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Filling a Void – EMS Providers Step Up To Address Community Health Care Needs

Last month I had the pleasure of representing CIVHC at the International Roundtable for Community Paramedicine (IRCP) conference in Vancouver, Canada. My friends and family were a bit surprised (and somewhat jealous!) to learn I was travelling out of the country for a conference. I explained that CIVHC identifies and promotes innovative solutions to address Colorado’s health care crisis, and the IRCP is the only conference that focuses exclusively on the up and coming community paramedic model. Community paramedic programs, although relatively new to the US, have proven successful in improving health and saving costs, and CIVHC is identifying how this model might fill gaps across Colorado.

The concept of the community paramedic is not entirely new. It just didn’t have a name until a few years ago. Paramedics have been filling voids in health care for many years – especially in rural areas – often in the emergency rooms of understaffed hospitals. At the IRCP, a paramedic from Idaho told me that in the 90s, he and two nurses used to staff the entire rural hospital on weekends and during the night shifts. The nurses often asked him to intubate their patients - something well within his scope of practice – plus, they felt he had much more experience, having performed intubation hundreds of times in the field. Turns out it was against operating procedure at the hospital for a paramedic to intubate, and he often got reprimanded when his supervisor found out.

It dawned on me, after hearing that story and details about other current and very different community paramedic programs, that one challenge EMS faces in expanding this role for paramedics is that a “community paramedic” isn’t easily defined. Like many of their calls to the scene of an emergency, how they serve the needs of the patient depends on the situation.

One way to define community paramedicine is to say that it’s whatever it needs to be. In Nova Scotia, Canada, it’s using EMS to respond to emergency calls in long term care facilities, and providing care (like simple sutures) on site to keep seniors out of crowded emergency rooms. A remote island in Nova Scotia uses community paramedics to do check-ups in the home, a program started in response to losing their only local medical provider and the closest health care facility being two ferry rides and hours away. In Eagle County, Colorado, physicians can delegate to community paramedics things like post-hospital discharge checks to prevent readmissions, and well-baby exams for newborns whose parents have transportation issues or no insurance coverage.

What do all of these community paramedic programs have in common? They were all developed and designed to fill a specific gap and augment health care in their community, not to replace or duplicate current services. Community paramedics can provide essential services: blood draws, vital signs, injections, fall risk assessments, vaccinations, medication checks and more. And, a community paramedic is mobile and can see patients outside of a medical facility, or at home when a patient doesn’t qualify for home health. This is important when we think about access to transportation and other mobility issues that keep people from getting the preventive medicine they need to stay healthy.

So why aren’t community paramedics used more often in the U.S.? With the exception of Minnesota which recently passed legislation to reimburse community paramedic services, the current payment system falls short of reimbursing EMS for services beyond a transfer to the hospital, making community paramedics costly to start and difficult to maintain. However, as more projects in Colorado and nationally find support to expand and are able to gather data on cost savings and patient health, the industry aims to demonstrate the value of a community paramedic and become part of the payment structure. After just a year of serving their community, the program in Eagle County, Colorado has estimated a 97% reduction in health care costs for their patients by keeping them out of costly ERs, preventing hospitalizations, and reducing skilled nursing center visits.

New programs are beginning to develop across Colorado and the country, and a few have been funded nationally through the Center for Medicare & Medicaid (CMS) Innovation Challenge grants, including the Upper San Juan Health District in Pagosa Springs, Colorado. Through the Innovation Challenge funding, programs can rapidly implement and evaluate impact on cost, quality and population health, providing a great opportunity to quantify the value of community paramedics on a larger scale.

The IRCP was pleased to have a representative from the U.S. Department of Health and Human Services and the Department of Homeland Security participate in the conference again this year, another sign that community paramedicine is gaining interest and momentum across the nation. With so many hurdles facing us in the health care system – access to primary care, high costs, uncoordinated care - it just makes sense to consider all available assets in the health care community. Paramedics are a potential solution that shouldn’t be overlooked.

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