Md. fire dept. partners with hospital to launch mobile paramedic service
Baltimore City Fire Department officials hope the pilot program will reduce strains on first responders and emergency rooms
By Sarah Meehan
The Baltimore Sun
BALTIMORE — Nurses and doctors are partnering with paramedics in a new mobile service to bring treatment directly to patients in West Baltimore in a pilot program city officials hope will reduce strains on the city’s Fire Department and emergency rooms.
The two-year pilot program aims to prevent unnecessary emergency room visits and ambulance trips while also helping patients returning from the hospital manage chronic conditions at home.
The first patients were enrolled in May 2018, and officials unveiled the program, dubbed Mobile Integrated Healthcare — Community Paramedicine, at a news conference at the University of Maryland Medical Center in downtown Baltimore.
“You have to meet patients where they are, and that’s what this program is doing,” said Dr. Jay Perman, president of the University of Maryland, Baltimore, one of the partner institutions in the program. “It’s low-tech, it’s high-tech, it’s community-based. It combines what we can do with our tele-health abilities. And it is a model that puts the patient at the center of the team.”
Other partners include the city of Baltimore, University of Maryland Medical Center and Baltimore Fire Department.
Mayor Catherine Pugh said the program aims to serve people who don’t consume health care services like most insured people and “use emergency rooms as though they’re their own personal doctors.”
“This will transform the way we provide services,,” Pugh said.
The partnership estimates the program could save the Fire Department $1.7 million per year, and UMMC $4.02 million a year.
Part of the program, called Minor Definitive Care Now, augments the Fire Department’s routine emergency medical services by sending a team of paramedics and nurse practitioners or doctors to people who call 911 for medical problems.
That program offers treatment for qualifying patients at their homes or wherever they are without transporting them to a hospital. To date, providers have treated conditions including digestive issues, rashes, musculoskeletal pain, and ear, nose, throat and mouth concerns. The paramedic-nurse team can write prescriptions and recommend follow-up care.
Patients still can request transport to an emergency room after their evaluation.
That initiative aims to reduce the strain on emergency rooms and free up ambulances. The program’s partners estimate the strategy will keep 2,000 patients out of emergency rooms annually. And Dr. David Marcozzi, assistant chief medical officer for acute care at UMMC, estimates ambulances return to service 20 minutes faster when patients opt to be treated outside the emergency room.
The other part of the program, Transitional Health Support, aims to improve care and reduce hospital readmissions for patients after they return home from hospital visits.
The support program links patients with care teams while they are still admitted to a hospital. Caregiving teams — community paramedics and nurse practitioners or doctors — then conduct home visits and monitor the patient for 30 days after they are discharged. The program also helps patients arrange follow-up appointments, and provides transportation, social services and education around medical issues.
Since the program launched, Marcozzi said providers have learned patients need the most help getting their prescriptions, taking those medications, traveling to appointments, coordinating care between multiple providers, and obtaining food.
The program is currently staffed by 30 Fire Department registered nurses and paramedics. Another dozen pharmacists, physicians, social workers and other community health workers support their work from an operations center.
“We are in this transformation in how we think about the delivery of healthcare, and moving from hospital systems to health systems means taking on the responsibility of the health of our community beyond the walls of our organization,” Dr. Mohan Suntha, president and CEO of the University of Maryland Medical Center, said at the news conference announcing the program.
Baltimore modeled its program off similar ones in Fort Worth, Texas, and Mesa, Ariz., according to UMMC.
The pilot currently operates in six ZIP codes in West Baltimore: 21216, 21217, 21223, 21229, 21201 and 21230. Leaders in the program hope to expand it to the entire city.
Funded by a $4 million grant from the Maryland Health Services Cost Review Commission, the program is free to patients. Marcozzi said they will reevaluate funding sources as the two-year pilot draws to a close.
The program dovetails with a relatively new model for how hospitals are funded in Maryland known as global budgeting. The state essentially caps hospitals’ revenue each year, letting them keep the difference if they reduce inpatient and outpatient treatment while maintaining quality of care. Emergency room care is among the most costly in a hospital.
The mobile health initiative also was announced as the Baltimore City Council prepares to hear from fire department officials about the department’s struggle to manage its high volume of requests.
More than 80 percent of calls the Fire Department receives are for emergency medical services, and the department estimates 15 percent of people transported to emergency rooms could instead be treated safely in non-urgent settings.
Baltimore City Fire Chief Niles Ford said at Tuesday’s new conference that one of the most frustrating parts of his job when he served as a paramedic was feeling like he was part of an “assembly line” that took patients to the hospital time and time again. He said this pilot could change that.
“It felt like we weren’t making a significant difference,” Ford said. “Where we are now and the direction we’re looking in now gives us an opportunity to make a difference.”
U.S. Rep. Elijah Cummings praised the program at the news conference. He recalled the months he spent hospitalized for an infection about a year ago, when he said he met a number of African-American men who had gone without regular care.
“They came in for one thing and discovered they had a whole lot of other things, a whole lot of other problems, and in some instances it was too late,” he said. “This is about saving lives. That’s what’s so wonderful about it.”