Community paramedics catching on in Wis.

Hospitals consider paying for community paramedicine to avoid patient readmissions


By David Wahlberg
The Wisconsin State Journal

MADISON, Wis. — Paramedics in the Madison area are being trained to not only respond to medical emergencies, but prevent them.

Known as community paramedics, they’re learning to check wounds, monitor chronic diseases and manage medication lists, in an effort to avert unnecessary 911 calls, emergency room visits and hospital stays.

The work is similar to what home health nurses do, but community paramedics could visit before or after home health care is covered by insurance or when people don’t qualify for it, authorities say.

It’s not clear how and when community paramedicine, which is just emerging in Wisconsin and around the country, will be paid for. But proponents are lobbying for Medicaid and Medicare coverage, and hospitals are looking at funding the service to help avoid government penalties for patients who return soon after being discharged.

“A community paramedic can be an excellent gap filler in a health care system,” said Patrick Ryan, co-owner of Madison-based Ryan Brothers Ambulance.

“As the Affordable Care Act continues to be implemented, we’re going to see more incentives to provide more cost-effective services,” Ryan said.

Che Stedman, chief of medical affairs for the Madison Fire Department, is visiting homes to help people who need social, dental, mental health and transportation services find them so they are less likely to call 911.

“It’s focusing on the frequent fliers, or super-users, of 911,” Stedman said.

The state Department of Health Services has approved community paramedic pilot programs at the Madison and Green Bay fire departments, spokeswoman Jennifer Miller said. The department is reviewing proposals from Ryan Brothers and other emergency services around the state.

Fire departments, ambulance services and tech schools are drafting proposed legislation to certify community paramedics and authorize payment under the state’s Medicaid program.

Madison Area Technical College plans to start a community paramedicine course next year, said Bill Ballo, EMS instructor at the college. Herzing University is considering a course, said William Vinson, president of Herzing’s Madison campus. The training is in addition to standard paramedic training.

The Madison Fire Department and Ryan Brothers are talking with Madison’s three main hospitals about working together on community paramedicine.

The hospitals might use community paramedics to help reduce hospital readmissions, or admissions within 30 days of discharges. Through the Affordable Care Act, the federal government has started penalizing hospitals that have more readmissions than expected, given their mix of patients.

“We certainly acknowledge the merit of the (community paramedic) program,” said Maria Brenny-Fitzpatrick, director of transitional care at UW Hospital.

Minnesota faced opposition from the Minnesota Nurses Association when it passed community paramedic legislation, but nurses appear to support the movement in Wisconsin.

Madison-based Home Health United is letting paramedics from Ryan Brothers observe its nurses as part of the paramedics’ training in community paramedicine.

“It really augments what Home Health United service lines are trying to do, which is keep patients out of the hospital unnecessarily,” said Rick Bourne, president and CEO of Home Health United.

Paramedics are an “untapped resource” in managing patients outside of hospitals, as long as doctors specify their duties so they don’t overlap with nursing care, said Gina Dennik-Champion, executive director of the Wisconsin Nurses Association.

“They have a role, but their role is very prescriptive,” Dennik-Champion said.

At Ryan Brothers, six paramedics have finished classroom training in community paramedicine at Hennepin Technical College in Minneapolis. One did most of his clinical training in Minneapolis, and the rest plan to do clinical training in the Madison area — at Home Health United and other places.

Steve Zank, the Ryan Brothers paramedic trained in Minneapolis, is applying his new skills at a free health resource center in the Triangle apartment complex in Madison, near Brittingham Park.

Meriter-UnityPoint Health closed its free clinic for low-income residents in the Triangle last year. Community paramedics were invited to fill the gap, said Sally Jo Spaeni, property manager for the city of Madison Community Development Authority’s Triangle site.

On a recent day, Zank checked Triangle resident Priscilla Dunbar’s blood pressure and discussed her medications, and he gave resident Dionte Crawford bandages for a small wound. Zank said he often checks larger wounds and helps residents determine if they need to see a doctor.

“We’re making sure people don’t fall through the cracks,” he said.

Stedman, of the Madison Fire Department, is taking a community paramedic course through UW-Milwaukee’s School of Nursing.

The fire department is looking at hiring a full-time community paramedic to do home visits, Stedman said. That way, the visits wouldn’t interfere with other paramedics’ response to 911 calls, he said.

Other cities, such as Baraboo, have trained paramedics in community paramedicine. But the service won’t really take off until it gets state approval and Medicaid funding, said Dana Sechler, chief of Baraboo EMS.

“Statewide, this is picking up a lot of traction,” Sechler said. “But we really need to have legislation that recognizes community paramedics.”

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©2015 The Wisconsin State Journal (Madison, Wis.)

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