By: Dan Reid, President/Managing Member, Grove Transit
Recently numerous articles and news spots have seemed to depict UBER/Lyft as the solution for healthcare related transportation. One recent article described Lyft as a “critical part of the medical transportation system in Georgia” by pointing out that from April 2022 to April 2024 Lyft drivers performed “thousands” of rides of greater than 50 miles. I would note that “thousands of rides” takes into account both to and from the doctor, so the number of individuals actually transported to medical appointments is roughly half. What the article doesn’t mention anywhere is the hundreds of thousands of rides, many for individuals in wheelchairs, performed in that same period by qualified NEMT drivers working for NEMT providers, taxi companies and other privately owned or operated providers. Companies like UBER and Lyft may be a workable solution for a certain segment of the population living in urban areas, specifically individuals without disabilities or special needs, but for the many individuals, those living in rural regions, using mobility devices, or requiring extra assistance, the reliance on services like Uber or Lyft for essential trips—especially medical ones—presents significant challenges.
Although Uber and Lyft can be an effective solution in city environments, many medical trips, particularly rural medical trips often require more specialized services, especially considering the unique demands of rural healthcare access and the logistical shortcomings of Uber in these settings.
I want to take a look at why I say UBER and Lyft might be an answer to NEMT trips, but they are far from THE answer for individuals needing these services.
Limited Availability of Uber/Lyft in Rural Areas
Rural areas often have limited or inconsistent access to rideshare services such as Uber and Lyft. While urban centers boast a high density of drivers and shorter wait times, rural areas are typically underserved. It is a simple matter of economics, in sparsely populated regions the demand for rides is lower, thus the opportunity for drivers to make a more money becomes more difficult. The bank robber Wille Sutton became famous with his reply when asked why he robs banks, “Because that’s where the money is.” The same holds true for someone trying to make a living as a ride share driver, to make money they need to be where the rides (e.g. people) are! Unfortunately, this makes it more difficult for riders in rural areas to find available drivers. This deficit in availability can be particularly problematic for medical trips, where timely transportation is essential.
Equally problematic can be return trips to rural areas. Uber/Lyft drivers can reject one-way trips that will take them out of revenue earning service areas requiring them to dead head (i.e., drive empty, no revenue) back to an urban population. Finally, individuals going to medical appointments are often “contract” trips, which may mean the price for those trips are fixed and potentially not subject to surge pricing or have caps on the amount of surge pricing that can be applied. Recently Lyft rolled out their Price Lock feature for those with daily trips to avoid surge pricing during their commutes, but many individuals relying on Lyft for medical transportation are “assigned” to a Lyft driver, rather than selecting Lyft for their trip, thus these individuals likely would not be able to take advantage of this “additional cost” feature offered by Lyft. On the other hand, drivers clearly know (or often can tell) if a trip is a contract trip that may not give them the opportunity for extra revenue, or they simply don’t want to leave an urban area during surge time (after all the surge pricing is to encourage drivers to be in that area) when they can maximize their profits. Individuals relying on ride share for medical transportation often schedule their medical appointments early in the morning or towards the end of the day so as to minimize disruption to their daily lives, unfortunately this often puts their transportation needs squarely during surge periods.
For patients who need to get to medical appointments, the unpredictability of Uber’s availability can cause considerable stress. The lack of local drivers also means that patients might have to wait for a ride to arrive from a neighboring town, exacerbating delays and adding to the uncertainty, or even possibility that a driver found a better alternative than driving “into the sticks”, to quote one driver from an Uber Reddit post, to pick up one trip.
Lack of Multi-Loading Options for Medical Appointments
With the problems confronting rural medical facilities these days, more and more individuals living in rural areas are finding it necessary to travel into urban areas to get their medical needs fulfilled. (Hence the point of the aforementioned article citing Lyft’s trips of over 50 miles to medical appointments.) One of the key challenges with using Uber or Lyft for medical trips is the lack of multi-loading functionality, which is especially inefficient when transporting patients from rural areas to urban medical centers. For example, let’s say three people live in rural areas either near each other or on a relative straight travel line within a 50+ mile radius of medical facilities serving those individuals. Further assume they all have appointments in the same general timeframe as each other at the various medical facilities, and one or more may even have special needs (i.e., wheelchair transportation, walker, door to door assistance, etc.).
Uber or Lyft do not specialize in the logistics of multi-loading, as most of their trips are for one individual (or group of individuals) to go to one location. Therefore, it is entirely possible that these ride share companies might send three vehicles (drivers) to get these three passengers, with all of the “risks” associated with finding just one willing driver to do a rural trip.
Even if all the individuals are transported to their appointments, this is a very inefficient use of scarce resources (drivers and vehicles) and probably not the most cost-effective option either for the paying source. Companies focused on providing NEMT trips specialize in the logistics of multi-loading to optimize efficiencies. An NEMT provider would most certainly send one vehicle and driver, capable of handling the needs of all three passengers, to perform all three trips in one “run” and get each passenger to their appointment on time.
Many individuals who live in rural areas face complex healthcare needs that may involve multiple appointments, frequent medical supplies, or the need for a caregiver to accompany them. Uber and Lyft are highly “hands off” when it comes to assigning trips to drivers, whereas companies working with NEMT drivers, while still highly digitized and using computer dispatching systems, still often have live individuals able to make decisions when it comes to assigning trips. Instead of looking solely at each leg of the trip, dispatchers can determine that a driver should wait for an individual to run in and out of a pharmacy, or they might know that Mrs. Hatfield cannot be in the same vehicle as Mrs. McCoy, so they override the decisions made by their automated dispatching or scheduling software.
Accessibility Challenges for Passengers with Special Needs
Uber and Lyft also struggles to provide accessibility for individuals with physical disabilities or complex medical needs. Although Uber offers an option for wheelchair-accessible vehicles (Uber WAV), these services are offered in very few markets and are rarely available in rural areas. Furthermore, Uber and Lyft’s driver-partners are not always trained or equipped to assist passengers with mobility challenges, medical conditions, or the need for specialized care. In contrast, companies focused on providing NEMT services typically provide drivers who are educated and credentials to assist passengers with specific needs, ensuring a higher level of safety and comfort.
An article appearing just this week in the Arkron Legal News (Dec 3rd) pointed out the many problems individuals with disabilities face when they try to, or have to, rely on Uber or Lyft for transportation. A spokesperson from a guide-dog training school in California stated that the new app updates these companies are rolling out to address “cancellations and misunderstandings” for passengers with special needs is simply “window dressing”, pointing out that “This option puts the burden back on the client rather than the companies themselves to directly address (discrimination) with their drivers.”
Other articles have noted that while both Uber and Lyft offer “healthcare” transportation services, there is no assurance that the driver picking you up when you are utilizing these services has any specialized training for NEMT trips. While these companies may give priority to their “designated healthcare” drivers, in reality the driver performing your trip may have been delivering a pizza an hour ago. I don’t want to downplay the importance of proper pizza handling when making a delivery, but it hardly compares to the training needed to assist a person with special needs.
A quick Google search will identify numerous Reddit threads with posts from Uber and Lyft drivers discussing how they avoid medical related trips. One driver posted just a month ago, “… Medical ride orders usually send a text message "to call the rider" when we are near the pickup location. That's when we realize it's a 3rd party order and cancel the ride. It's a headache and $0 tip.” In fact, even the article mentioned in my opening paragraph touting the “importance” of Lyft to the medical community quoted a driver as saying, his vehicle “… is large enough to accommodate a medical passenger requiring a wheelchair, but he isn’t paid extra to transport those with medical needs. He said some of his recent passengers in Atlanta have been Medicaid recipients with mental health conditions or disabilities.” He was also quoted as saying, “I feel like Uber and Lyft are trying to catch me off guard. When I see that ride is going to a hospital, I try to avoid it or cancel the ride.”
Summary
Clearly this article would have been much easier to write if I used the term “TNCs” instead of Uber and Lyft everywhere, but that was intentional. While the issues discussed above may not be limited only to Uber and Lyft in the TNC world, it would be remiss to paint all TNCs with the same brush, especially since I know of several TNCs that take great effort to minimize or eliminate these issues within their organizations. Companies such as TTA member-owned Ace Taxi in Ohio, Uzurv, and MedTrans Go are examples of TNCs (or TNC equivalents) who are focused on operating and providing the quality and qualified services of any NEMT provider.
At the end of the day, for individuals with no extra or special needs and who live in an area with a regular supply of rideshare drivers, Uber and Lyft can be an answer. In reality the universe of individuals needing transportation that fits those parameters is a small segment of the population utilizing NEMT. Unfortunately given their seemingly endless marketing budget they are able to get themselves featured in stories and articles where their role in providing NEMT services is vastly overstated. That is one of the reasons NEMTAC published its first standard on Levels of Service (NEMTAC 1001-202X) where it was clarified that Curb-to-Curb was a Level of Service where no assistance is required to be given to the passenger (unlock the doors and go), whereas Curb-to-Curb with Assistance and other Levels of Service are defined to provide that the NEMT driver must provide assistance to the passenger. The first level, Curb-To-Curb, should be used for the traditional Uber/Lyft TNC where the driver is neither required to, nor trained to, provide additional assistance or services. This is the low hanging fruit and should, clearly, and this service should be paid at lower rate than the other services defined in the standard.
What we really need is for the people making decisions regarding NEMT, and those writing about those decisions, to focus on what is best for the vast majority of people in need of utilizing NEMT services and recognize that these needs are met by predominantly private owned, locally operated companies, whether using employee drivers or independent contractors, who spend real dollars and utilize scarce resources to make sure their passengers receive safe, reliable and high-quality transportation. And so I conclude with the title of this article, Uber and Lyft may be an answer for the NEMT industry, but they are by no means THE answer for NEMT.
Dan Reid operates NEMT Provider companies in Mississippi and Louisiana. He currently serves as TTA’s President and on NEMTAC’s Board of Directors and Co-Chair of NEMTAC’s Certification and Standards Advisory Committee as well as serves on other Advisory Committees, and is a member of the IATR Tech & Innovation Committee
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