Some patients choose to follow doctor’s Uber

Ride-sharing services can be remedy, but claims of inequality arise

For Jeff Barker, the question came shortly after he retired.

His Parkinson’s disease, diagnosed in 2014, was progressing, and he no longer felt safe driving. His wife, Betty, was still working and unable to take long periods off during the day.

So how was he going to get to his medical appointments?

The answer came via a smartphone app: He’d take Uber, as millions of other people do daily.

His decision highlights the growing role that ride-sharing companies such as Uber and Lyft have in providing medical transportation to patients who cannot drive. But the companies are also seen as providing solutions that currently work well only for a subset of patients — continuing the disparity in access to health care.

Barker, 62, says Uber has been a godsend for him.

“These guys, they’re always very polite, always very good to me,” he said.

“It helps,” Betty added, “to take the pressure off of ‘How are we going to deal with these transportation issues today?’”

But people who can’t afford the ride, who don’t use a smartphone or who require specially equipped vehicles are often left out — even though they form the group most in need of transportation help. Advocates for those with disabilities argue that the disparity violates the law. Uber has been sued at least twice nationwide over accessibility.

“As we try innovative solutions, we have to make sure the regulatory framework keeps up with them so that people aren’t being excluded unfairly from services that they need,” said Aubrey Hill, the director of health systems change at the Colorado-based Center for Health Progress.

There are other medical transportation services in Colorado — the Regional Transportation District offers one, and there are others available to people who qualify for Medicaid — but those services need to be scheduled well in advance and aren’t as conveniently on-demand. In lieu of better options, patients sometimes call for expensive ambulance rides, even if it’s not an emergency.

“If you don’t have any other way of getting there right now, that’s often what happens,” said Julie Reiskin, the executive director of the Colorado Cross-disability Coalition. Across Colorado, this is a growing problem. In a 2017 survey by the Colorado Health Institute, more than 5 percent of those polled said

Nationwide, a 2005 study estimated that 3.6 million Americans miss or delay non-emergency medical care every year because of transportation issues

they weren’t able to get medical care because they didn’t have a ride to the doctor’s office. That percentage has risen over the past five years that the health institute has polled on the question.

Nationwide, a 2005 study estimated that 3.6 million Americans miss or delay non-emergency medical care every year because of transportation issues — and the group has disproportionately high rates of chronic disease and multiple chronic conditions.

To meet this need, Uber and Lyft, the country’s two dominant ride-sharing companies, have moved aggressively to position themselves as medical transportation options. Earlier this month, Uber launched Uber Health, a specialty portal where medical offices can help arrange rides for patients. Denver Health in 2016 began working with Lyft to provide certain patients with rides that the hospital pays for.

And it’s having an impact. A study last year from University of Kansas economists found that ambulance rides dropped by at least 7 percent in cities after Uber entered the market. Drivers have reported people with broken bones, bloody gashes and other serious injuries opting for an Uber or Lyft ride rather than paying for an ambulance.

In perhaps the biggest move to date in Colorado, Uber and Uchealth last week announced a partnership where Uber will offer a 30 percent discount on all rides that start or end at a Uchealth facility.

“The whole point of it is to ease that burden, even if just a little bit,” said Nikki Caputo, Uchealth’s director of experience and innovation.

And, for patients like Barker, who uses the app as many as three or more times a week to get to and from Uchealth, it does just that. Barker said Uber made it much easier for him to give up driving, and he hopes the new partnership will allow more people whose health makes driving difficult to also give up the keys.

In addition to his doctor’s appointments, Barker now takes Uber to volunteer work he started doing at the University of Colorado Hospital, where he serves as a mentor to newly diagnosed patients with Parkinson’s -- making Uber a crucial tool for him to combat the social isolation that can come with a chronic health condition.

“It’s not just going to affect me,” he said. “It’s going to affect so many other people.”

Each ride costs him around $15, and he said he has never been concerned about his safety or the professionalism of the drivers. (While average costs of non-emergency ambulance rides are hard to come by — and vary based on whether the patient has private insurance or Medicaid — ambulance services generally charge more than $1,000 for a ride, plus an extra per-mile cost.)

But Hill, with the Center for Health Progress, said it’s not certain everyone’s experience will be as positive. She wondered what Uber is doing to educate drivers on how to load medical equipment — such as walkers, wheelchairs or oxygen equipment — into and out of vehicles.

“The challenge with Uber, and I hope that they can work on this over time, is that a lot of drivers might not be trained specifically to drive people with health care needs,” she said.

In an email, Uber spokeswoman Stephanie Sedlak said the company has launched two pilot programs — UBERWAV and UBERASSIST — that provide wheelchair-accessible vehicles or provide top-rated drivers with the opportunity to receive third-party training on how to help passengers in and out of their vehicle. Neither is available yet in Colorado, she said.

In one of at least two lawsuits filed against Uber over accessibility, disability rights advocates in San Francisco labeled UBERWAV a sham because, they alleged, there aren’t nearly enough vehicles available. An earlier lawsuit in New York echoed those frustrations. And Reiskin, with the Colorado Cross-disability Coalition, said Uchealth’s partnership with Uber might violate the Americans with Disabilities Act if the health system hasn’t made sure there’s a way for disabled patients to access the same kind of benefits that more able-bodied patients can.

In an email, a Uchealth spokeswoman said all ride transactions between Uber and patients are independent of Uchealth and that “our role is to make sure patients, visitors and employees know this is available to them.” Uchealth isn’t paying Uber any money for the partnership or vice versa.

Uber encourages people to call 911 for an ambulance ride during serious medical emergencies, and the company’s drivers have the ability to cancel rides when they don’t feel comfortable. Passengers do not have to disclose their medical issues to drivers, either.

Hill said she hopes ride-sharing companies can one day become a convenient option for people of all abilities to access medical care.

But, she said, it’s clear that day isn’t here yet.

“I think there are some things they will definitely have to think through,” she said.

Joe Amon, The Denver Post Jeff Barker, who has Parkinson's disease, enters a car operated by an Uber driver on March 14 at University of Colorado Hospital. Barker uses the ride-sharing service for transportation to and from the medical center.

Photos by Joe Amon,the Denver Post Dr. Heather Baer, a physiatrist and movement-disorder specialist at University of Colorado Hospital, works with Jeff Barker during a recent visit. Barker, who has Parkinson’s disease, uses Uber to get to his appointments.

Jeff Barker, who has Parkinson’s disease, on March 14 schedules a pickup with Uber, a ride-sharing service that gives 30 percent discounts for any trip that starts or ends at a Uchealth facility.