Without funding, will community paramedicine just be a fad?

if financial incentives cannot be aligned with the right thing to do for the patient, what has to give?


Updated Jan, 5, 2015

Has the topic of mobile integrated healthcare reached the point of saturation? Is this a fad that will eventually fade away (or at least be limited) for the lack of a sustainable business model? In other words, if financial incentives cannot be aligned with the right thing to do for the patient, what has to give?

It was 20 years ago that the so-called Sand Key conference was held in Pinellas County, Fla. Writing for JEMS in 1994, Mannie Garza wrote an article with the headline “Rethinking EMS: After Sand Key, Things Will Never Be the Same.” I actually had the opportunity to recently review the findings/recommendations that came out of that historic meeting, and it’s remarkable how much they mirror the mobile integrated healthcare concepts we’re discussing today. It seems those seeds of innovation needed 20 years of nurturing before getting a kick-start with the changing paradigms of healthcare reform.

Writer Michael Gerber recounts the Mobile Integrated Healthcare Policy Summit held recently in Washington, D.C. As you’ll read, the meeting was all about the “sustainability” part of the equation. In it he mentions Brenda Staffan, project director for Reno’s Regional EMS Authority’s Innovation Grant, issued by the Centers for Medicare and Medicaid Services. (At nearly $10 million, it was the largest grant issued to an EMS agency.) More recently I was also able to listen to her present at the Navigator conference, sponsored by the International Academies of Emergency Dispatch. The focus there was on how the 911 system and nurse triage fit in the mobile integrated model in the Reno system.

Reno uses Priority Dispatch’s LowCode system to triage non-emergency patients safely out of the 911 system, transferring calls determined to be “low code” to a nurse who is physically located in the call center, who similarly follows a protocol to assess the caller’s needs and determine the best resource, be it a clinic, physician’s office or any number of resources that are exceedingly less expensive than an emergency department—and more appropriate for the patient. Interestingly, Reno also promotes a seven-digit number as a way for anyone to access the nurse advice line. They advertise it to the public using funds from the grant and have had remarkable success.

The grant to REMSA comes with strings—stringent requirements for collecting data and how/when that data is shared. While Staffan said the data would be forthcoming, she added that grant-funded programs are already reducing costs to the healthcare system and that these programs are receiving very positive feedback. The EMS community has been watching the Reno experiment very closely. This bodes well for EMS and the concept of mobile integrated healthcare.

In an interesting connection, Staffan was one of the organizers of the Sand Key conference all those years ago. She reminded me that the Pinnacle conference (which reintroduced MIH concepts with popular workshops last year) has a direct lineage to Sand Key. The Sand Key meeting was the result of a new high-performance EMS system contract put in place for Pinellas County by none other than Jack Stout, the noted consultant. In an innovative move, the contract called on the provider that won the bid to host a national meeting that advanced the EMS profession. Sand Key was the result. Pinnacle started in 2006 in Pinellas County as a result of the same provision in the contract.

On July 22 of this year, Jack Stout will be honored at Pinnacle with a lifetime achievement award. What goes around, comes around.

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