The business of emergency response is always facing new challenges, whether it be advanced technology and equipment, new on-scene medical procedures or the growing stress of the job.
Another one headed their way is something the entire medical community faces — health care reform.
“We’re looking at a community paramedic program where we’d have paramedics on the street that wouldn’t run an ambulance, but just have a car,” said Dan Wheeley, executive director of Washington County/Johnson City EMS.
“They would make home visits and follow up with patients after they’re discharged from the hospital to make sure they’ve got their medicines and they’re taking their medicines correctly.”
The impending changes have arisen in the discussions about health care reform, one of EMS’ big challenges for the future.
“It’s really changing the way providers are looking at taking care of patients. For many years we’ve gone out and treated our patients, and they’ve either been treated and able to stay at home or we took them to the hospital. Health care reform is really looking at is if the hospital the right destination for a lot of these patients or are there more appropriate facilities for them to go to,” Wheeley said. One such more appropriate place could be an urgent care clinic.
“If you’ve had a cold for four days, do you really need to go to the emergency room or can you go to an urgent care center and get just as good or better treatment for that?” he said.
Talks are under way about how to address the issue of reducing hospital readmissions and unnecessary visits and it could bring about the creation of a community paramedic aspect of EMS, Wheeley said.
Dr. Mark Wilkinson, Mountain States Health Alliance’s director of emergency services and chief medical officer for Sycamore Shoals Hospital, Johnson County Community Hospital and Unicoi County Memorial Hospital, said a partnership with EMS is a step in the right direction.
“Preventing hospital readmissions is a major quality focus for MSHA, so we are excited that our local EMS organizations are interested in partnering with us to help deliver better care to patients and achieve lower readmission rates,” Wilkinson said.
With health care reform, for providers to ensure patients get the proper care they need, they will have to change their approach to a patient’s symptoms “and maybe we don’t take all our patients to the emergency room, we take them where it’s most appropriate to go,” Wheeley said.
Such a system isn’t ironed out and certainly no part of it has been implemented “but that’s the direction we’re going now. It creates a lot of challenges.”
This kind of new emergency response system would benefit hospital systems in terms of penalties from Medicare associated with readmissions.
“When a patient is brought to the hospital for congestive heart failure, they’re treated and released back home. If they’re admitted within a certain amount of time, the hospital can’t bill for that (readmission),” Wheeley said.
“And if the readmission rate is high enough, Medicare penalized them across the board for every Medicare patient that they treat. It’s up to two or three percent.”
If we don’t just pick them up and take them back to the hospital — if we can do some things, catch some illnesses and make sure they’re progressing before they get to that stage — it reduces the readmission rates,” Wheeley said.
Of course, that also reduces the number of transports EMS does, which in turn reduces revenue. EMS bills insurance companies for transporting someone to the hospital.