Medical transportation barriers are a major concern for the healthcare industry. Patients, including injured workers, who struggle with transportation issues often miss or are very late for appointments, causing delays in recovery. According to a recently-released research study by Transit Cooperative Research Program, 3.6 million Americans miss or delay medical appointments because they have trouble with transportation. This amounts to a cost of $150 billion per year.
Traditionally, hospitals have either offered vouchers for taxis or encouraged patients to schedule rides with a local company that is contracted with the hospital as a non-emergency medical transportation (NEMT) provider. In the last few years, however, there has been a shift toward using rideshare services such as Uber or Lyft transportation network companies (TNCs). TNCs offer amenities that make them especially attractive to some medically-vulnerable people, such as:
Uber officially launched a health platform in March 2018 and is contracting directly with healthcare facilities to provide patient rides. Lyft has also began offering a similar type of service called Lyft Concierge. These services, while certainly desirable to a certain segment of the population who need non-emergency medical transportation services, has introduced new risks. Healthcare organizations who are seeking to contract for NEMT services should consider the following factors before choosing the right service.
Not every patient is a good fit for an Uber, Lyft or other TNC. Some patients, such as people who are coming out of anesthesia, really need someone that can watch them closely to make sure they aren’t having a reaction. TNC drivers are not chaperones. They are not trained to make medical decisions and cannot take on the risk of being responsible to pay attention to patient acuity.
Many TNCs don’t have a wheelchair lift and are not able to accommodate medical equipment. People with medical equipment may not be a good fit for a TNC ride. Also, people with mobility issues that need help getting in or out of the vehicle may not be a good fit as TNC drivers are not able to provide assistance for people that have medically-related mobility challenges.
Healthcare organizations need to be aware that they may be vicariously liable for driver conduct if they facilitate the ride. While most companies carry $1 million in auto liability limit, in the case of a severe accident, a hospital or other healthcare facility may incur damages.
These risks extend to driver skills, conduct and inappropriate actions, such as abuse or sexual assault. Furthermore, these types of incidents typically attract significant media coverage due to the high-profile nature of companies like Uber or Lyft. Medical malpractice policies typically include coverage for sexual assault claims, meaning the contracting healthcare provider may ultimately be liable for any damages.
Most healthcare-contracted TNC platforms connect directly with electronic patient records, putting personal patient information – like medical history, name, address, social security numbers and insurance records – at risk for cyber hacking. A records breach of this nature would violate HIPAA laws that could result in serious regulatory and negligence lawsuits.
Not only are patient electronic healthcare records at increased risk for cyber security breaches, but they are at risk for being out of HIPAA compliance due to driver knowledge. Drivers do not know ahead of time if a requested visit is for a medical patient, meaning information can be easily shared with the driver by hospital personnel at the time of pick-up or drop-off. For example, mentioning that a patient had a certain procedure and will need extra help may constitute a privacy breach according to HIPAA regulations.
It’s important for healthcare organizations to be aware of the increased risks involved in contracting with ridesharing TNCs like Uber or Lyft. While using TNCs for non-emergency medical transportation may be appropriate given certain conditions are met, it’s essential that healthcare providers identify potential exposures to ensure that patients needs and privacy requirements are met.
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