How health systems can quantify and recapture the margin lost to transportation inefficiency
Co-authored by AVIA and DocGo | March 2026
The beds your organization cannot turn are not waiting for a doctor’s order. They’re waiting on a ride.
Every health system CFO can tell you what they spend on contract labor, drug costs, or IT infrastructure. Very few can tell you what transportation inefficiency is actually costing their organization. Not the line item for rides, but the full downstream cost: the beds occupied by patients who are medically ready to leave, the nursing hours consumed by phone-tag with transport vendors, the denied claims from incomplete medical necessity documentation, and the admissions deferred because discharge throughput has stalled.
In AVIA’s work with more than 80 U.S. health systems, the dominant theme in every executive conversation this year is the same: cost reduction with a clear, near-term line of sight to margin improvement. Initiatives that cannot demonstrate hard ROI within twelve months are being deprioritized. CFOs and COOs are now directly involved in technology and operations decisions that once lived in departmental budgets. Against that backdrop, transportation represents an unusual opportunity. A workflow where the cost exposure is significant, the levers are operational and technology-enabled, and measurable results can materialize in months rather than years.
A Multi-Stakeholder Challenge
Whether you are approaching this from finance, operations, or clinical quality, transportation inefficiency shows up differently in your data, but traces back to the same root cause. For CFOs, it is avoidable days and denied claims. For COOs and operations leaders, it is bed turns stalled and ED boarding compounded. For nursing and quality leaders, it is clinical time consumed by administrative tasks and patient experience implications that directly affect HCAHPS scores and readmission rates. This article addresses all three, because any operational solution has to.
What Transport Delays Actually Cost
When a patient is medically ready for discharge but waits hours for a ride, the hospital absorbs an unreimbursed day of room, board, nursing, ancillary services, and overhead. According to the AHA’s 2025 Cost of Caring report, total hospital expenses grew 7.5% in 2025, more than double the rate of growth in hospital prices 1, and the average U.S. inpatient day now costs between $2,800 and $3,300 depending on facility type and geography 2. In high-cost states, that figure exceeds $4,000.
The scale of the avoidable-day problem is well documented. Advisory Board analysis of CMS claims data found that approximately 19% of total inpatient days are avoidable, driven by non-clinical factors including transportation coordination failures 3. The AHA has reported that length-of-stay for patients discharged to post-acute care settings has increased sharply, with Medicare Advantage patients experiencing double the average pre-discharge length-of-stay compared to Traditional Medicare beneficiaries between 2019 and 2024 4.
These costs do not appear as a transportation line item. They show up as extended length of stay, slower bed turnover, increased ED boarding, and deferred admissions. A 2025 peer-reviewed synthesis of 20 studies published in PMC found that centralized discharge coordination oversight, which includes transportation, reduces length of stay by 0.5 to 1.0 days on average 5. At $3,000 per inpatient day across a system doing 25,000 discharges annually, even a half-day improvement translates to meaningful margin recovery.
The workforce cost is equally concrete and rarely measured. Case managers and nurses spend an average of 15 to 30 minutes per transport event on phone calls, status checks, and rebooking coordination. At a 250-bed community hospital handling 50 discharges per day with 30 percent requiring arranged transport, that is approximately 15 transport events daily. With an estimated 20 minutes per event, clinical staff absorb five hours of low-value administrative work every day for a loaded nursing cost of $85 per hour. That translates to approximately $155,000 annually in clinical time consumed by a task that is ripe for automation, before accounting for the morale and retention implications of asking highly trained staff to spend their shifts on hold with transport vendors.
Why Transportation Stays Invisible
Transportation is typically managed within case management, siloed from finance and IT. The data (which often might not exist) lives in phone logs and spreadsheets, not in the EHR or enterprise analytics. AVIA’s work on patient throughput and command center strategy consistently finds that transportation is one of the last major discharge components to be digitized, even in systems with mature Epic implementations and sophisticated capacity tools. The result: no systematic way to measure discharge-to-departure intervals, attribute avoidable days to transport causes, or benchmark vendor performance. Health systems have treated this as a vendor management problem when it is a workflow and data problem.
Beyond the Balance Sheet: Patient Experience and Health Equity
Transportation delays are not only a financial problem. They are a patient experience problem and, increasingly, a health equity issue that health systems cannot afford to ignore.
Discharge delays rank among the most common sources of patient dissatisfaction captured in HCAHPS surveys, contributing to lower scores that affect value-based reimbursement and public reputation. When patients wait hours in a hospital bed for a ride they were told was coming, the experience of an otherwise successful clinical encounter ends on a note of frustration and uncertainty.
The equity dimension is equally significant. Transportation gaps disproportionately affect Medicaid beneficiaries, elderly patients, and individuals in underserved communities. These populations who are less likely to have personal vehicle access and more likely to depend on arranged transport for every care encounter. When coordination fails for these patients, the consequences extend well beyond an inconvenient delay: missed follow-up appointments, disrupted transitions to post-acute care, and preventable 30-day ED readmissions. For health systems working toward health equity commitments and managing readmission rate penalties, transportation is not a peripheral operational concern. It is a social determinant of health with direct financial and quality implications.
The Broader Stakes: Why This Matters Now
The U.S. Non-Emergency Medical Transportation (NEMT) market alone is valued at approximately $6.6 billion and projected to more than double by 2031 67. But the financial exposure for health systems extends well beyond direct transportation spend. From AVIA’s conversations with members, we know that transportation intersects with nearly every operational priority on the executive agenda.
Patient throughput. Systems investing in command centers and real-time capacity tools need transportation to function as a predictable, integrated discharge component not an unpredictable bottleneck. When a bed cannot turn because a ride is late, the cost cascades upstream through the ED and surgical schedule.
Workforce efficiency. Nurses and case managers spending 15–30 minutes per transport event on phone calls, status checks, and rebooking compounds across an organization. Eliminating low-value administrative work from clinical workflows is one of the most direct levers available.
Revenue protection. Transportation gaps contribute to patient leakage. When post-discharge follow-up is delayed or a patient cannot reliably reach their next care setting, the downstream revenue and quality implications are real, especially as they compound across populations.
Platform consolidation. AVIA’s members are rationalizing their technology portfolios and strongly favor solutions that integrate into existing EHR workflows. Any transportation approach that requires a standalone portal or parallel data entry is a non-starter in most environments. The organizations getting this right are deploying solutions that embed directly into the clinical record, allowing staff to order, track, and document transport without leaving their existing workflow.
What Technology-Enabled Transportation Management Looks Like
Solving the cost problem requires moving from fragmented manual coordination to a unified platform that treats transportation as an instrumented, measurable part of the discharge workflow. The capabilities that matter most address the root causes of cost leakage. Order entry integrated into the clinical record so requests auto-populate patient data and eliminate phone delays; live vehicle tracking that gives staff real-time visibility instead of repeated status calls; automated medical necessity documentation at the point of order to improve the insurance-paid versus hospital-paid transport ratio; a single interface that brings all transport vendors like ambulances, wheelchair vans, sedans, rideshare, into one coordinated network with standardized performance data; and analytics that surface bottlenecks, vendor on-time rates, and reimbursement capture metrics that previously did not exist.
When these capabilities work together, transportation shifts from an untracked cost center to a measurable, improvable workflow embedded in how the clinical team already works. The organizations getting this right do not add a new portal or require parallel data entry. They integrate transportation directly into the clinical record so that ordering, tracking, and documenting a transport happens without staff leaving their existing workflow.
DocGo’s Dara platform represents one mature implementation of this model currently deployed across multi-hospital health system networks, including a large, nonprofit system (operating five hospitals and more than 150 outpatient sites) that relies on the platform to support enterprise discharge and interfacility transportation workflows. In that deployment, Dara’s EHR-integrated ordering replaced phone-based coordination, giving care teams real-time visibility into transportation availability while automating insurance population, medical necessity documentation, and downstream billing processes. The platform helped reduce average transport response times by 25%, cut idle time between transports by more than 30%, and saved nearly ten minutes of staff time per transport request, all of which directly improved patient throughput and bed management efficiency. The platform’s recent incorporation of agentic AI for automated outreach and pre-billing extends these gains, signaling a broader industry shift toward intelligent automation not only within clinical documentation, but across the operational workflows that surround and often constrain care delivery.
Red Flags in Your Current Transportation Process
If any of the following are true for your organization, your cost exposure is likely larger than you realize:
– Your case management team cannot tell you the average time from discharge-ready to patient departure for transport-dependent patients
– Your finance team cannot separate transport-related avoidable days from other avoidable-day drivers in your LOS data
– More than 40% of arranged transports are paid by the hospital rather than a payer
– Staff contact multiple transport vendors primarily by phone for bookings and status updates
– Transportation is not visible in your throughput dashboard or command center reporting
Estimating Your Transportation Cost Exposure
The most common barrier to action is the inability to size the problem. The framework below is a step-by-step diagnostic that health system leaders can apply to their own operations — before any technology decision is made.
| # | Metric | How to Calculate | Typical Range |
|---|---|---|---|
| 1 | Daily discharges | Pull from ADT data | Avg U.S. community hospital: ~40–60/day |
| 2 | % requiring arranged transport | Estimate from case management records | Typical: 25–40% of discharges |
| 3 | Avg transport delay | Time from transport order placed to actual departure. Note: this figure has two components to consider: (1) the gap from discharge-ready to transport order placed, and (2) the gap from transport order placed to actual departure. Both can add hours and together determine whether you cross into a full inpatient day. | If unmeasured, assume 2–4 hours |
| 5 | % of delays adding a full inpatient day | Delays exceeding the half-day billing threshold | Typical: 10–25% of arranged transports |
| 6 | Your cost per inpatient day | Use your facility’s cost-per-day figure | National avg: $2,800–$3,300/day 12 |
| 7 | Annual avoidable days | Step 1 × Step 2 × Step 4 × 365 | This is your baseline exposure |
| 8 | Annualized cost exposure | Step 6 × Step 5 | The number your CFO needs |
| 9 | Insurance vs. hospital-paid ratio | % of transports reimbursed by payer | Below 60% signals documentation gaps |
How Does This Look At the Average 250-Bed Community Hospital?
50 discharges/day × 30% requiring arranged transport × 15% experiencing a full-day delay = 2.25 avoidable days per day. At $3,000 per inpatient day, that is approximately $6,750 per day — or $2.5 million annually. A 30–40% reduction in transport-related delays would represent $750K–$1.0M in recaptured margin.
*These figures are illustrative. Actual exposure varies by facility size, payer mix, geography, and current process maturity. The purpose of this framework is to establish a starting point for internal analysis.
Setting Realistic Expectations
AVIA’s members consistently tell us they value honest assessment over optimistic projections. Health systems have been burned too often by vendor claims that do not survive contact with operational reality. In that spirit:
Within 3 months of deploying a digital transportation platform, organizations should expect to eliminate phone-based ordering for the majority of discharges, gain baseline data on delay intervals, vendor performance, and reimbursement mix that previously did not exist, and see early improvements in discharge-to-departure time for straightforward transport cases.
Within 12 months, realistic outcomes include a 20–40% reduction in transport-related avoidable days (depending on baseline maturity), an improved insurance-paid versus hospital-paid ratio through better documentation, and integration of transport analytics into throughput dashboards.
What is not realistic: Complete elimination of delays: vendor availability, weather, and patient-side variables will always exist. Immediate ROI without change management: staff adoption and workflow redesign take time. A standalone fix for the broader throughput challenge: transportation is one component of a complex discharge ecosystem.
*Suggested timelines vary based on the size of the health system and enterprise wide implementation/adoption
From Cost Center to Strategic Lever
Medical transportation will not appear on a strategic plan alongside AI governance or enterprise EHR optimization. However, the most actionable cost-reduction opportunities are often the ones hiding in operational workflows that have not been meaningfully updated in decades.
Transportation sits at the intersection of throughput, workforce efficiency, revenue capture, care quality, and health equity, all priorities that are already commanding executive attention. Bringing visibility to this workflow is not just a cost reduction exercise. It is the prerequisite for meaningful improvement across all of them.
The first step is not a technology purchase. It is a set of honest questions for your case management and finance teams: How long does it take from discharge order to patient departure for transport-dependent patients? What percentage of arranged transports are reimbursed by payers versus absorbed by the hospital? Do we have that data? If not, why not?
If you cannot answer those questions today, you have already identified the problem, and for most health systems, that gap in visibility is where the real opportunity lives. The data exists somewhere in your organization but it is rarely assembled or analyzed as a unified cost story, and almost never connected back to the financial reports where it would command attention. The best way to pressure-test this analysis is a conversation with a peer who has already worked through it. DocGo can connect interested health system leaders with operational counterparts at deployed sites; case management directors, COOs, and throughput leads who have run the diagnostic and can speak to what the data actually showed. If that kind of peer conversation would be useful, reach out through DocGo’s AVIA Marketplace profile.
About the Authors
AVIA is a digital health strategy consultancy partnering with over 80 U.S. health systems to navigate technology decisions, evaluate vendors, and accelerate digital transformation across patient throughput, AI governance, workforce efficiency, and connected care strategy.
DocGo (Nasdaq: DCGO) is a technology-enabled mobile healthcare and medical transportation company. Its Dara platform provides EHR-integrated transportation management across 31 U.S. states, and its clinical services span mobile health, care gap closure, remote patient monitoring, and virtual care.
Sources
- American Hospital Association, “2025 Cost of Caring Report,” March 2026. https://www.aha.org/guides-and-reports/2026-03-09-2025-cost-caring-report
- Becker’s Hospital Review, “Hospital Expenses per Inpatient Day Across 50 States,” 2025. https://www.beckershospitalreview.com/finance/hospital-expenses-per-inpatient-day-across-50-states.html
- Advisory Board / CMS, avoidable inpatient days analysis, FFS claims data. https://www.advisory.com/content/dam/advisory/en/public/shared/Research/PACC/Resources/2019/Data-Primer-Avoidable-Hospital-Days.pdf
- American Hospital Association, “Patients and Providers Faced with Increasing Delays in Timely Discharges,” updated 2025. https://www.aha.org/issue-brief/2022-12-05-patients-and-providers-faced-increasing-delays-timely-discharges
- PMC/NIH, “Reducing Delays, Improving Flow: The Importance of a Dedicated Discharge Coordinator in Hospital Discharge Planning,” 2025. https://pmc.ncbi.nlm.nih.gov/articles/PMC12166983/
- Mordor Intelligence, “Non-Emergency Medical Transportation Market Size Report,” 2025–2030. https://www.mordorintelligence.com/industry-reports/non-emergency-medical-transportation-market
- Business Market Insights, “US Non-Emergency Medical Transportation Market,” 2025. https://www.businessmarketinsights.com/reports/us-non-emergency-medical-transportation-market
- Becker’s Hospital Review, “Hospital Expenses Grew Twice as Fast as Prices in 2025: 4 AHA Findings,” March 2026. https://www.beckershospitalreview.com/finance/hospital-expenses-grew-twice-as-fast-as-prices-in-2025-4-aha-findings.html
