Program targets preventing calls for help

Community paramedic program aims to prevent unnecessary ambulance calls and emergency room visits.

By Pam Eubanks
| 6:00 a.m. February 10, 2016

Jimmy Crutchfield and Paul Dicicco, of Manatee County Emergency Medical Services, believe community paramedicine can bridge a gap between patients, healthcare providers and services available.

East County
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Two county paramedics hope they have the answer to a large percentage of unnecessary emergency room visits and 9-1-1 calls.

Jimmy Crutchfield and Paul Dicicco are pushing community paramedicine as a way to relieve stress on the county's medical system.

Nationally, the concept has many names and formats — social medicine, integrated healthcare and advanced practice paramedicine, to name a few — but the idea remains the same.

“In Florida, we’ve been challenged because legislation prohibits an ambulance from transporting a patient to another location besides the emergency room,” said Dicicco, deputy chief of clinical affairs for Manatee County Emergency Medical Services.

Other programs

MedStar

In Fort Worth, Texas, the Medstar Mobile Heathcare program started in 2009 as a way to add value to the healthcare system, reduce healthcare costs and improve patient experience. For the first year, the program was self funded. Now, healthcare partners — hospitals, physician offices and other healthcare partners — pay for the service. The program is self-sustaining.

“We’ve been able to slow the growth of the ambulances on the street because we are preventing the unnecessary 911 calls by educating the patients how to find healthcare in an appropriate way,” said Matt Zavadsky, director of public affairs for Medstar. The revenue stream that’s being derived from helping our community partners deliver the right care to the right patient at the right time and at the right cost is our fastest growing service line.”

Data shows MedStar's "high utilizer" program, which targets frequent users of the system, from Oct. 1, 2010 to Dec. 31, 2015 realized a savings of $8.1 million in ambulance payments, emergency room visits and hospital admissions.

MedStar covers 15 cities in the Fort Worth area, serving more than 930,000 residents in a 421-square mile territory. It responds to about 125,000 calls annually and provides exclusive emergency and non-emergency ambulance service, critical care transport, mobile integrated healthcare and 9-1-1 nurse triage services.

Eagle County Paramedic Services

Eagle County Paramedic Services, in Eagle County, Colorado, began seeing patients in 2010, and started off with grant funding.

Now, however, the program is funded through a special taxing district (health service district) for Eagle County.

“We do that by showing savings from the ambulance transports we avoid,” said Chief of Clinical Services/Assistant CEO Christopher Montera.

The program receives patient referrals from EMS and ambulance crews, as well as physician groups.

Assessments of the program show that from July 2012 through December 2013, it produced an overall cost savings of more than $288,000.

In 2013, it began assisting Vail Valley Medical Center to help prevent hospital readmissions by providing followup patient care within 72 hours of discharge.

From February 2013 to February 2014, the community paramedic program received 1,243 referrals and conducted 692 interviews. By the end of the program, readmission rates for VVMC had gone from 4.26% to 1.01%, a 76.3% decrease in readmission rates.

Coral Springs Fire Department

EMS Division Chief Juan Cardona said Coral Springs Fire Department launched its community paramedic program in March 2015, but already is seeing a payoff. One full-time community paramedic assists patients with getting transportation to appointments, taking medications correctly and other needs.

“It’s a totally different mindset,” Cardona said, noting the fire department funds the program. “It goes from medical to a sort of social worker role. The goal is to keep the patient healthy and out of overcrowded emergency rooms.”

The hard data is still being collected, but preliminary figures are encouraging Coral Springs Fire Department to add an mobile integrated healthcare program. Through a partnership, a local hospital provides a nurse practitioner and handles administrative duties, while EMS provides a community paramedic and a vehicle. The combination creates a mobile urgent care center that can see patients at home.

He noted some EMS responses are simply to help an individual off the floor or respond to a toothache. “What do you do about that?” Dicicco said.

He and Crutchfield, the interim community paramedic program manager, propose a program in which specially trained paramedics would be allowed to visit the homes of individuals who utilize the 911 call system three times in one month or more to check the home for safety, help a patient take medicines correctly, or address other needs.

For example, if an individual falls numerous times, the community paramedic could evaluate the home for improved safety. Are there hand grips in the bathtub? Could area rugs be causing the individual to trip?

If a diabetic is transported to the emergency room and then sent home with instructions to “eat healthy,” do they even have food?

“This is doing healthcare right,” Crutchfield said. “It allows the patient to become empowered in their own healthcare.”

Dicicco said, “In this case, it’s more of a preventative service. We’re going to prevent a future fall that could prevent a future transport. The physicians don’t see them in their home environment.”

Manatee County EMS has secured funding for the pilot program with a grant (about $250,000 of a larger $860,000 grant with co-recipients Manatee County Health Department and Manatee Memorial Hospital) through June 30 to pay for vehicles, training and other program equipment. EMS has earmarked county dollars to fund the remainder of the fiscal year. Crutchfield and Dicicco are scheduled to present their idea to the Manatee County Commission Feb. 16 because they hope the board will include the program in the Fiscal Year 2017 budget.

Manatee’s proposed Community Paramedic program would target five groups, those who suffer falls or those who have respiratory problems, congestive heart failure, diabetes or mental health/substance abuse.

There will be two new positions for community paramedic, as well as a program manager. The community paramedics will receive special training.

An annual survey of EMS calls will help guide the program’s focus.

Crutchfield and Dicicco said the financial impact could be huge, helping the county deal with an overall funding issue for indigent health care. Manatee County has depleted a trust from the sale of Manatee Memorial Hospital, which it historically used to pay about $10 million in indigent healthcare annually.

To put the figures in perspective, on Jan. 26, the Manatee County Commission agreed to write off $517,736.78 in uncollectible EMS ambulance user fees, just for the month of November 2015. Manatee County EMS has a collection rate of 67%, which exceeds industry standards of between 35% and 45%.

The majority of uncollected charges involve patients who cannot pay for service, patients who provide an unverifiable billing address, patients who have moved and left no forwarding address, patients who have a large insurance deductible they cannot pay and patients who fail to meet their co-pay requirements.

Such patients, Crutchfield and Dicicco said, are the target of the program.

They also believe the county is resource rich in terms of services available to patients. The problem is that the programs don’t intermingle. This program will help resolve that problem.

“Everyone is operating in their own little kingdom and it’s costing so much money,” Crutchfield said.

Crutchfield said other community paramedic programs across the country, such as Medstar in Texas, are realizing better patient outcomes and saving money for medical providers and governments alike.

Manatee’s EMS division chief, Stephen Krivjanik, supports the efforts for that reason.

“I think this is going to have such a significant impact,” he said. “The folks who over-utilize the system will have hands-on, in-home intervention.”