Jay Bradshaw, Director Maine EMS 1 Paramedic Paradox The - - PowerPoint PPT Presentation

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Jay Bradshaw, Director Maine EMS

Paramedic Paradox

• The further one moves from an emergency medical facility

The more one may need a higher level of local EMS capability And the less likely that this EMS capability will be available

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∗ Financially Less Supportable

∗ Fixed Cost of Paid Crew

Rural Paramedic Paradox

Fixed Cost of Paid Crew ∗ Availability of Volunteer Paramedics

∗ Operationally Less Supportable

∗ Skill Retention

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Adapting EMS resources to address community health care

Community Paramedicine

Adapting EMS resources to address community health care and/or public health needs not currently being met and embracing the “paramedicine paradox” as one of those needs.

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∗ EMS Systems Act of 1973

Blueprints for the System of EMS

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EMS Agenda for the Future (1996) The Vision Emergency medical services (EMS) of the future:

Blueprints for the System of EMS

Emergency medical services (EMS) of the future: ∗ Community-based health management … ∗ Fully integrated with the overall health care system… ∗ Able to identify and modify illness and injury risks.. ∗ Able to provide acute illness and injury care and follow-up, and … ∗ Able to contribute to treatment of chronic conditions and community health monitoring…

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2004 – “EMS Based Community Health Services”

Already exist in

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many settings across the country…..

∗ Not Universal

∗ Volunteer Svcs. ∗ Busy FD Svcs.

However…..

∗ Will Evolve Only

∗ As needed ∗ Where needed ∗ How needed

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Similar; but different

∗ Community Paramedic ∗ Community Paramedicine ∗ Mobile Integrated Health Care

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∗ IS

∗ A generic concept ∗ A means to fill a temporary or on-going health care need ∗ Expansion of EMS roles and services to assist community health team colleagues ∗ Generally on an episodic, not case management, basis

Community Paramedicine

∗ Generally on an episodic, not case management, basis

∗ IS NOT

∗ An expansion of EMS scope of practice ∗ Just for the Paramedic license level…. ∗ The same in every (or any) community ∗ Competing for community health roles, but leverages the 24/7 presence and mobility of EMS resources in the community

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∗ Community Paramedic

∗ A state licensed Paramedic who is certified as graduating from a recognized college program in community paramedicine and operates within the scope of practice for

Evolving Concept…..

paramedicine and operates within the scope of practice for their licensure level as approved by the state under appropriate medical direction for the nature of their practice. ∗ Episodic Care (e.g. “Deli Menu” Approach)

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∗ No/Minor Statutory Changes – Delegated Practice ∗ No Statutory Change/Current Definitions Work

Statutory Approaches

∗ No Statutory Change/Current Definitions Work ∗ Statutory Changes Needed for Practice and/or Reimbursement

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Medical Direction

∗ Primary Care & EMS Mix

∗ Flexible Models to Meet Resource Availability

∗ Small, Rural Facilities: Single Physician? Medium Facilities: 1 PCP & 1 EM/EMS? ∗ Medium Facilities: 1 PCP & 1 EM/EMS? ∗ Health Systems: 1 Physician Coordinating Many?

∗ The Balancing Act

∗ When is a patient interaction an EMS event? ∗ When is a patient interaction a CP event? ∗ What happens when an interaction transitions?

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∗ Currently No Direct Funding Provisions

∗ CMMI Grant Program ∗ Minnesota: Medicaid

Supporting CP Programs - $$$

∗ Minnesota: Medicaid ∗ Maine: Has Medicaid “No Transport”

∗ Future:

∗ Demonstrate Value to:

∗ Current Reimbursement Model Payers ∗ Evolving Accountable Care Organizations ∗ Evolving Medical Home Model Practices ∗ Community Health Colleagues Who Perceive Gaps

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∗ Colorado - Public Health Nursing Partner Model ∗ Pittsburgh – Home Health Partner Model

Others

∗ Pittsburgh – Home Health Partner Model ∗ San Francisco – “Frequent Flyer” Overutilization ∗ Wake County, NC ∗ Dallas – Fort Worth ∗ Minnesota

∗ Collaboration:

∗ Maine EMS (DPS) ∗ Maine Office of Rural Health (DHHS)

Maine CP Project

∗ Maine Office of Rural Health (DHHS)

∗ Components (Over 3 Years)

∗ On-Going Task Force ∗ Pilot Project Approach With Uniform:

∗ Medical Direction/Quality Improvement Processes ∗ Prospective Research Methodology ∗ Integration Into Community Health Teams

∗ Components (continued)

∗ Pilot Requirements

∗ Current Paramedic/Other Provider Capacity ∗ Relationship With Primary Care Practice Site(s)

Maine CP Project

∗ Relationship With Primary Care Practice Site(s) ∗ Willingness of Site To

∗ Provide Medical Oversight/QI ∗ Access Data on Patient Population (MHMC or other)

∗ Solicit Pilots, Assist, and Monitor Reporting ∗ Work with Payers

∗ Community Paramedic Model

∗ Licensed Paramedic ∗ 100-200 Hour College-Based Program ∗ Primary Care/Emergency Medicine Oversight

Pilot CP Project Models

∗ Primary Care/Emergency Medicine Oversight ∗ Integrated in Community Health Team

∗ Enabled/Extended Health Services Model

∗ Licensed Providers Within Their Scope ∗ Limited/Selected Services ∗ Additional Training, and Oversight as Appropriate ∗ Integrated in Community Health Team

CP Pilot Projects

∗ Greater Kennebec County (MGMC, Delta, Winthrop) ∗ Castine FD ∗ Calais FD (MGMC, Delta, Winthrop) ∗ Central Lincoln County (Miles Memorial, CLC, Waldoboro, Boothbay) ∗ North East Mobile Health ∗ St. George Amb ∗ Searsport Amb ∗ Calais FD ∗ Crown Amb ∗ Mayo (Dover-Foxcroft) ∗ C.A.Dean (Greenville) ∗ Northstar (Farmington) ∗ United Amb (Lew/Aub)

What’s Next?

∗ Objective evaluation (USM Muskie School)

∗ Link CP data with MHDO, others

∗ Expand pilot sites? ∗ EMS Rules? ∗ Reimbursement

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