In a segment on “Jimmy Kimmel Live” earlier this month, people on the street voiced their opinions about the new healthcare bill’s various provisions.
However, the segment, called Lie Witness News, was really a sketch made up by show’s producers.
Those interviewed approved of proposals like deploying veterinarians to perform surgeries on patients who lacked insurance, and paying people to stitch up their own wounds using YouTube tutorials.
But one suggestion, which elicited peals of laughter from the studio audience, was not actually so far-fetched.
“Let’s talk about the bill’s provision replacing ambulances with Uber EMT,” the interviewer said. “A lot more drivers on the road obviously and time is of the essence. It doesn’t really matter who drives.”
“Yeah, as long as you get to the hospital quick, reliable. I think that could be provided by regular people,” said the young man on camera.
“You support Uber EMT?” asked the interviewer.
“I’d be in for that,” he said.
Uber, for real
While the government is not actually proposing that Uber replace ambulances, more and more people do seem to agree that “regular people” are capable of bringing someone to the hospital in the event of an emergency.
According to Stat News, and other outlets, hard data isn’t available to quantify the trend, but Uber and Lyft drivers are encountering riders who need more than a ride home from the bar.
“When I got there, to my dismay, I see him literally dragging himself toward my car, hand on his chest, stating he was having chest pains and was getting dizzy,” wrote a driver on an online message board.
“I offered to call 911, as the hospital he wanted to go to was over 15 minutes away, but he insisted for me to take him,” the driver continued. “Fortunately, I was able to get him to the hospital and he was admitted, but it made me wonder why someone in that situation would prefer an Uber over an ambulance — the only rationale I can come up with is money.”
Uber, Lyft, and medical experts would all agree that the man’s situation was one that required an ambulance, not a rideshare.
In an ambulance, EMTs can administer treatment en route. Plus, their knowledge of the area’s emergency rooms enables them to bring the patient to the hospital best equipped to handle the situation.
But there are occasions when ridesharing services are appropriate, and may even serve to fill a void in access to healthcare.
Last year, Uber partnered with Circulation, a company that arranges rides for people getting medical care.
And Lyft is entering the healthcare market in multiple ways, forging direct partnerships with providers like Blue Cross Blue Shield, and with traditional medical transportation companies like American Medical Response.
“For us as an organization, healthcare aligns very, very well with our mission, with our values,” Dan Trigub, head of healthcare and elder mobility solutions at Lyft, told Healthline.
People who get insurance through a company that has partnered with Lyft don’t request a ride themselves. Their providers schedule a pickup through the company’s stand-alone website, Concierge.
So whether they know it or not, a patient covered by one of these services may be taking an Uber or a Lyft to their next doctor’s appointment.
‘Need for something better’
A 2005 report from the National Academies of Sciences estimated that 3.6 million Americans miss or delay healthcare due to lack of transportation.
Minorities, people with low incomes, and those with chronic illnesses are affected disproportionately.
The same report found that paying for transportation to make sure people get to their appointments would cut down on healthcare costs in the long run.
That reasoning fuels the federal requirement that Medicaid pay for its beneficiaries to take a cab, van, public transportation, or other mode of transport to the doctor’s office if the patient has no other way of getting there.
The Centers for Medicare and Medicaid Services (CMS) spent $2.7 billion on nonemergency medical transportation (NEMT) in 2013, according to the U.S. Government Accountability Office (GAO).
Most companies providing Medicaid services partner with transportation brokers, who in turn contract with cabs or other livery services to arrange rides. They then bill CMS for reimbursements.
But this system has come under scrutiny for being opaque, expensive, and ineffective. GAO officials identified NEMT as an area of “high risk for fraud and abuse.” Last year, New Jersey’s Medicaid program failed an audit of its NEMT services for improper oversight and reporting.
There was clearly a “need for something better,” Robin Heffernan, chief executive officer of Circulation, told Healthline.
With the traditional service, “you had to call several days in advance of the ride and then the broker would go take several hours to figure out whether they could accept your ride, and come back and give you a four-hour window for your patient to be ready,” she said.
“It’s huge to be able to have one platform which can, in a more structured manner, deliver these rides, track them, and account for them,” she said.
According to CareMore, a company that serves Medicare beneficiaries, its partnership with Lyft has cut both wait times and per-ride costs by about a third.
People no longer have to wait an hour or more to be picked up after their appointment ends, Dr. Sachin Jain, CareMore’s president and chief executive officer, told Healthline.
“With Lyft, you’re working with a driver who is proximate, they’re relatively close to where you are, so that wait time on the pickup ride is shorter,” Jain said.
Jain said that CareMore provided senior sensitivity training to Lyft drivers to prepare for picking up a customer base that is not widely associated with using ridesharing services.
Drivers to the rescue?
But these services are not, however, replacing ambulances. At least not yet.
Unnecessary ambulance rides rose from about 13 percent to 17 percent between 1997 and 2007, according to a study from the University of Pittsburgh.
James Langabeer, a professor of health informatics at the University of Texas Health Science Center at Houston (UTHealth), said that people call an ambulance — when they don’t really need one — for all sorts of reasons.
“I think the emergency department is a place where you can go and you know you’re going to get care, whereas if you call a provider and they say tell me about your insurance, it’s a barrier,” he told Healthline.
Even people with insurance may not have a primary care doctor or “medical home” they feel comfortable visiting, he added.
Langabeer studied a pilot program run by the Houston Fire Department, called Emergency Telehealth and Navigation (ETHAN).
ETHAN allows EMTs to offer alternatives to patients who call 911 but do not require emergency services.
One solution is to offer cab vouchers for office visits, which the EMT can help schedule. Langabeer said he can imagine ridesharing filling a similar role.
But despite his interest in easing the burden on ambulances, Langabeer stressed that 911 is still the best option for anyone in medical distress.
“We’re not always as patients the best people to diagnose, or the right people to diagnose our own conditions,” he said. “On the other hand, we do know our body, and we know what’s abnormal. And if you do know this isn’t normal, and you’re completely convinced, now how do you get there?”
“In those cases I say, ‘Yeah,’ call any type of special transportation that can get you to those places and get you in.”