Paramedics fight to combat ED visits, readmissions
One recurring problem payers and providers grapple with is 30-day readmissions, and the financial penalties associated with them. To help address this issue, and improve patient outcomes, more organizations are turning to community paramedic (CP) programs that enlist the services of EMS teams to answer calls and offer short-term interventions that help divert patients away from emergency departments and funnel them back into appropriate care channels.
Kevin McGinnis, MPS, program manager of Community Paramedicine-Mobile Integrated Healthcare and Rural Emergency Care for the National Association of State EMS Officials, says community paramedicine got its roots in the late 1990s in the Northeast United States and Canada but didn’t come to prominence until the mid-2000s. There are roughly 170 documented CP programs nationwide.
“We can start to help the health system affect savings where others in the traditional healthcare system can’t because we’re in the community 24/7 and we’re used to being in patients’ homes,” McGinnis says. Data suggests CP programs are effective in reducing repeat ED admissions and 30-day hospital readmissions, he adds. “… This is one small solution that the healthcare system can invoke.”
CP programs work by allowing EMS personnel to answer emergency calls and assess patients’ needs to determine whether less-costly, more beneficial interventions are appropriate. Patients may need a quick fix for low blood glucose and a referral to an endocrinologist, for example. “They can take care of the issue right then and refer the patient for primary care at a future date. Or they can refer patient to a higher level of care more immediately,” McGinnis says. “It’s very powerful. It’s that triage force. You don’t want triage being done in the ED, you want to come out in front of the ED to do that.”
CP programs are also offering additional services. Dan Swayze, DrPH, MBA, MEMS, vice president and chief operating officer of the Center for Emergency Medicine of Western Pennsylvania, Inc., says that while community programs vary from state to state, most utilize the services of community paramedics for areas within their scope of practice where there are gaps in traditional care, such as for patients without insurance who don’t qualify for home health nurse visits. “Some home nursing agencies are actually contracting with CP services to supplement their care, to help reduce the likelihood their patients will be readmitted to the hospital,” Swayze says.
CP programs are also helping bridge the gap between health and human services, he says. They can provide patient navigation and patient advocacy services for patients who can’t get them on their own or who need help finding the right program.
“Our CPs often accompany patients to their providers’ visits so we can reinforce and translate the next steps in ways the patient will understand when they get back home,” Swayze says. “Once we address the underlying social determinant issues facing the patient, we find that their dependence on 911 and the local emergency department goes down drastically. It’s much more effective to have a paramedic call these patients than it is to continue to react as we have traditionally done.”
He adds that more CP programs are coming from hospitals that operate their own ambulance service. “The medics are already FTEs in the healthcare system and hospital administrators are beginning to realize it’s more cost effective to deploy the medics to the patient based on their predictive and risk stratifications models rather than waiting for the patient to call 911,” he says.