Tri-County Health Care launches community paramedic program

These days, paramedics at Tri-County Health Care aren't just being dispatched for emergencies; they are working to prevent them, too.

The local ambulance service launched a "community paramedic" program last week aimed at helping patients avoid costly return visits to the hospital by providing preventative primary care in the days and weeks after discharge.

"We want to look at bridging gaps in health care and making sure our patients get appropriate health-care options and reduce overall costs," said Allen Smith, TCHC emergency medical services manager. "It's all about keeping the patient in their home."

While paramedics have traditionally focused on transporting patients in emergency situations to hospitals, the community paramedic program expands their scope of service to include visiting patients with chronic illnesses such as COPD, congestive heart failure or mental illnesses who physicians have identified as being at a higher risk of getting re-admitted to the hospital.

"We're trying to break that cycle," Smith said. "If we can keep them out of the hospital for the first month than already we're doing pretty good."

During the study phase of the program, three primary care physicians will refer patients. The goal, Smith said, is to serve 20 people within a month. By the middle of 2014, after working out the kinks and improving processes, it will expand to more physicians and patients.

"If the process is correct, the quality will occur and the patient satisfaction will be high and everybody wins," Smith said.

After the patients who are referred leave the hospital, a paramedic will visit them within 24 to 48 hours to make sure their medications are working, identify potential hazards in their homes and catch problems before they become emergencies that require additional hospitalization, said community paramedic Julie Jenson, TCHC EMS education coordinator.

"Who wants to hang out in the hospital?," said Jenson, one of three TCHC EMTs who completed a semester-long community paramedic course at Hennepin Technical College in Brooklyn Park. "I feel very passionate about this program because I see such promise with it and benefits to the community."

Using a $12,500 Wadena County Public Health grant, two more TCHC paramedics will start the program in January.

Jenson stressed that community paramedics services are not the same as home care. "I'm not a nurse," she said. "What we do is more short term."

Minnesota has been a leader in the community paramedic field. In 2008, Kai Hjermstad was among the first eight people in the nation to receive a state-approved community paramedic certification. Now he's the coordinator for EMS and community paramedics at Hennepin Technical College, where students from 20 to 25 states are training in the program.

"There's no limit to where it can go and where we can take this," Hjermstad said.

Judy Bergh from the Minnesota Department of Health's Office of Rural Health and Primary Care extolled the virtues of the community paramedic program, from saving elderly patients costly trips to the clinic to keeping rural EMTs busy during low volume times.

"You need the coverage 24/7, but there's a lot of down time and this allows (paramedics) to be employed and offering services during their otherwise down time," said Bergh, who runs a state grant program, which this year funded rural community paramedic programs in Ada and Fosston.

In 2012, the Minnesota legislature established reimbursement for community paramedic services for the state's Medicaid patients. Now other states, including Colorado, are considering similar measures, said Chris Montera, assistant CEO of Eagle County Paramedic Service, the first rural community paramedic program in the nation.

In the Colorado program's first 18 months, an economist found that the service saved the health-care system an average of $1,250 per patient, Montera said. "Everyone we've talked to said (a reimbursement bill is) going to be a no brainer."

So far, few private insurance providers cover community paramedic services.

"I'm not worried about the money," Smith said. "I'm worried about the quality of care to my patients."

But Smith said he expects insurance companies will start covering community paramedic services once its value is firmly established. As the Affordable Care Act moves forward, he said, "quality and accountability" will be the things that matter most.

Medica, Minnesota's second largest health insurance provider, "will consider covering the programs for (non-Medicaid) members as we understand them better and evaluate the outcomes they provide," wrote company spokesman Greg Bury in an email. "We used a similar approach to convenience care clinics when they were first introduced. After we evaluated the outcomes they provided, convenience care clinic visits became a covered service for all of our members."

While there are other community paramedics at other rural ambulance services, Smith said the Wadena program will be the most fully integrated rural program he's ever heard of. He said he hopes it can be used as a model for the rest of the state and nation.

"One goal is to take what we do here and make it reproducible," he said. "All health-care organizations are going to have to adapt to this new environment. We're at the leading edge of it."

BREAKOUT BOX/GRAPHIC

Frequently Asked Questions about Community Paramedics

Q: Does a community paramedic (CP) replace current health-care systems like home health care or primary care physicians?

A: No. CP is an extension of the primary care provider to provide care to patients without access, and does not replace the specialized services available in a home health care model or physician office.

Q: Does a CP have the right training to provide primary care?

A: Additional education is provided to CP specific to providing preventive care in the home within their current scope. However, services provided do not fall out of the currently defined scope of practice for EMS personnel.

Q: Is the quality of care compromised by using a CP vs. a primary care provider?

A: No. A CP provides care under the supervision of a physician, so the quality of care is consistent with care provided in a clinic setting.

Source: Eagle County (Colo.) Paramedic Services