hospital for treatment, that could negatively impact their prognosis.
The use of mobile apps to minimize no-shows
Now, thanks to on-demand transport companies like Uber and Lyft and new tools, hospitals have other options to help them cut down on costly no-shows.
In Florida, startup Doc-Quick allows doctors to fill last-minute cancellations and no-shows using an app where patients enter their own names on an appointment wait list. “If you’re a medical office or somewhere where it’s a pretty common appointment type, you can pretty much recover that slot if you have a database of full-day leads,” says Tracy Donegan, practice director at Top Tier Consulting.
Many hospitals and medical practices are already using email and text notifications to remind patients of upcoming appointments. Some of these allow the patient to request a change or cancel the appointment. Depending on the patient population, doctors and hospitals could also push out calendar invites with a three-day reminder alert on Outlook, Donegan says.
The patient and physician both have a role in maintaining the appointment, she says, adding physicians and hospitals should alert patients if they are running behind schedule, just as airlines post estimated arrival and departure times. “If you make it a two-way street, you’re likely to see more adherence from the patient side,” Donegan says.
Hospitals partnering with ride-sharing apps
HackensackUMC recently partnered with Uber to try and cut down on its no-shows and late arrivals as well as to give patients a better overall experience. Located in the heavily congested Bergen County, just outside New York City, the hospital’s specialty care facilities, emergency rooms, and medical office building are sprawled across a 3 million-square-foot campus. On any given day, about 10,000 patients and employees go through its doors.
Lozano says when patients are asked why they canceled at the last minute or rescheduled an appointment, the answer often relates back to transportation, especially when patients are coming in for an outpatient procedure and know they will be able to drive themselves home.
What the hospital needed was a convenient option for getting patients to their appointments on time by delivering them to the appropriate building, says Lozano.
“What happened before was people always would come to the front door," Lozano says. "Now, with Uber, we’ve allowed them to come on our campus and specifically map out every specific entrance point … into the hospital.”
On Tuesday, Uber Stop signs went up in front of each drop-off site. When people go on Uber and say they want to go to Hackensack, a scrolling dial pops up that asks where they need to go on the campus, Lozano explains. “When you click on that entrance point, the driver’s GPS will take you to that site.”
Hackensack is tackling the no-show conundrum in other ways, too. A couple of months ago, the hospital launched an app that lets patients schedule an appointment and then send themselves a reminder. It also includes a symptom checker, how to search for a physician, and it links back to the patient’s electronic medical record.
“What we’re hoping for is anything that’s Hackensack or physician or medical related to you, we’re hoping that it’s right in the palm of your hand,” Lozano says.
In the Washington, D.C., region, MedStar Health is using Uber to ferry its neediest patients, who do not have reliable transportation and are reliant on mass transportation, to and from its various campuses.
The pilot program got underway a little over two months ago and is not yet available at all of MedStar’s locations, says Michael Ruiz, vice president and chief digital officer of the $4.2 billion health system.
Today, the pilot is running about 15 different sites. Statistics from the first 10 sites show that Uber gave rides to about 200 people who otherwise would have missed appointments.
“It’s too early to know if we’ve moved the needle,” Ruiz says, “but I think, anecdotally, we have some really great stories on the progress that we’ve made.”
According to Ruiz, MedStar’s partnership with Uber is built around three guiding principles: provide a better patient experience, improve logistics when patients get to the hospitals, and make it easy for needy patients to get healthcare services. People who do not qualify for the pilot program but may be too sick to drive themselves to the hospital or just want a more convenient way to get there, can also use the Uber service.
MedStar pays for those who qualify for the pilot program. But Ruiz says the on-demand app is “significantly cheaper” than the taxi service it has been using, so “we can provide that many more rides for our patients.”
Since partnering with Uber, more than 50 hospitals across the country have contacted MedStar with questions about the regulatory and technical hurdles involved in the deal, Ruiz says.
To protect personal health information, MedStar only provides Uber drivers with the patient’s first and last names and telephone number. The driver is told where to drop the patient off, but not the name of the doctor or the service area in the hospital.
“There were negotiations back and forth on how to do billing and how to ensure that we can protect against any fraudulent use of this process, but at the same time there’s a way to protect patients’ information and do it in compliance with all applicable regulatory constraints,” Ruiz says.