Community Paramedicine – The House Call is Returning while Cutting Costs at the Same Time
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As high health care costs continue to eat into the disposable income of American families, whether or not they’ve opted into the Affordable Care Act, many cities and townships are exploring the idea of Community Paramedicine (CP) as a solution. In fact, over 100 EMS units in over 33 states and the District of Columbia have already implemented CP programs.
Also known as “Mobile Integrated Healthcare,” CP is a new form of health care delivery that harkens back to an era before mega-hospitals and medical centers where the town doctor was the only medical resource available to the populous of a remote community and the house call was commonplace. Fortunately, CP practices utilize all the latest technology, networks, and science while finding a more reasonable and economically efficient method for treating patients.
The idea of CP is simple: by utilizing the already-existing local EMS/paramedic framework and expanding upon the roles these individuals play in the delivery of healthcare to patients, the cost to both the patients and the medical community goes way down. One of the main demographics CP seeks to unburden is the over 75 million Americans in rural areas that must travel great distances, and at hefty costs, when the need for medical care arises. These communities already contain “disproportionate numbers of elderly citizens, immigrants, impoverished families and those in poor health,” according to communityparamedic.org.
Urban hubs are another area CP seeks to alleviate where 911 calls are sometimes abused as more of a way to ring up an expedited “taxi to the hospital” than the intended purpose of emergency services dispatch. With CP reaching these “mega-, super-, and heavy-users” and offering a primary care alternative that doesn’t bog down precious ambulance resources, both the medical community and the patient benefit. Let’s say you’re a patient with chronic pain and depression. In the past you’d call 911 frequently about these ailments due, perhaps, to a lack of education on the purpose of the emergency number and also a lack of better options. With CP practices in place, a paramedic would arrive at your home (sans sirens and lights) at predetermined, regular appointment to check your vitals, assist in preventative care, and, in turn, stave off any desire to impulsively dial 911. The regularity and certainty of these check-ins may even partially alleviate associated depression as well (as shown in some cases).
Some CP programs, such as the pilot programs in California, seek to expand the knowledge base and toolsets of EMS practitioners as well, giving them additional training on the social determinants of health, illness prevention, health promotion, advanced wound care, and other topics.. By broadening the scope of what these healthcare practitioners can do for patients, the need to transport them to a separate facility to be treated by others is mitigated, taking with it the associated high costs.
Enacting CP on a larger scale is not as simple as one might imagine, however. One major roadblock is entrenched Medicare laws established with austerity in mind, but woefully unprepared to evolve with technology and ideas on how to best treat patients. As the law currently stands, Medicare will generally not pay for an ambulance ride unless the patient is delivered to a hospital or clinic for treatment. With CP, the tools could be in place to save the medical community millions, but red tape and bureaucracy would still saddle the patient with a hefty out-of-pocket bill. This is all because the law has not yet caught up with modernized practices. With that in mind, what impetus is there for a Medicare-reliant patient to change their ways and stop dialing 911?
On top of that, CP is fighting pushback from those legislators who seek to curb the expansion of the role of the paramedic in the field. With the AMA and other special-interest groups for doctors being some of the biggest spenders on health lobbying in recent years, it is evident from where some of the pushback is coming. But we have to stop and ask ourselves if imbuing a paramedic with the agency to diagnose something as simple as strep throat and writing the corresponding prescription would diminish the significance of doctors, medical school, and the present hierarchy in any real way. Hopefully, there will be a workable resolution between the two interests.
As government leaders begin to more seriously weigh the costs and benefits of CP, there seems to be a consensus on a few issues:
1. Outcomes will matter more than process (particularly in the eyes of the Center for Medicare and Medicaid Services);
2. Performance measures will be evidence-based and will drive reimbursement;
3. Hospitals will (and many already do) have a renewed interest in EMS in the new healthcare environment;
4. Cost of service will matter; and
5. Patients, optimally, should be linked to the CP program via their primary care physician.
These are five areas of accords reached at a recent conference on CP in March of 2015, where key EMS leaders discussed the myriad ways a rollout of Community Paramedicine could play out in the coming years.
One thing seems to be certain across the board – CP works for those areas willing to commit to it. Sorting through the laws, money trails, and educational outreach will be another battle to contend with entirely.