When discussing this new and growing field of pre-hospital care, there seems to be two very unique paths emergency services are following.

I’ve broken the two community paramedicine paths into two distinct models – hospital-owned or contracted service and 911 abuse reduction.

Model 1 – Hospital-owned or contracted service

In hospital-owned or contracted service, community  providers are looking for ways to decrease readmission rates for chrnoic illnesses. These can include congestive heart failure, COPD, pneumonia, sepsis, MI and others.

When a patient is discharged with one of these targeted conditions and readmitted within a 30-day window, the hospitals face penalties of up to 3% of Medicare payments in 2018, according to a USA Today article.

That is a lot of money, especially for hospitals in Florida. USA Today reported that southwest Florida’s largest hospital operator, Lee Health, expected to lose $3.4 million in payments.

This model represents the if/or/and type of service. If we can do it for less – and there are providers who are willing to do this type of medicine – then we can save the expensive penalties from CMS.

Model 2 – 911 abuse reduction

The second model of community paramedicine is 911 abuse reduction. For years EMS has conditioned the public to call 911 for any emergency. Today, however, what we consider an emergency is far from the public’s perception of an emergency.

“EMS has experienced a 37% increase in 911 calls since 2008,” reported a Sarasota Herald-Tribune article.

But have we increased staffing 37%? A JEMS article reported that we have not all staffed to levels needed. “Only 50% of EMS services in 2008 were fully staffed, of which, more than 63% had a volunteer component as part of their staffing level,” the journal reported in a staffing article.

The JEMS article also talks about increasing wages to help compensate for the decrease in trained providers. With the CMS limiting payments and major insurance companies following suit, this won’t be an option in the near future.

We can try to re-educate the public what a true emergency actually is, but that will be a long and slow process. Philadelphia has already started the trend to re-educate and placed several billboards in the neighborhoods that account for an ordinarily high amount of non-emergent 911 calls.

Will this be effective? Time will tell, but I would believe not enough to change the volume of calls.

Could community paramedics work here? Yes, I believe they can with nurses triaging the low acuity calls in the 911 center.

After evaluating the calls they can dispatch community paramedics armed with not only the usual equipment but also the knowledge base to connect these patients with primary care physicians, social workers and the programs that are available to them to get the long-term care they deserve.

If you want to learn more about community paramedicine, you can read the blueprint they are using in South Carolina.

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