Uber to the ER?

Ambulances are expensive. Some cities are beginning to offer other ways to get to the hospital.
by | May 2018
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It’s more than just an inexpensive, convenient way to get to the airport or back home safely from an evening of bar-crawling. More and more, people are calling Uber, Lyft and other ride-hailing services in place of ambulances to take them to the emergency room. There’s no mystery to their motivation. People see ride-hailing as more reliable and vastly cheaper than traditional emergency transport: A ride in an ambulance can cost a user as much as $1,200, depending on what insurance covers.

So it probably shouldn’t be surprising that in March Uber announced that it was venturing into health care. Uber Health is a digital portal that allows health-care organizations to book rides for a patient or caregiver. The company says it is also working to allow people without access to a smartphone or computer to receive trip details.

It’s not the first time that ride-hailing companies have been tapped to supplement traditional health-care transportation options. Last year, the AARP Foundation and UnitedHealth Group partnered with Lyft and the University of Southern California to offer free rides to low-income Los Angeles seniors who had missed two or more medical appointments in the previous year. And the University of Pennsylvania offered Lyft rides to 800 West Philadelphia Medicaid patients for scheduled appointments.

The results for the Philadelphia project weren’t particularly encouraging: The missed appointment rate improved by barely a percentage point. Still, these projects are evidence for many in health care that the current model of health transportation and ambulatory services needs to be diversified. Ambulances, along with government-provided paratransit for the disabled, are increasingly thought of as overly expensive services plagued with bureaucratic inefficiencies and the high costs of “super-utilizers” who overuse the transportation services and emergency rooms. “We’ve done a wonderful job of telling people that they can call 911 and have emergency services show up,” says Dean Dow, president and CEO of the Reno, Nev.-based Regional Emergency Medical Services Authority (REMSA). “Now we must educate people on when to use and when not to use it, as well as give people alternate numbers [for nonemergency situations].”

Serving Reno and Washoe County since 1986, REMSA is a nonprofit provider of emergency medical services that receives funding from both the state and federal government for a three-pronged effort aimed at taking some of the pressure off of its ambulance services. The program’s offerings include a nurse health line for people needing immediate health advice. There’s an alternate transportation program that sends people who don’t really need the ER to more appropriate services such as urgent care, a mental health facility or rehab. And a paramedicine program helps those super-utilizers with needs like nutrition and medication management.

Similar efforts are underway elsewhere. In 2014, for example, the city of Houston launched its Emergency TeleHealth and Navigation program, which connects patients with a nurse over video chat if a paramedic responding to a 911 call deems a situation a nonemergency. In its first three years, the program has reportedly prevented some 6,000 emergency transports.

There are barriers to quick, widespread adoption of these alternatives. Private insurers are reluctant to reimburse new models of care without years of data and evidence of effectiveness. Dow says REMSA struggles “on a weekly basis” to find long-term reimbursement streams, even with support from the state’s Medicaid program. But “the model has to evolve,” he says. “It’s not functionable for the future.”