How EMS can clear community paramedicine roadblocks
State-specific restrictions, Medicare reimbursement, turf battles and public and patient acceptance must be tackled for any program to be successful
EMS may sit at the kids' table of health care, but the industry still gets to eat.
"We may not be the biggest player, but we're a substantial player," Page, Wolfberg & Wirth attorney Stephen R. Wirth said Wednesday during his session "Shedding Light on the Dark Side of Community Paramedicine" at the ZOLL Summit 2014 tradeshow in Denver.
"There needs to be an 'us' mentality," he added.
As EMS agencies nationwide are gearing up to deliver mobile integrated health care through a community paramedicine model, roadblocks such as state-specific restrictions, Medicare reimbursement, turf battles and public and patient acceptance have emerged as critical aspects that must be tackled in order for any program to be successful, he said.
The good news is that under the Affordable Care Act, there's a federal incentive and support from the Inspector General for hospitals to reduce readmission rates to avoid being penalized, and it opens the door to experimental community paramedicine programs with that aim.
Getting around the red tape
In 2011, Minnesota was the first state to pass a community paramedicine statute that includes Medicaide coverage and offer an EMT-CP certification a year later.
"It did not come easy," Wirth said. The law allows CP services to be included in a patient's care plan and billing — with approval from the patient's primary-care provider.
Authorized coverage includes everything from health assessments and chronic disease monitoring and education, to medication compliance, minor medical procedures, vaccinations and hospital discharge follow-up care.
When it comes to dealing with your own state, there's no need to reinvent the wheel.
"Show them the Minnesota law," Wirth said.
He admits that although we're starting to see some changes, pursuing legislation to get Medicare to go beyond non-transports is not going to happen overnight. Many states also limit EMS providers to ambulance service operations, and require that ambulances go to the ER.
In this case, partnerships are the key. It may be possible to implement community paramedicine programs through medical practice associations, physician groups and hospitals rather than going through the state.
Now that hospitals will soon be penalized for excessive readmissions under the Affordable Care Act’s Hospital Readmissions Reduction Program (HRRP), it makes sense to start an initiative focused on acute myocardial infarction (heart attacks), heart failure, and pneumonia — which are the readmissions HRRP has identified as those that hospitals need to reduce in order to avoid penalties.
"The money," Wirth said, “that's where this is going to benefit."
Collaborate on a fundamental change
Of course, it helps if your hospital is supportive of a proposed community paramedicine program from the start — along with doctors, health agencies, nursing groups, assisted living facilities and other organizations in the health care field.
These groups should see community paramedicine not as a threat, but rather a way for everyone to work together to meet a common goal of increasing patient access to health care, increasing patient outcomes to health care, and reducing costs.
"It really comes down to collaboration in overcoming these obstacles," Wirth said.
Meeting with hospital administrators before proposing a community paramedicne plan, and coming up with one together, can go a long way in making sure the plan is successful, he said. "It's also about showing other health care providers how EMS can add value to its piece of the pie. Taking the lead in the coordination of patient services and care can also lead to public education and acceptance.
"We need to demonstrate we're not just a bunch of ambulance jockeys," Wirth said.
And it's important to present community paramedicne programs as an expansion of existing services and skills.
"Don't paint a picture that this is a big new thing," he said. At the end of the day, it really comes down to the changing the "if you’re sick, call 911" mentality, and getting EMS in at the ground level.
"There are some really cool opportunities for us to get on board a fundamental change," Wirth said. "And those who get on the train early will benefit the most."
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