Rising readmission rates are a pressing – and costly – concern for healthcare entities across the U.S. Many patient readmissions are also potentially harmful to the patient and often avoidable. Paramedics can help reduce readmission rates via location and community factors in both emergency and non-emergency situations — helping to improve patient outcomes, decrease readmission costs and generate revenue for the community paramedicine (CP) model. CP, in its various models, empowers trained paramedics to help communities meet the healthcare needs of vulnerable residents in more cost effective ways than emergency room visits and hospitalizations.
A Dec. 17, 2015, article1 in FierceHealthcare covered the following four lesser-known – but effective – ways hospitals and those using the CP model can reduce readmissions:
- Assess Community Factors: Thirty-day readmission rates dropped by 60% for targeted diagnosis-related groups when three western Pennsylvania hospitals launched a program that connected patient navigators with patients. These navigators helped patients find valuable health services and schedule appointments as well as following up with the patients after discharge. Health coaches at the Mercy Clinic (Des Moines, IA) provide education on the patient’s condition, help coordinate case and find resources that will provide the patient with the most value.
- Make House Calls: Two hospital systems, Valley Hospital (Ridgewood, NJ) and North Memorial Health System (Minneapolis/St. Paul, MN) have seen reductions in readmissions by launching programs that utilize paramedics, emergency medical technicians and critical care nurses to coordinate follow-up care.
- Consider Transitional Care Programs: Community Care of North Carolina saw a 20% reduction in readmissions after they launched a physician-led transitional care program in 2008.
- Establish Emergency Departments for Elderly Patients: Because elderly patients can have an increased issue with performing daily tasks after surgery, they are at high risk for readmissions. However, emergency rooms can be confusing. Several hospitals have created special emergency departments for elderly patients with specially trained staff to assist this patient population by assessing patients for readmission risk factors.
Similarly, in an Aug. 17, 2015, article2, the Wall Street Journal discussed CP and that paramedics are making home visits to elderly patients to perform lab tests, administer IV medications and help ensure that patients understand follow-up instructions from the hospital.
Performing some simple steps can help generate revenue in the CP model. EMS Financial Services noted in a Dec. 2013, article3 the three ways below that the CP model is generating revenue and the differences in financial exchange among providers, insurers, facilities and patients in large and small EMS providers.
- Lower 9-1-1 use and reduce hospital admissions without jeopardizing patient care
- Work with your state ambulance association or other local providers to lobby for coverage of treatment without transport services or other CP services
- Home visits
Interest in CP and Reducing Readmissions is Burgeoning in Ohio
The SouthernMedinaPost.com reported on July 4, 20154, that officials of the Lafayette Township of Medina, OH, wanted a CP model. They successfully pushed state legislators to pass a law that allows EMTs and paramedics with fire departments to work on patients in non-emergency situations either at stations or at residences.
As noted in a July 14, 2015, piece from the Council on Aging5, this new legislation passed with Ohio's Biennium Budget in early July, allowing local fire and EMS departments to practice CP. Previously, EMS personnel could not provide services in people’s homes unless they were summoned there to respond to an emergency. Under the new law, trained paramedics may perform emergency medical services in a non-emergency basis if the services are performed under the direction of the department's medical director or cooperating physician advisory board.
While CP is voluntary in Ohio, and fire and EMS departments can choose the CP program they want to implement in their communities, many have not because of inadequate staff, funding levels and other factors.
Two McKesson clients in Ohio are participating in CP models. They are the Monroe Fire Department (MFD), located within the City of Monroe, OH, and the Violet Township Fire Department (VTFD) in Pickerington, OH, one of the 13 townships of Fairfield County, OH.
Each has partnered with a local group to implement a CP program to help reduce readmissions of vulnerable residents. MFD has partnered with Mount Pleasant Retirement Village (MPRV), a continuing care retirement community in Monroe, OH. They will study a group consisting of patients with congestive heart failure (CHF), chronic obstructive pulmonary disease, myocardial infarction, cerebrovascular accident and hip/long bone fracture to determine if a formalized follow-up program would reduce re-admissions and newly developed illnesses that might ultimately necessitate an ER visit. The study data will allow MFD to roll out a tested, data driven program for the community. VTFD has partnered with Mount Carmel Health System (MCHS) of Columbus, OH, for a CP program (currently in the test phase). The group’s focus is on residents who were released from their respective hospitals with a diagnosis of CHF — one of the most expensive diagnoses that Medicare pays on, according to the American Heart Association.6 They have identified personnel to review those patients’ records and assimilate data, and to help provide services that will help reduce readmissions. Services include filling prescriptions, performing in-home safety checks and helping to manage appointments. They will also determine if a patient needs home healthcare.
Through smart practices, creative programs and collaboration with healthcare providers and community resources, the CP model can help to deliver quality outcomes — and to keep patients out of the hospital.