- A new study in JAMA Internal Medicine raises questions about the potential for rideshare-based nonemergency medical transportation programs to reduce missed medical appointments.
- In the study, Medicaid enrollees who were established patients in one of two West Philadelphia medical practices were offered ridesharing services if their prescheduled appointment fell on an even day of the week. Those whose appointments fell on odds days did not get the offer. Both groups received up to three phone call reminders in the days prior to their appointment.
- Among those in the trial arm, only 26% took up the offer of ridesharing. More significant, perhaps, was the lack of difference in missed appointment rates — 36.5% in the intervention group versus 36.7% in the controls. The study was conducted between Oct. 24, 2016 and April 20, 2017.
Missed appointments are a costly problem for providers and insurers, with estimates running upwards of $150 billion a year in the U.S., according to the Washington Business Journal. An opinion piece in JAMA suggested rideshare programs could help the federal government rein in its $2.7 billion annual spending on nonemergency medical transportation.
A number of hospitals and health systems — including Maryland-based MedStar Health and HackensackUMC in New Jersey — have partnered with rideshare companies like Uber and Lyft to cut down on no-shows and late arrivals. In addition, American Medical Response teamed up with Lyft to provide nonemergency rides for patients in 42 states, citing benefits to hospitals and health plans in reducing missed visits. And last year, Blue Cross and Blue Shield said it would begin offering Lyft free to members of select BCBS companies to reduce missed appointments.
What the new study suggests is that rideshares alone may not improve attendance rates. “It is possible that modifications to our model of providing rideshare-based transportation services or how we informed patients about the service might produce different results,” the researchers say.
They note, for example, that West Philadelphia, where the study took place, is a small geographic area with an existing network of public transportation options. The study also didn’t consider other social risk factors such as home environment that might cause patients to miss an appointment. And some patients may not have been comfortable with text messaging, which was required to dispatch the ridesharing services.
Future studies on the association between ridesharing and no-show rates should consider alternative delivery models or target populations with more serious transportation needs, the researchers say.