Recently there was an article in the Washington Post titled, “Uber and Lyft think they can solve one of medicine’s biggest problems,” in which these two companies are angling to provide better, safer more reliable transportation for patients. While I applaud this mission, given the depth and reach of both companies, I think they may be underselling their abilities to improve health care delivery and reduce cost.
Recently, one of my colleagues had to take her son to a local emergency department for a laceration on his face. Lyft or Uber would have no role in helping my friend or her son as she has a car and drove him to the ED.
After waiting three hours, the area on his face was numbed with medication. The laceration was sewn closed and a dressing, akin to superglue, was applied to keep it covered for a week. The bill (and this is incomplete as there is a second bill coming for the physician fee) was $2,000. The breakdown; $241 for supplies (prep, suture, numbing medication and dressing) and $1,766 for facility charges. Of those facility charges, $1,300 was for her son simply occupying a room in the ED. Crazy, right?
So, what does this have to do with Lyft or Uber?
Well, in our current health care paradigm, these $1,766 in facility charges do not qualify as waste. No insurance company is going to argue with this bill as being necessary. But if we are going to reduce health care costs while improving quality, we need to rethink the current paradigm because $1,766 of facility charges seems awfully wasteful.
Again, what does this have to do with Lyft or Uber?
Rather than having Lyft or Uber bring the patients to the ED, why not flip the script and have Lyft or Uber bring the health care provider to the patients for the care they need? This isn’t so implausible in this era of smartphones, EMR, telemedicine and portable medical technologies.
One could imagine a Lyft or Uber triage center where my colleague could send or live stream a photo or a video of her son’s laceration. A health care provider would evaluate/triage/level this call. A physician trained in emergency medicine would be dispatched with a cell phone in a Lyft/Uber to the location with the necessary supplies. The length of time the physician spends with her son would be trackable by GPS. The clinical documentation, including photos of before and after the procedure, could be uploaded through a secure portal to the electronic medical record. Lyft/Uber would transport the physician to the next call at $0.90 per mile providing time to complete documentation during the ride. With this approach, my friend and her son would not need to leave their house. In all likelihood, the length of time waiting for her son to be seen compared to sitting in an ED would be reduced. The total costs for fixing her son’s laceration would also go down primarily because the $1,300 in facility charges would be significantly reduced or replaced by the much lower cost of the triage center. Furthermore, the physician would have fewer distractions and potentially more time to spend with the patient, thereby re-enforcing the patient-physician relationship.
Another byproduct of this approach would be that by eliminating these types of lower acuity visits to the local ED, the wait times for other patients that must to be seen in an ED would be reduced. This would benefit patients that really do need an ED and its resources; people having stokes, heart attacks, trauma victims, burn victims, patients requiring immediate, complex procedures or surgical interventions where the speed of undertaking an intervention is critical to a good outcome.
To be clear, this is not a one size fits all solution for all medical problems. And there certainly will be unforeseeable obstacles in implementing such an approach. But a triage center for a mobile medicine program could significantly reduce costs and waste. It would also result in better traffic flow of patients by matching them to the most appropriate location or solution. It may seem overly ambitious, but who honestly would have imagined five years ago that ride-sharing would become a multibillion-dollar industry?
Peter F. Nichol is chief medical officer, Medaware Systems.
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