Providing Medicaid beneficiaries with a no-cost ridesharing transportation service, such as Uber or Lyft, did not have an effect on beneficiaries missing primary care appointments, according to a study published Monday in JAMA Internal Medicine.
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According to FierceHealthcare, patient no-shows can hurt providers' revenue and create unexpected gaps in providers' schedules. The researchers estimated that at some point up to 50% of Medicaid beneficiaries have missed or rescheduled appointments because of unreliable transportation.
For the study, researchers from Penn Medicine examined whether access to a no-cost ridesharing service would lower the rate of appointment no-shows. To do so, they offered on-demand ridesharing services through Lyft to nearly 800 Medicaid beneficiaries who received care at one of two Penn Medicine primary care practices in Philadelphia between October 24, 2016, and April 20, 2017. Each of the beneficiaries received an appointment reminder call. During that call, half of the beneficiaries also received information about the complimentary ridesharing service.
The researchers found "no significant difference in missed appointment rates for [beneficiaries] offered a Lyft ride compared with those" who were not offered a Lyft ride. According to the study, 144—or 36.5%—out of 394 Medicaid beneficiaries offered a Lyft ride missed their appointments, compared with 144—or 36.7%—out of 392 Medicaid beneficiaries not offered a ride.
According to the study, few beneficiaries accepted the complimentary Lyft ride at the time of the call. Among those offered a ride, 85 of the 288 beneficiaries who answered the phone used the complimentary ride.
More research needed
However, the researchers acknowledged that the study's design might have contributed to the low ridesharing use and that new studies are needed to examine the topic. Krisda Chaiyachati, the study's lead author and a VA advanced fellow at Penn Medicine, said, "We think this may be the result of the way we delivered the service or lack of familiarity."
For instance, the researchers wrote phone calls "may not be the best way to contact" beneficiaries to offer the free rides. They also said it is possible that some beneficiaries were not comfortable using Lyft's text-based system. The researchers also speculated that the ridesharing service might have performed better in a geographic area where there is less access to a public transportation network of buses and trolleys.
The researchers concluded that providing rideshare-based transportation services might not decrease the rate of missed primary care appointments, but targeting populations with transportation needs or delivering rideshare services in other ways warrants further research.
David Grande, an assistant professor of Medicine at Penn's Perelman School of Medicine and a senior fellow and director of policy at the Leonard Davis Institute of Health Economics, said, "One of the takeaways here is that we need to be thoughtful about how we design and test new programs that address social barriers to health care." Grande continued, "While we want hospitals and health systems to address patients' social challenges that impact health—we need to rigorously evaluate new programs to make them successful." He added, "In this case, addressing transportation alongside other barriers could make a difference or doing a better job identifying who needs the services" (Rapaport, Reuters, 2/8; MedPage Today, 2/5; Finnegan, FierceHealthcare, 2/6; Penn Medicine release, 2/5; Bryant, Healthcare Dive, 2/6).
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