Little Rock's ambulance service will begin training medics June 7 to provide personalized medical care and consultation at certain patients' homes, an initiative expected to reduce costly nonemergency 911 calls and hospital visits.
The Metropolitan Emergency Medical Services program will provide treatment for pre-hospital patients and discharged patients who don't receive home health or hospice care. Known as community paramedicine, the program will consist of six MEMS medics acting under the supervision of a physician. The medics are to finish training in September.
A similar program in Fort Worth that served 207 patients saved at least $7.9 million in ambulance transportation costs, insurance fees and emergency room expenses over a five-year period that ended in October, according to MedStar Health, the city's ambulance service provider. That's just over $38,000 per patient.
North Carolina, Colorado, Minnesota, and Maine have also implemented community paramedicine programs in recent years. California began testing the programs in municipalities across the state last year, according to reports.
MEMS, a nonprofit agency, is required to respond to 911 calls no matter the circumstances. But now the agency is working to identify patients known as "high utilizers," those who frequently call 911 when primary care or retail clinic services might be more appropriate, said Ed Gilbertson, MEMS director of community paramedicine.
"People dial 911 sometimes because they're not sure if they should," he said. "And we absolutely want them to call. We don't want anyone to think they shouldn't call. But, as we have ambulances responding to things that are less of an emergency, that could be handled through a physician's phone call or physician's office visit or something along those lines, that's resources that get tied up."
MEMS has about 220 uniformed personnel who serve roughly 530,000 residents in Pulaski, Faulkner, Grant and Lonoke counties. The agency responds to about 240 calls per day.
Gilbertson said the most frequent 911 callers sometimes have underlying problems, such as malnutrition or addiction. Many are older, live in rural areas and lack transportation, making it difficult for them to visit a physician. Others have mental health problems and need long-term treatment.
Those problems, Gilbertson said, usually come to light when someone repeatedly summons the ambulance service. But the repetition itself shows gaps in the health care system, he said. The community paramedicine program aims to fill those gaps through checks on welfare, in-home health assessments, basic treatment and referrals to outside agencies.
Gilbertson said the program will also educate those enrolled on treatment options so they can "navigate the system so they can take care of themselves." He said patients will enroll voluntarily and eventually "graduate" from the program.
"The positive of this is we want to give the people the resources that they need," Gilbertson said. "That if they don't need an ambulance, we don't want to be sending one. We want to keep that resource where it is more useful. So if we can get the patient a paramedic to come out in the car and visit him, and review some things and help him get on track, that saves that patient a whole day in the hospital and a lot [of] charges that are going to be run up on their insurance, or Medicare, or whoever."
A 2010 study by the Rand Corp., a nonprofit policy institute, found that between 13 and 28 percent of emergency room visits in the United States are for nonurgent care. The trips amount to roughly $4.4 billion in health care expenses that could be saved per year, according to the study.
Mack Hutchison, director of quality assurance of MEMS, said the agency has identified eight patients who accounted for 222 calls to 911 last year. The agency is identifying other high utilizers by analyzing calls in which patients were treated but not transported to hospitals. Hutchison said MEMS logs about 80 of those calls per month, and many come from the same patients.
Arkansas Act 685, passed in March 2015, allows for the creation of community paramedicine programs in the state. Medics must have two years of full-time experience and complete 300 hours of classroom and clinical training in emergency department services, home health services, hospital case management and public health agency services.
MEMS reported the training will cost the agency at least $50,000. The ambulance service had not determined how much its community paramedicine program will cost annually.
Gilbertson said MEMS is interested in obtaining grants to finance the program, but for now it will function under the agency's $23.5 million annual operating budget.
Metro on 05/30/2016