Health care reform presents both a daunting challenge and a significant opportunity for EMS providers. Part I of this series covers how to identify whether a community paramedicine program is right for your agency and how to demonstrate the need to policymakers and stakeholders. This article explains how to design and introduce a program once you’ve demonstrated a need and identified your partners in the health care community.
Collaborate and cooperate
Without the support of those calling the shots and controlling the purse strings, as well as the medics on your team, any program you might attempt is likely to perform poorly. You’ll also need buy-in from other health care providers, such as hospitals and home health agencies, to avoid any potential turf wars.
It’s important to understand and embrace the collaborative processin order to achieve a successful outcome. First, agree that a problem exists and that it requires a new solution. Invite discussion about the difficulty every agency faces in providing health care and how you can all work together to make improvements. Set deadlines to keep the project moving forward.
“Let’s sit down and identify what those gaps are and how we can meet those together. Everybody’s looking to reduce costs and to do what’s best for the patient,” said Regina Godette-Crawford, advocacy liaison with EMS Management & Consultants. “You have to be open-minded about it. It’s really not affecting anyone’s turf. It’s just doing what’s best for the overall care of the patient.”
Choose your focus and launch a pilot program
You’ve already defined the problems, gathered data and assembled the stakeholders. Once you have reached consensus in the collaborative process, it’s time to design a pilot program to demonstrate the better patient outcomes and potential cost savings community paramedicine can yield.
Start small. Select one of the issues you’ve identified as most pressing in your community. If this is frequent fliers who place a strain on your agency’s resources, identify these callers and develop a program toconnect them to alternate, appropriate providers for their concerns.
Define the operations. How much you can reasonably expect to accomplish, given your available resources? You must be sure that your program does not interfere with emergency readiness, which is always your primary focus.
“You have to show this is not going to be a detriment to 911, because that’s your main reason for existing,” said Godette-Crawford. “You don’t want to over-extend yourself, because then you are not going to do well at the one thing you’re put there in position to do.”
Many pilot programs assign one or two medics and a regular passenger vehicle, much cheaper to operate than an ambulance, to test the waters. By shifting to a regular passenger vehicle, you can reduce the specific cost of sending a costly ambulance with two paramedics to treat these patients. This also preserves the capacity of your system to treat the next patient, because ambulances are less likely to be tied up on non-emergency calls.
Find funding to support your program
The pilot program is your opportunity to show how community paramedicine can reduce costs, and you will need funding, or at least some extra room in your agency’s budget. The good news is that many grants are available for community health initiatives, including but not limited to:
- Health Care Innovation Awards (from the Centers for Medicare & Medicaid Services) provide funding for programs that serve people enrolled in Medicare, Medicaid and CHIP.
- HRSA makes grants to improve and expand health care services for underserved people.
- Some insurance companies offer grants to support community health initiatives.
- Private philanthropic organizations like the Kresge Foundation award grants to support improvements in health, human services and community development.
Partnering with a hospital looking to reduce its readmission rates may also prove fruitful. An ongoing analysis of programs in Maine has found that the programs making the most progress are affiliated with a hospital system that can serve as a source for referrals.
Compare data to demonstrate savings
It is imperative that you track any cost benefits and improved patient outcomes in order to sustain a program for the long term, especially if you want to demonstrate those savings and improvements to a hospital or other entity to engage their help in paying for the program. Again, look for patterns and trends in your patient care reports and billing data. Be sure to measure results at regular intervals and compare these numbers to the data you gathered at the beginning.
How you demonstrate improved patient outcomes will depend on the problem your program targets. If your goal is redirecting frequent fliers to more appropriate providers, measure the frequency and types of calls and look for reductions in both. If you are partnering with a hospital to reduce readmissions, compare the numbers before introducing the program to the numbers after three months, six months, etc. You may also consider using a patient satisfaction survey.
To demonstrate cost savings, multiply what a normal transport would cost by the number of times a frequent flier is transported – decreasing that number in itself can provide a huge cost savings. Because many of your target patients are likely on Medicare or Medicaid, and those reimbursement rates for ambulance transport don’t cover the actual cost of an ambulance ride, your agency may actually save quite a bit of money simply by treating that patient at home.
“What we’re looking at is treatment with no transport – so you’re treating the patient in the home for whatever their illness is,” said Godette-Crawford. “That’s a lot less cost than sending a $120,000 ambulance out there when they don’t need to be transported. They just need some preventive care and education on how to take care of themselves. It’s the right thing to do for the patient at the right time, and it’s cost-effective.”
Close the gaps
Because EMS serves almost every community and provides 24/7 mobile capability, it may be the ideal system by which to link all levels of care. Successful community paramedicine programs build on a careful assessment of needs and community partnerships to deliver better care at a lower overall cost by redirecting chronic problems from expensive emergency treatment to appropriate providers, improving patient outcomes and easing the burden on EMS services and hospital emergency departments.