Edith Stowe, 83, waited patiently on a recent afternoon at the bus stop outside MedStar Washington Hospital Center in the District of Columbia. It's become routine for her, but that doesn't make it any easier.
Stowe, who lives about five miles from the hospital, comes into the medical center twice every three months to get checkups for chronic kidney failure. She doesn't own a car and relies on buses. During rush hour, buses are more frequent, and she can keep the commute to about 30 minutes. But when she has to come in the middle of the day, it takes her at least an hour to get in and another hour to get home.
"It's pretty good except for waiting during non-rush hours," she said. "When that happens I don't plan anything else for the day."
For people without access to private transportation, getting to medical appointments can be a challenge, especially if they have chronic conditions that require frequent appointments.
Some hospitals and medical providers think that the hot-new technology in town -- ride-hailing services such as Uber and Lyft -- can address this problem by making the trips easier and, in some cases, it is even covered by Medicaid and other insurance plans. Partnerships between ride-hailing companies and hospitals are emerging around the country. While the efforts are still small, some hospitals and medical transportation providers think the potential for growth is large.
MedStar Health, a nonprofit health care system with hospitals in Maryland and the district began a partnership with Uber in January that allows its patients who use Uber to access the ride service while on the hospital's website and set up reminders for appointments. Medicaid patients who may not have access to the Uber app can also arrange the ride by calling the hospital's patient advocates.
National MedTrans Network, a transportation system that provides non-emergency medical rides for patients and medical providers in a number of states, expanded its services through a partnership with Lyft last year in New York, California and Nevada.
Hackensack UMC, a hospital in New Jersey, the Sarasota Memorial Hospital in Florida, and Relatient, a health care communication company have also announced partnerships with Uber in the past year. Veyo, a San Diego startup, says it is offering a ride-hail-like technology for health care appointments in Idaho, Arizona, Texas, Colorado and California.
"We probably had 50 different systems across the country reach out to us and ask us 'How did you do it?'" said Michael Ruiz, chief digital officer for MedStar. "I would say that it has been a seismic shift for the people who have used the service and the places we've provided it."
Patients' costs for the services vary. For Medicaid patients, transportation for non-emergency medical visits are covered, although the extent of reimbursement depends on state rules. Traditional Medicare does not cover non-emergency medical transportation, although some private Medicare Advantage plans may offer some benefits.
Getting To Your Doctor
When going to a medical appointment becomes a hassle, patients are likely to miss the visit, and that can help lead to untreated symptoms or worsening health.
"Transportation can make it difficult for people to see health care providers on a regular basis," said Ben Gerber, an associate professor of medicine at the University of Illinois at Chicago who has studied patient transportation issues. "It is important to see health care professionals regularly, especially for patients with diabetes or asthma."
In a 2013 analysis of 25 studies, Gerber and colleagues found that 10 to 51 percent of patients reported that lack of transportation is a barrier to health care access. One of those studies showed that 82 percent of those who kept their appointments had access to cars, while 58 percent of those who did not keep appointments had that access. Another study reported bus users were twice as likely to skip on appointments compared to car users.
In addition to concerns about patients' health, those absences can also be expensive for medical institutions, which lose revenue from the missed appointment.
Hospitals and managed care organizations do offer a variety of options to assist with transportation for non-emergency medical appointments. Health centers often work with volunteer drivers to pick up and drop off patients.
Patients can call them ahead of time to arrange a ride, but these services generally require advance planning, which becomes a problem when the patient needs to go in for an unscheduled appointment or if the patient forgets to book ahead.
Some patients also end up calling 911 for non-emergency situations, potentially diverting resources that could be used for others with more pressing needs.
The National Medtrans Network partnership with Lyft began after an incident in February 2015. One of its clients, an elderly woman, was left waiting for a ride to a hospital in New York in freezing weather for 30 minutes. The contracted provider failed to show up.
"It was almost a dangerous situation," said CEO Andrew Winakor. When his company was notified of the situation, officials immediately called a ride-hail service. The ride arrived within six minutes. Winakor said Medtrans officials realized they had to find a transportation option that could respond immediately to canceled rides.
But ride-hailing services do have some disadvantages. Wheel-chair friendly rides are still limited to a few cities. They also depend on the availability of drivers, which might be scarce in rural areas and low-income communities.
MedStar in Washington, dealt with the problem in one of its hospitals in rural Maryland, where there was a lack of Uber drivers, when a patient there had to travel to the flagship hospital in D.C. for an outpatient surgery at 6 a.m.
"Our social workers worked with the folks at Uber to be able to coordinate the ride to pick this patient up at 4:30 am, and coordinate the ride back," Ruiz said.
Buses, vans and local public transportation for people in wheelchairs come and go frequently in MedStar Washington Hospital Center's bus center. Stowe is satisfied with the transport options available. While she hasn't used Uber before, she said it is something she wouldn't mind trying especially when it gets cold outside.
"There are times when you come out and you really don't feel that well. If Uber is here, it'd be really nice to have it," said Stowe.