N.C. alternative destination pilot program proves successful

The Wake County EMS 6-year-old pilot project saved Medicaid about $500,000 in hospital and related costs during a recent 12-month period

RALEIGH, N.C. — Inside the ambulance dispatched to a Southeast Raleigh parking lot, Wake County paramedic Benjamin Currie calms a mentally troubled man who is coughing through an oxygen mask. The patient is well-known to Wake County Emergency Medical Services, sometimes calling 911 several times a day.

“What’s going on? Anything different today?” Currie asks the man as he inhales his nebulizer treatment. “I think you know we’re repeating a pattern – going to the hospital and going home – and we want you to work on the long term.”

The patient, a low-income Raleigh resident, has come to rely on hospital emergency rooms to treat his recurring breathing difficulties. Each time he calls 911, paramedics have to assess whether they’re dealing with a health emergency or another case of panic and confusion. In the past, he would have been taken to the hospital. But, under one of the first programs of its kind in the country, Wake County Emergency Medical Services is trying to keep people with behavioral health problems out of emergency rooms.

Expert Analysis

Without insurance changes, CP programs will be on life support

North Carolina’s alternative destination pilot program is just one of the increasing number of community paramedicine (CP) programs that have launched across the country in the past four years.. Initially greeted with skepticism, our industry has begun to embrace the concept of providing appropriate, nonemergent interventions while maintaining emergency response readiness.

These projects have ranged widely in scope, from alternative transport destinations to post-discharge follow-up care. Health care systems see the potential in reducing the overall cost of care, while EMS builds a stronger foundation to maintain services.

Still, what all of these pilot projects have in common is huge - none of it is currently reimbursable by the Centers for Medicare and Medicaid Services (CMS). These projects have been funded by grants and other sources of government funding. Without reimbursement, these projects run the risk of collapse. Sadly, it takes time for CMS to deliberate on the results of these projects and determine if they are worthy of insurance payments.