Under the Affordable Care Act (ACA), hospitals are at risk of penalties and cuts to reimbursement if the rate of patient readmission for the same condition is high. This penalty intends to prevent misuse and overuse of healthcare interventions and achieve a greater patient satisfaction with the care provided to them.
However, this new incentive given to hospitals around the nation calls for more than just political awareness of rising healthcare costs in America. In fact, the very foundation of healthcare delivery demands to be redesigned.
Essentially, the ACA urges for a switch from healthcare quantity to healthcare quality, putting more emphasis on preventative care to keep patients out of hospitals. In fact, the Center for Medicare and Medicaid Innovation was created solely in response to the ACA, and it serves to award grants to researchers and doctors who have innovative ideas for improving the current healthcare system. The triple aim is to lower per capita costs of healthcare, provide better access, and improve overall care.
In the last decade, hundreds of fire departments, ambulance services, and hospital systems nationwide have launched health resource programs that hope to do just that. One such type of program, Community Paramedicine, is especially remarkable, and is beginning to be widely researched.
The appeal of programs like Community Paramedicine originates from the extra involvement of specially trained paramedics and emergency medical technicians (EMTs) in the treatment process. In a “killing two birds with one stone” approach, Community Paramedicine and programs like it (such as Mobile Integrated Healthcare) help to fill in the gaps of the current healthcare system by providing patients with the care they need while also keeping them out of the emergency room.
Generally, the role of the emergency medical services (EMS) is simply to transport all patients that call 911 for a medical emergency, independent of their actual condition, to the ED (Emergency Department). However, a significant percentage of EMS calls have been shown to be non-urgent and result in unnecessary transportation and exorbitant ED visit costs for the patient. This cycle of unnecessary admission and readmission, usually stemming from patients with chronic and special care illnesses, contributes to ED overuse. Essentially, transporting all patients causes a decrease in the quality of care for patients who need it the most.
From 2000-2010, Emergency Department visits have increased over 20 percent from 108 million patients to 129 million. This statistic illustrates the increasing burden of the current system of healthcare, especially that of EMS. Unfortunately, ED overuse is only the beginning of the problem. Often times, higher healthcare costs and longer wait times caused by non-urgent patients being transported to the hospital generates lower patient satisfaction in healthcare. Further, this may even imbue a sense of distrust in or fear of calling 911 when a real emergency does occur.
Community Paramedicine presents immense potential in response to ED overuse and helps hospitals work to reduce penalties of the ACA. The implementation of Community Paramedicine comes from the participation of paramedics and EMTs that provide services outside of their traditional response and transport roles. Generally, the term Community Paramedicine describes the expansion of potential roles that EMS can perform to improve our current healthcare system.
Not only are these healthcare personnel racing to emergencies and transporting patients in need, they are also actively helping keep non-emergency patients out of the hospital. Along with permitting urgent assessment via telemedicine on an EMS call, Community Paramedicine programs also emphasize preventative check-ups and in-home care with the goal of reducing emergency calls and costly trips to the hospital for the patient.
Community Paramedicine strives to be a community health resource. Triaging and In-Home Care models have been piloted in order to better help a patient who frequently calls EMS and requires regular evaluation. These models recognize that frequent visits to the ED does not always lead to better care for the patient. Instead of transporting, EMS dispatches to the scene as if it were a non-emergency and evaluates the situation with the help of the patient’s primary care physician (PCP). Then, the paramedic is able to make a coordinated decision about the appropriate course of action for that particular situation.
This system empowers paramedics to deliver care through consultation with a PCP to patients who might be served best by being cared for at home, rather than being immediately transported to the hospital. In fact, programs that allocate more care responsibility to the non-emergency side of EMS work to reduce strain on limited emergency EMS and ED resources. In turn, these programs give EMS the opportunity to be included as an additional factor in more efficient coordination of care for patients.
In pilots of Community Paramedicine programs, paramedics receive 16 hours of training that prepare them for telemedicine-enhanced care and physicians undergo a formal certification process that allows them to participate in telemedicine with the community paramedics in the field. If successful, these programs could greatly improve the quality of care provided to the public, increase the value of EMS in the healthcare system, and ultimately prevent penalized readmissions, filling in the gaps in our current health care system.
As a certified EMT, I value initiatives like this one that encourages extra participation from trained personnel in emergency situations. It has become widely understood that America’s modern healthcare system requires much modification; it is no longer debated that the ways in which Americans receive care is far from achieving its potential. However, programs like Community Paramedicine are just one of the many great ideas that could positively revolutionize the healthcare system. Hopefully, as the ACA is further implemented and programs like Community Paramedicine continue to be pushed into existence, healthcare in America will begin to change as well.
Jhaveri is a member of the class of 2018.