Limited resources at specialty transit services as well as pending changes exacerbate existing issues

A patient with two broken legs, a broken arm and broken ribs was released from TriStar Skyline Medical Center in October, but her family in Kentucky couldn’t come pick her up. So the hospital called a rideshare driver. When Steven Henry showed up in his Honda CRV, nurses helped the patient, who was wearing just a hospital gown, into the car. 

“I thought to myself, ‘She should be going home by ambulance,’ ” Henry says. “That was just patient dumping.”

The Lyft app told him ahead of time that it would be a long drive, but he didn’t know he’d be relied on to help the woman into the house once they arrived. In fact, he wasn’t supposed to, per company guidelines. So when he arrived in Kentucky and the patient’s family wasn’t physically able to get her into the house, Henry had to place her on the lawn and call an ambulance.  

With spotty coverage from insurance-sponsored rides and Nashville’s public transport services as well as a lack of drivers for specialty vehicles, hospitals rely on Uber and Lyft to fill in the gaps when a discharged patient doesn’t have a ride home.

Driver Andrew Holm was put in a similar position in October when nurses helped a patient into his car from Nashville General Hospital. He asked if she was ambulatory, and the nurses said yes. During the less-than-10-minute drive to the address the hospital had entered on her behalf, the woman defecated in his car. There was no one home at the address he was directed to, she didn’t have a key, and she was asking for help. 

“I can’t help you get in, and I can’t help you get out,” Holm tells the Scene. “It’s against the rules. I’m not going to touch you.”

She moved herself to the curb and called an ambulance.  

Holm took that ride in an effort to keep a streak — an incentive in which, for example, the rideshare company offers a bonus of $21 to accept the next three rides without refusing any. After that experience, he says he is more selective. His acceptance rate is down to 65 percent from his previous 90-plus, he says, and he hasn’t accepted a hospital ride in three months. 

Joy Evans, moderator of a Facebook group for local rideshare drivers, says it’s not uncommon for drivers to refuse a hospital ride because the patient can be in bad shape and the driver doesn’t want to be responsible. Plus, when the ride is hailed by a hospital, there might not be a tip. Even so, drivers risk being deactivated for discrimination if they refuse too many. 

Marcia Colone is responsible for care coordination and transition management at Vanderbilt University Medical Center. The hospital typically operates under a patient-assistance policy guided by its legal and finance department, restricting rides to 25 miles and forbidding the hospital from interfering to arrange a ride if the patient has insurance that could pay for it. She says the public health emergency declared for COVID allowed them to financially assist patients in a way they otherwise would not be able to — though once the emergency period ends (likely in April) it will become more challenging again. 

“That means that those patients we have to find other ways to get them discharged and wherever they’re going from the hospital,” Colone says. “It sounds easy, but it is not.”

When the public health emergency ends, VUMC will no longer be able to step in to help on longer rides or when TennCare or WeGo Access (WeGo’s application-only program for the elderly and disabled) rides aren’t available. Kevin Jackson, project manager in Colone’s department, says it’s been especially tough to get TennCare-sponsored rides in the last year.

“TennCare has that 30-minute to four-hour window, that they have to fulfill that transportation,” Jackson says. “A lot of times, due to their lack of staffing, those routes don’t get fulfilled. The [health emergency] waiver allows us to have an extra measure in place, just in case as a backup plan. If those rides don’t get fulfilled, we can cover that transportation if needed.”

Medical transportation brokers have been around for decades, explains Mindi Knebel, CEO of Kaizen Health, which Vanderbilt uses for about half of its non-emergency rides. At Vanderbilt, Kaizen contracts with seven local agencies to offer more than 30 types of rides — including Uber, Lyft and taxis, as well as wheelchair-accessible vehicles, stretcher vans, ambulances, vehicles with car seats, door-to-door services, door-through-door services, bed-to-bed services and more. What’s relatively new to the field, however, is the addition of Uber and Lyft drivers into the fold, and workforce issues at more specialized contracted transportation services that have taken hold in the past year.

In 2018, Uber introduced a limited model called Uber Health with a health care provider-facing interface that allows providers to request rides on behalf of patients who may not have access. It’s now in use at 3,000 health care organizations nationally, including 80 in Tennessee. 

“They need someone to help them navigate the system, explain their benefits, get them where they need to go,” says Caitlin Donovan, global head of Uber Health. “We built [Uber Health] for that group of users that can really tackle those most vulnerable populations at scale.”

In 2021, Lyft launched Lyft Pass for Healthcare, which is meant to allow patients to arrange rides via the app that are paid for by sponsoring medical providers, social services organizations or government insurers. Lyft declined an interview request, directing the Scene to its website and driver policy information.

Ascension Saint Thomas’ practice is similar to Vanderbilt’s, though the hospital declined to comment further on the ins and outs of its process. 

“During the intake process, we help each patient develop a personalized plan to meet their transportation needs,” the hospital says in a statement. “When situationally appropriate, we will cover the cost of the patient’s transportation home via rideshare.”

Nashville General acknowledges services like Kaizen and Uber Health and their usefulness, though reps clarify that the hospital is not actively using any such services at the moment.   

“Hospital staff may utilize transportation services for anyone experiencing a transportation challenge,” Nashville General says in a statement. “Patients seen in a procedural area must be accompanied by a responsible adult upon discharge, regardless of the mode of transportation. Any usage outside of these instances will be investigated.”

When it’s time for patients to go home, hospitals are incentivized to get them on their way rather than use resources to have patients wait in the facility. With the unpredictability of hospital discharge timing and more hands-on transportation services not always having enough drivers to handle demand, drivers like Holm and Henry answer the call to help out — whether they anticipate it or not.

“I am a human being, and a lot of these people are being thrown out of the hospital and I’m the last act of kindness,” Holm says. “I can only be the neighbor that I need to be during the ride, but there’s things I can’t do. If they have an emergency, I have to call 911.”