By Philip Haldiman
The city’s community paramedicine pilot program concluded in 2017 and was successful in diverting unnecessary visits from local emergency rooms, freeing up time for more serious needs.
But the program has since moved to part-time, and is in search of partnerships to bump it back up to full-time.
Mayor Cathy Carlat said paramedicine is a huge benefit to the citizens and wants the program back to full-force.
“I am a big fan of community paramedicine,” she said. “It is an area we can get out in front of and be proactive and actually control our fate a little bit instead of being reactive. I would like to see us expand this program as quickly as we possibly can.”
Emergency Medical Service Chief Jim Bratcher said 758 patients were contacted during the program. Of those, 74 were frequent users of the 911 system for health care needs.
He said at completion of the program, visits decreased from 447 to 54, or an 89 percent decrease.
The program has garnered encouraging results and has given residents resources to help meet their health care needs and not rely on the 911 system, Mr. Bratcher said.
“The program allows us to interact with patients who are enrolled in the program and delve into their needs and support them moving forward,” he said. “Patients didn’t know how to access their resources and the program helped them navigate the health care system, refer to primary care, specialists, other community resources, or in some cases, simply help them get things like a walker, to avoid fall injuries, and didn’t have those resources and on an emergent basis, because we don’t really have time to delve into those needs.”
The ultimate goal of the grant-funded program was to reduce hospital readmission rates, help discharged patients stay on the road to good health, reduce emergency room visits for preventable illnesses and reduce 911 calls when emergency services are not be needed. Community paramedicine reduces health care costs by providing the right level of care in the most appropriate place based on an individual’s medical needs.
The program uses the existing infrastructure of the fire-medical department to provide preventive healthcare services and improve overall community wellness. This could include providing follow-up care for people recently discharged from the hospital to prevent unnecessary readmissions; providing community-based support for people with issues like diabetes, asthma, or other chronic conditions and providing preventative care in undeserved communities.
The one-year pilot program in Peoria was made possible through a $150,000 grant from the Vitalyst Health Foundation to the consortium of five fire-medical departments in Peoria, Goodyear, Avondale, Surprise and Sun City.
The program provided outreach to frequent utilizers of the 911 system for non-emergency events or to patients who may need additional resources.
The grant program ended but Peoria continued the program with existing resources on a part-time basis, one day a week.
Mr. Bratcher said the full-time program allowed greater flexibility in scheduling participants and had greater capacity to see patients or participants. The part-time program has less flexibility for the participant and obviously less capacity, he said.
“[The part-time program] does limit our ability to see participants depending upon the participant’s personal schedule,” he said.
The Peoria Fire-Medical Department provides clients with the city’s community resource guide as a starting point and a source of information for available services. The guide can be found at peoriaaz.gov/peoriasupport.
After meeting with a member of the paramedicine team, individuals are referred to the Peoria Neighborhood and Human Services Department, where their needs can further be assessed.
Community Assistance Manager Carin Imig said the department acts as a conduit between Peoria residents and local and regional nonprofits serving very specific needs such as: food/meal assistance, senior services, transportation services, and services for persons with disabilities.
She said housing can also be an issue with clients.
“While the medics are working with their client, they may notice certain housing issues which may contribute to the overall well-being of an individual, such as noticing that the air conditioning or heating in the house is inoperable. In this case, our division is responsible for the operations of an emergency home repair program which addresses life and safety concerns. We can work to assist our residents with repairs through this program,” she said. “So, we believe there is a strong synergy between our departments with paramedicine and the variety of programs we offer. Together, we are able to provide more holistic services to some of our most vulnerable residents.”
Jonathan Fisher , MD, an associate program director in the Maricopa Integrated Health System emergency department, said paramedicine is a new, evolving pre-hospital care that is relatively new to Arizona.
He said it brings urgent care to the patient and creates an option for patients with minor illness or injury in need of care after-hours, because usually the only thing open 24 hours a day, seven days a week is the emergency room. And, he said, it saves money because it cuts down on emergency room visits and other costs.
However, Mr. Fisher said finding a funding stream for paramedicine programs is difficult because the practice is so new.
A shared saving model is one way to pay for this type of program, he said.
“Generally, Centers for Medicare & Medicaid Services and other insurers only pay Emergency Medical Services for transporting patients to the hospital, so if a community paramedic takes care of a patient in their home, they cannot be paid for the service,” Mr. Fisher said. “However, the system is saved money because there is a bill for the ambulance transport and subsequent ER visit. If a portion of the savings is ‘shared’ with the EMS provider, it is a win for the payor and the EMS agency financial, and the patient got the care they needed.”
Kim Licciardi, a nurse practitioner who worked on a paramedicne program in Mesa, said many fire departments have limited budgets and rely on partnerships and grants for non-traditional programs, while lack of funding keeps programs from moving forward.
“Funding is the issue for sustainability,” she said.
Ms. Licciardi worked as part of Mesa’s Community Care Initiative, a three-year pilot program that responded to low-level 911 calls delivering care to non-emergent patients. As part of the program, paramedics also provided resources and information for follow-up care within the community for the homeless or uninsured.
She said the program had more than 13,000 diversions from the ER during the pilot.
The city is now maintaining a similar program which started this year via partnerships.
“We have had great outcomes to date,” she said. “I believe [paramedicine] is in a growth phase as nursing and physical shortages continue. The supply is outpacing the demand for providers and overcrowding and extending wait times in emergency departments, which may continue for years. Demand is for effective, timely care for an aging and growing population with diverse health care needs.”
The cities of Peoria and Surprise have collaborated to create a Community Resource Guide, which provides contact information for nonprofit agencies that assist individuals with basic needs and services. Although the guide is comprehensive and intended to provide general information, it is not considered to be all-inclusive. The complete guide can be seen here: peoriaaz.gov/peoriasupport.
Paramedicine in Peoria
Total patient contacts during program: 758
Average number of visits per patient: 3
Average age: 70
Average length per call: 1 hour and 10 minutes
Percentage of patients with Primary Care Provider: 90 percent
Source: City of Peoria