Patient transportation is a well-documented thorn in the side of the healthcare industry. Missed or delayed appointments not only drive up costs but can also lead to overall poorer health outcomes as well. These statistics highlight the scope of the problem:
- 3.6 million Americans miss needed medical care each year due to transportation barriers.
- Approximately 3 million children skip a healthcare appointment each year due to unavailable transportation.
- Lack of reliable transportation is the third most commonly cited barrier to accessing health services for older adults.
Until recently, healthcare providers have largely relied on community partnerships, taxi vouchers, or contracted non-emergency medical transportation companies (NEMTs) to reduce the gap. But a modern solution is underway.
A new cure for non-emergency medical transportation
Ride-sharing companies, such as Uber and Lyft, are looking to disrupt traditional transportation methods. These transportation network companies (TNCs) are rapidly connecting with healthcare providers as an alternative means of scheduling non-emergency patient rides.
In March 2018, Uber officially launched its Uber Health platform and began partnering directly with healthcare facilities to provide patient rides. Lyft also began offering a similar service via Lyft Concierge.
These platforms use an online portal that’s integrated with patient health records, allowing hospital transport coordinators to schedule and manage on-demand rides from one centralized location.
“Is it a strategic road map to improved patient access or a mobility trend that expands healthcare organizations’ risk? Ultimately, the answer may be some of both.”
-Jeff Duncan, Chief Underwriting Officer, Healthcare Practice, Liberty Mutual Insurance
In some scenarios, TNCs may offer a faster, more convenient, and more secure way to get patients to and from their appointments. But these unique features also introduce new exposures – which deserve scrutiny from a healthcare risk management standpoint, says Jeff Duncan, Chief Underwriting Officer, Healthcare Practice, Liberty Mutual Insurance.
“Are TNCs a strategic road map to improved patient access or a mobility trend that expands healthcare organizations’ risk? Ultimately, the answer may be some of both,” he says.
Mitigating the risks of transportation network companies
To reap the benefits without falling victim to unforeseen exposures, healthcare risk managers should consider the following guidelines before committing to using TNCs for patient transportation.
1. Make matches with care.
TNCs may not be the right choice for every patient. For example, if a patient has been under anesthesia, a caregiver may need to travel along.
“TNC platforms don’t solve for acuity. They aren’t chaperones,” advises Duncan. “If patients need chaperones under traditional transportation options, they’re still going to need chaperones under this option.”
In addition, hailing an Uber or Lyft may also not be a good match for patients with mobility challenges or who use wheelchairs.
“There is the loading and unloading exposure since the provider would be the one assisting the patient to the vehicle and securing them in,” notes Njoki Wamiti, VP & Miscellaneous Medical Facilities Product Manager, IronHealth. “Most healthcare professional liability policies cover loading and unloading exposure, but there are some that exclude it.”
2. Document driver background checks and confirm auto liability limits
Most state laws mandate that TNCs carry $1 million in auto liability limits, but in the case of a severe accident or a driver’s inappropriate behavior, “a hospital or other healthcare provider may be vicariously liable for the conduct of the driver and pulled into a subsequent lawsuit because it facilitated that ride,” Wamiti says.
Ask the TNC how thoroughly and frequently it conducts driver background checks and how it follows up on reports of misconduct, Wamiti advises. Then, confirm the TNC has adequate auto liability limits and transfer the risk via a formal contract.
3. Verify cyber insurance protections.
TNC dashboard platforms integrate with providers’ electronic health records, pulling patient information to identify transportation needs. This link may create an access point for hackers, which could lead to personal information breaches, HIPAA violations, and negligence claims.
“Hospitals heavily secure their data, but are they making sure their vendor partners adhere to the same standards?” asks Wamiti. After reviewing your own cyber policy for both first- and third-party coverage, confirm the level of security and privacy protections and amount of cyber insurance coverage the TNC carries.
4. Clarify HIPAA compliance issues.
Unauthorized access to medical records is not the only threat to patient privacy and HIPAA compliance. TNC platforms use their existing networks of drivers, but drivers are not informed if rides are for patients versus regular passengers.
“A driver doesn’t know that a ride is for a hospital-related visit – which is a benefit, not a bug,” Duncan says. Withholding this information helps TNCs maintain HIPAA compliance, but an untrained employee escorting a patient to a vehicle can easily break that confidence by sharing unnecessary details with the driver.
“The benefits of TNCs may well exceed the challenges. Where risk managers run into trouble is when they use TNCs extensively – and don’t talk to their insurance brokers and carriers about it.”
To mitigate this risk, always use a TNC’s specific healthcare platform, if available, because personal or even business accounts don’t guarantee HIPAA compliance. And train employees to not divulge details of patients’ visits to drivers.
Above all, because a TNC would be a Business Associate for purposes of HIPAA under this arrangement, make sure to enter into a well-drafted business associate agreement and consult with your insurer.
“The benefits of TNCs may well exceed the challenges,” Duncan says. “Where risk managers run into trouble is when they use TNCs extensively – and don’t talk to their insurance brokers and carriers about it. By working with insurance partners, you can help ensure your organization has the right coverage and risk mitigation strategies in place so you can take advantage of this technology.”
Like ridesharing, telemedicine as a vehicle to improve patient care continues to grow. Learn more about how your healthcare facility can help mitigate potential risks in our article.
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