How Do You Know if Your Uber Driver Has Toom in His Trunk for a Walker

Uber and Lyft are taking on healthcare, and drivers are merely forth for the ride

Experts worry that rideshare drivers aren't prepared

By Feb 17, 2022, ten:00am EST

Within the first week that Austin Correll was driving for Lyft in the fall of 2021, he was sent to pick up passengers at an accost that turned out to be for a hospital. When he pulled up to the curb, he found an elderly woman in a wheelchair and another other with a walker, waiting for him — flanked by four or five nurses.

He got out and talked to the nurses, who told him that the woman in the wheelchair had only had heart surgery and needed to go to assisted living. The woman with the walker was her daughter, and she also appeared to have some health issues, Correll says.

Correll, who said he started working for Lyft for a few months while he waited for the results of his bar exam, doesn't take any medical training. He told The Verge he immediately felt unprepared for the responsibility of transporting these two women, who were supposed to get to a motel around ii hours away. When the nurses then told him that, on inflow at the motel, he should phone call an ambulance to help motility the passengers into their room, he grew even more than uneasy.

"The biggest thing I was worried about was, what if there was a medical emergency? This isn't somebody who got their arm broken, got a cast, and needed to get home," Correll says. "These are two people with severe medical issues."

When they got to the cabin, Correll decided he didn't want to call the ambulance. Instead, as carefully as possible, he helped both women out of his truck and into their hotel room. After the ride was over, he reached out to Lyft to ask how he got put in this situation. The company wasn't much help, he says. Lyft did non answer to a request for comment on this specific situation.

Correll is now working as a lawyer. But if he had kept driving, he might have meet more situations like this one. That's because, for the by few years, rideshare companies Lyft and Uber accept been moving into the not-emergency medical transportation (NEMT) business, offering their networks to healthcare organizations that demand to schedule rides for patients. Correll isn't sure if his ride was through a formal NEMT program, simply it could have been: to protect patient privacy, drivers aren't told if their rides are from healthcare partnerships or not.

NEMT is used as a way to help depression-income patients and Medicaid recipients get to appointments they might otherwise miss because they lack access to transportation. The need for such services is significant: millions of people in the United States, mostly low income, miss doctors' appointments each year because of transportation barriers, costing the health system billions of dollars. Merely while NEMT is ofttimes washed through dedicated companies, rideshare groups are now interested in what'due south estimated to be a $iii billion market.

Rideshare is a cheaper alternative for healthcare organizations, and some experts think information technology has the potential to fill up gaps in what NEMT services are able to offer. But research so far hasn't borne that out, and clinicians say they worry that Uber and Lyft drivers aren't fairly trained to safely transport the types of passengers who typically employ NEMT.

"It has the benefits of flexibility," says Yochai Eisenberg, an assistant professor of disability and human development at the University of Illinois Hospital & Health Sciences Organisation. "Information technology can save money, and it's less costly than a lot of the existing infrastructure. Only the lower cost is taking away in some mode from the quality that traditional transportation companies can provide."

A healthcare gap

Lyft was the outset rideshare company to launch an NEMT program. In 2016, information technology started offering healthcare organizations the power to volume rides for patients through its platform. In Apr 2021, the company launched the Lyft Pass for Healthcare program, which lets organizations comprehend the cost of rides that patients book themselves. Uber launched its NEMT program in 2018.

Both companies accept expanded their partnerships with the healthcare sector over the by few years. Uber and Lyft now have their systems built into some electronic health record platforms, so doctors can schedule directly through a patient's medical record. They also have specialized programs available in some cities, called Lyft Assisted and Uber Assist, where drivers provide light physical assistance walking riders door to door rather than just taking passengers curb to curb. While Lyft and Uber consider their assisted services to exist split up from their NEMT programs, in that location's some overlap: healthcare organizations partnering with Lyft for NEMT can schedule Lyft Assisted rides for patients, and Uber'southward NEMT programme pulls from the full general driver pool, which includes Uber Assist drivers.

Uber said in a public statement in Jan that information technology has over 3,000 healthcare customers and that it saw over seventy percent growth in bookings for its health services between late 2020 and belatedly 2021. Lyft did not respond to a question about the number of bookings through its health program.

With these new programs and expanded services, Uber and Lyft seem to be attempting to position themselves as healthcare companies. Uber only hired its outset primary medical officer, geriatrician Michael Cantor. Lyft's new head of healthcare, Buck Poropatich, comes from a healthcare strategy and business background. He told The Verge in an interview that if someone asked him if he worked for a healthcare company, he'd say yes.

Lyft and Uber say that they desire to augment and improve on today'south NEMT services, which are covered by state Medicaid programs and some Medicare programs. Typical NEMT rides are more expensive than rideshare, and they are usually handled by companies that employ drivers trained to ship people with medical conditions. Wellness rides through rideshare companies are done by contractors who drive for the technology platforms and who get limited training — if they decide to participate in physical assistance programs — or no preparation at all.

While less driver training is a downside, rideshare can be more than flexible, says Krisda Chaiyachati, an assistant professor of medicine at the Hospital of the University of Pennsylvania. Traditional NEMT companies have to exist booked in accelerate, and patients become a wide window where they can exist picked upwardly. Sometimes, these rides aren't reliable.

"It wasn't but that the rides didn't show," Chaiyachati says. Even if people made it to appointments on time, the doctor might run late, and a patient would miss their ride domicile.

These are problems rideshare companies say they tin help solve. With Lyft or Uber, people can society rides on demand instead of having a pickup window, and they can call a ride back home even if their appointment runs late.

Rideshare programs have had some successes. Some private health systems study good results switching to rideshare for their NEMT programs. They've found more than on-fourth dimension rides, shorter wait times, and high patient satisfaction. Notably, rideshare programs are likewise much cheaper and atomic number 82 to cost savings for health systems and insurers (rides are subsidized by the companies, making for a cheaper product even as the business is unprofitable).

Simply the handful of more rigorously designed studies that look at the top-line problem facing NEMT — high rates of missed appointments — haven't institute as much benefit of rideshare. Chaiyachati ran a study in West Philadelphia in 2016 and 2017 that found people offered Lyft rides weren't any more than likely to make it to their appointments than people who weren't given rides. Another study, published in 2020, found that Medicaid enrollees had similar ride experiences with rideshare and not-rideshare NEMTs, only that people who had more than rideshare rides had a greater odds of failed pickups. (Lyft published a letter pushing dorsum on that study, criticizing its methodology.)

"On the one manus, this shows that [rideshare] is simply as good as the traditional mode" in terms of patient experience, says Eisenberg, an author on the 2020 study. "It's saving time and money, it has flexibility, and the satisfaction remains the same. That's OK — it doesn't take to exist better."

But on the other hand, he notes, higher failed pickup rates are a concern. More research is needed to get a good understanding of the function rideshare tin can play in NEMT, Eisenberg says. Information technology's hard to do rigorous research, though, considering the rideshare companies, like almost engineering companies, are reluctant to share their own data.

The studies done so far evidence that improving wellness admission isn't as simple as but using an algorithm to volume people rides, Chaiyachati says. In his report, people said they missed appointments because they wanted to ride with a friend or family member who ended up not being available or because they didn't call up the appointment was important. Transportation, he says, is necessary for good intendance, but if rideshare companies desire to solve healthcare bug, they have to offer more than the edgeless musical instrument of an available car. The car needs to be accompanied by a more than robust understanding of what people's barriers to intendance are and a way to identify the subset of people where access to a more flexible and on-time ride is what's needed to aid them make it to their medico'southward appointments.

"If our goal was to reach towards disinterestedness and admission, at that place are many other layers that need to be built into that," Chaiyachati says.

Vulnerable populations

Tim, who drives for Lyft in Baltimore, used to piece of work for a company that specializes in driving people with disabilities. Before driving for that visitor, he was trained in how to aid people with disabilities, how to secure wheelchairs and scooters, and how to perform CPR, he told The Verge over Reddit conversation.

Tim, who The Verge is referring to by his first name only because he however drives for Lyft, says he has concerns about Lyft'south healthcare programs, peculiarly the Lyft Assisted program, which lets drivers requite rides to people who need light physical assistance subsequently taking an online training course. At his previous company, he had in-depth training, knew that his passengers had medical issues, and had a back up organization in place that could come up and assist him out if a rider needed extra help.

That's non always the example with rideshare services. And riders he drove through the disability visitor oft needed more than help than was initially indicated, Tim says. "Some are very frail and can't handle a lot of bumpy roads. We constantly had to suit our routes to accommodate," he says.

Drivers who do not sign upwardly for Lyft and Uber's assisted programs tin be sent NEMT rides without any preparation. Drivers who want to participate in the assisted programs are required to take tutorials created past the Open up Doors Organization (ODO), a non-profit organization that aims to "teach businesses how to succeed in the inability market." Uber'south plan includes disability sensation training and information on how to stow assistive devices similar walkers, says Katy O'Reilly, program manager at ODO. They don't include medical or emergency information, she says: "I'd say it's more just about customer service."

Lyft's tutorial provides more information, developed in partnership with occupational therapists, on how to safely walk with older or frail riders, O'Reilly says. It includes details about where the riders' easily and anxiety should go while getting into a automobile and how to walk with someone who is blind, she says.

The Lyft Assist plan is entirely online. Uber's program used to have an in-person component, merely O'Reilly says it "wasn't really scalable," so at present, everything is online. Drivers in Uber'southward WAV program (for wheelchair-attainable vehicles) yet go through in-person preparation to larn how to secure a wheelchair in a vehicle.

"You can't simply practise something like that online," O'Reilly says.

Experts who work in NEMT training don't think an online tutorial would be sufficient to brand sure drivers tin can safely handle people who need physical assistance. The Community Transportation Association of America (CTAA), which offers an NEMT driver preparation plan with hands-on components, trains drivers on specific medical weather, teaches them methods for securing wheelchairs, and other skills. Online tutorials or classroom grooming can provide some of that data, says Scott Bogren, the executive director of CTAA. "But we recommend also that they practise a demonstration with some of our trainers where they're coached," he says.

Eisenberg, the professor of disability and human development, says he would as well want to run into a hands-on component that involves working with people in need of assistance. "That's the best practice," he says.

The University of Pennsylvania's Chaiyachati says he thinks online training could be enough, but only if drivers had resources available if they ended up in a state of affairs that they didn't feel would be safe for them or for the patient — like if there was a flight of stairs and a patient with a walker who they didn't call up they could safely assist. "I'm comfy with that level of training as long as… they tin call in the cavalry," Chaiyachati says.

In an emailed statement to The Verge, Lyft'south Poropatich said that medical providers who partner with Lyft are responsible for making sure patients are able to use rideshare services. Lyft Assisted drivers do not lift riders in and out of cars or provide medical assistance, and Lyft Healthcare should non be used for people who take "medical needs," he said. In an interview, he said Lyft aims to handle non-emergency send for riders with fewer needs so that traditional medical transport groups could focus on rides "at the pinnacle of their license."

Uber spokesperson Noah Edwardsen said in a argument that healthcare organizations select the transportation that meets individual patient needs.

Merely the experience of Correll, the lawyer who worked for Lyft, shows that if drivers are called for people with more extensive medical needs, at that place isn't necessarily a loftier level of back up or backstop. He didn't have any information virtually how to handle two elderly and frail women as a standard Lyft driver. Even if he'd gone through the Assisted tutorial, he still wouldn't take specific information nearly medical problems or exist expected to handle their more all-encompassing concrete needs. But he says he didn't have anywhere to turn, and he didn't desire to leave the women stranded.

Poropatich said in an interview with The Verge that there aren't different protocols for a medical emergency or apropos situation on an NEMT ride than for any other ride. For privacy reasons, drivers aren't even told if it's an NEMT ride or not, he says. Edwardsen also said that Uber drivers do not see any difference between ride requests from Uber Health customers and regular rides.

That on its own is a safety risk, Bogren says. NEMT drivers should know if a rider has a medical status and then that they know what to do if something goes wrong. Even something that seems low-risk and not-emergency, similar driving a kidney patient to and from a dialysis appointment, can have risks. If a patient starts to bleed from the incision where the dialysis is beingness performed — as sometimes happens — Bogren says trained NEMT drivers know to reroute patients to the emergency room. "You've got to match up skill sets with passengers," he says.

Bogren thinks at that place can be a part for rideshare companies like Lyft and Uber to help fill in gaps in the NEMT system, such as when patients are discharged from the hospital in the centre of the night and flexibility with rides might be helpful. And the companies' engineering science could help some of the logistical problems in the NEMT infinite.

But if companies similar Uber and Lyft want to be healthcare companies, they take to take on the burden of condom and care that healthcare requires. Bogren says his visitor has offered to work with Uber and Lyft, but they haven't yet taken him upwardly on that offer.

So, for now, the rideshare NEMT programs are left with mostly-untrained drivers who aren't given a heads up that they might exist on their manner to someone with a medical problem when they take a ride. Correll knows that there need to be transportation options for people without the resource to become themselves to appointments. Just he thinks rideshare NEMT programs, as currently structured, are doing a disservice to vulnerable people who demand support.

"There's nothing about my feel and what I know about Lyft that makes me think that this is a safe affair for Lyft drivers or for patients," he says.

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Source: https://www.theverge.com/2022/2/17/22937849/uber-lyft-health-transport-safety

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