Uber and Lyft ride into healthcare. What to expect (and what not to)
Here's the premise.
36 million American patients miss their medical appointments. If only they had a ride waiting outside, they'd make it to the doctor's office.
Uber and Lyft have both made announcements in healthcare this month. And why not? In recent months, Apple, Amazon, Google, Berkshire Hathaway have all plugged into healthcare.
Here are a few headlines that recap this ride-sharing story.
Basically, the doctor's office or the hospital would hail a ride. A patient would hop in, possibly share the ride with other patients. Helping providers not lose money in missed appointments ($150 billion per year). Helping patients not fall sicker by skipping those appointments. Further, sick patients end up in acute care burdening the system more and more.
I get the logic.
Just that I see a few bugs in it. More so because we are practically in the trenches with doctors everyday.
Why patients don't show up (really)
JAMA just published findings from a clinical trial of 786 adults with Medicaid. This is what they found:
"Offering a rideshare-based transportation service may not decrease missed primary care appointments."
The Annals of Family Medicine published this study in 2004. Why We Don’t Come: Patient Perceptions on No-Shows. Before Uber or Lyft existed.
Patient "no-shows" is a big problem for doctors. But you rarely hear that they didn't show up because they couldn't get a ride.
The 3 big reasons that the Annals of Family Medicine study found were:
- Perceived disrespect
- Not understanding the scheduling system
Here's quoting from the study:
"Appointment making among these participants was driven by immediate symptoms and a desire for self-care. At the same time, many of these participants experienced anticipatory fear and anxiety about both procedures and bad news. Participants did not feel obligated to keep a scheduled appointment in part because they felt disrespected by the health care system. The effect of this feeling was compounded by participants’ lack of understanding of the scheduling system."
This does sound right.
There's another study, Why do patients not keep their appointments? Prospective study in a gastroenterology outpatient clinic. The findings:
"Forgot to attend or to cancel (30%); no reason (26%); clerical errors (10%); felt better (8%), fearful of being seen by junior doctor (3%); inpatient in another hospital (3%); miscellaneous other (20%). 13 (27%) of the review patients had not kept one or more previous appointments."
In our experience, this sounds perfectly reasonable. More than a quarter of them cited "no reason"!
There are also unexpressed financial reasons. By showing up, patients need to face up to deductibles and co-pays. It's not always that they want to pay up.
Several articles talked about how the rides would help lower income populations.
The reality is doctors struggle to get paid by Medicaid (insurance that covers lower income). They never know if they'd get paid for the service they are about to provide. They do it anyways.
It seems unreasonable to expect that over-stretched doctors and staff would now hail a ride for patients via the EHR.
EVEN IF we do call Uber from the EHR
I was recently in a meeting at a large hospital in the east coast of US. It's easily considered one of the world's best. The doctors don't really have a problem patients showing up. It's what happens after they do.
Here's where they are stuck.
They see a patient. Order a test. Or schedule a procedure. The billing office calls the insurance to get "prior authorization" for the procedure. Insurances make it difficult to provide prior auths. The game goes on for several days. The billing office is overwhelmed by the many prior auth requests. Finally after 30+ days (on average), the patient ends up on the procedure table. Getting the care she rode in for.
Now imagine in the above everyday scenario, the doctor or her staff does call Uber for their patient. Possibly via their EHR. Of course, the integration is cool (for tech folks, not necessarily for doctors). It won't necessarily help the patient get care faster. It won't help doctors get paid for that care or service.
In fact, what it is is this. It's convenient. Like ordering food online. It may not really solve our clinical or economic burden in healthcare. It adds a layer of easy. And that's a good thing too.
May be we should say just that.