Community paramedicine conference promotes healthcare collaboration
The event brought together a broad spectrum of 475 healthcare providers to discuss ways different industries can work together to promote community paramedicine
By Teresa McCallion, EMT
Most agree it takes a community of healthcare providers to offer quality patient care. Unfortunately for many communities, that’s where the agreement ends. While there is passion for implementing new, community paramedic and mobile integrated healthcare (MIH) programs, there is often little consensus on how to build one.
In November, more than 475 healthcare system stakeholders from throughout Washington attended the state’s first community paramedic conference in an effort to change that.
Conference planning coordinator and East Pierce (Wash.) Fire and Rescue Assistant Chief Russ McCallion was well aware of the challenges when he proposed the two-day event. As the chair of the state’s Prehospital Technical Advisory Committee, he recognized that if MIH was to work in Washington, it would require a collaborative effort from a range of stakeholders.
“We recognize that there’s a certain amount of misinformation, concerns, turf disputes and general lack of understanding of both the opportunities and challenges when it comes to MIH,” McCallion said. “Too often, EMS colleagues are only talking toEMS colleagues. We needed to get the other healthcare professionals involved so we could break EMS out of its silo, and together learn how we can work to improve community health.”
When healthcare communities cooperate
To avoid the interprofessional fighting that has marred MIH attempts in other states, the conference planners began by working with 16 associations, payor organizations and private companies, including the Washington State Department of Health, Washington State Nurses Association, Washington State Hospital Association, Washington State Council of Fire Fighters, Washington Ambulance Association and the Home Care Association of Washington. Each group was represented on the conference planning committee.
Since funding at the Washington State Department of Health, EMS and Trauma Systems was scarce, McCallion reached out to the Washington Fire Chief’s Association to serve as the lead agency. The inclusive conference planning committee then spent much of the spring and summer securing sponsors and speakers. In the end, they had a broad spectrum of both, including hospital administrators, home health care nurses, physicians, public and private ambulance service providers, labor representatives, payer groups, regulators, attorneys and paramedics.
This unique approach wasn’t lost on the conference’s keynote speaker, American Medical Response (AMR) Chief Medical Officer Ed Racht, MD, who praised organizers and attendees.
“I’ve never seen this kind of participation for a regular conference,” he said. “Washington is one of the few states that has managed a collaborative effort.”
"The impetus exists for change," Racht said. Healthcare reform has laid out clear goals in the form of the Triple Aim — improved care, improved patient satisfaction and decreased cost. A shift from a fee-for-service reimbursement model to fee-for value provides the incentive.
However, appropriately managing a patient population through evidence-based approaches requires a focus on quality and coordination of care that rarely exists in the current system. Realigning the healthcare system at the local level, with the patient at the center, takes the cooperation of the entire healthcare community.
While Racht recognized the effort Washington attendees were making towards interprofessional alignment and advocacy, he still saw challenges ahead. He pointed to improvements in patient navigation, competencies within professions, defined reimbursement models, regulations and oversight implementation, and establishing the right metrics for quality control.
Getting down to business
The first day of the conference provided a sampling of MIH programs from throughout the U.S., including EMS provider MedStar Mobile Healthcare, of Fort Worth, Texas, an early and key player in MIH. Matt Zavadsky, public affairs director for MedStar, provided critical insight into how to get paid for MIH. He explained that data is fundamental to creating economically sustainable programs, and third party payers want to see proof of cost savings.
“EMS must prove its value,” he said. “We need to do studies and be prepared for the results.”
The conference also highlighted several local programs, including a community paramedic pilot program in northwestern Washington that uses “hot spotting” to identify repeat EMS patients and help connect them with appropriate community resources.
“We have tapped into a vast area of need,” said the Snohomish Fire District No. 1 Medical Services Officer, Captain Shaughn Maxwell. Through the program, Snohomish Fire is now working with community agencies they never knew existed. Not only does the patient finally get much needed care, Maxwell said, but first responders who were getting burned out responding to the same people are now doing a better job on the calls for which they are critically needed.
Through careful collaboration, the fire district was able to avoid some of the resistance other programs have faced from the nursing community — namely concerns that EMS and home health would compete for the same patients. Instead, Maxwell said, the program is identifying patients who have been falling through the cracks.
“We are giving [home health] more referrals than they can handle,” he said.
By the end of the first day, most of the attendees appeared to be in agreement with the general concept. “What they are doing is not unknown to us. We do it all the time. It’s just in a different setting,” said Northwest Physicians Network Lead Case Manager Shannon Mojica, RN, BSN, CCM. She and other nurses attending the conference recognized gaps that EMS could fill.
“They’re identifying patients we don’t know about,” she said. “That’s the community we are looking for so we can deploy resources. EMS is already out there. Let’s use them.”
Northwest Physicians Network Director of Clinical Operations Shari Peterson, RN, BSN, CCM said that working together shouldn’t be an issue. Nurses are used to working in healthcare teams.
“Having a team approach where everybody has their specialty makes sense,” she said. “The goal is to work together to do what’s right for the patient.”
Along with the presentations, conference attendees learned more about each other’s professions — a bonus of the diversity of attendees, McCallion said. Nurses learned the difference between a paramedic and an EMT; EMS providers got a lesson in how home health works.
“Members of both communities are now doing ride-alongs with each other to further their education,” he said.
One issue that surprised the Mojica and Peterson was that paramedics and EMTs are currently only allowed to transport patients to the emergency room. They also had no idea that so many patients were being seen by EMS, but not transported.
Not everyone at the conference was ready to jump on the MIH bandwagon. It was clear during the facilitated audience question and answer period that some attendees still believed there were boundary disputes that must be addressed. It was also evident that labor issues among firefighters, paramedics and other professionals could torpedo programs if ignored.
The conference also highlighted specific challenges for community paramedic programs, and identified regulatory issues as high on the list.
Zavadsky warned that it will take work to create successful programs, and encouraged participants to work together to get over regulatory hurdles. Programs must also have integrity measures, he said, and he promoted collaboration with home health and nurses associations to change laws that restrict EMS to emergency calls only. Most importantly, he said, “pick a model that meets the Triple Aim.”
“We welcome regulation,” said Mike Lopez, assistant director of integrated healthcare for the Spokane (Wash.) Fire Department. “Nobody wants ‘Mike’s Community Paramedic Service’ out there looking for patients.”
Other speakers focused on legal and workforce issues, especially when addressing patients with behavioral needs.
Tom Judge, executive director of Maine-based Lifeflight Foundation, argued that EMS is particularly well positioned to help identify areas of need.
“You know more about the epidemiology of the community than anyone else,” he said. “EMS is the safety net. Everything that goes wrong lands on your doorstep. The key questions to ask are: What does the community really want? What is it willing to pay?”
With that in mind, immediately after the event the conference planning committee transitioned into a standing, interdisciplinary workgroup to identify other stakeholders and changes to pursue, such as amending state laws regarding EMS. The workgroup will begin regular meetings in 2015.
Doris Visaya, RN, BSN, executive director of the Home Care Association of Washington, said the conference opened her eyes to a number of ways EMS could collaborate with home health.
“What I learned from the conference is that there are areas where we can enhance patient care by working together,” she said. “But it takes that effort. Otherwise, it’s that fear of the unknown. In our industry, we get concerned that people are recreating the wheel. Let’s improve the wheel — make it a better wheel.”
Teresa McCallion, a Washington-state EMT, is a professional writer who focuses on EMS topics. She is married to Fire and Rescue Assistant Chief Russ McCallion, an organizer of the conference.