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Maine Ambulance Service Begins “House Call” Healthcare Program

FARMINGTON - Starting Nov. 1, NorthStar ambulance service staff will tend to patients in a nonemergency home visit as part of a three-year pilot program called House Call.

The Franklin County ambulance service is establishing the community paramedicine pilot, joining 11 other pilots across the state, to determine whether the program is effective in reducing health care costs for emergency room care, ambulance calls, hospital admissions and readmissions, Michael Senecal, NorthStar director, explained Tuesday.

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About 20 NorthStar paramedics and emergency medical technicians will be trained to make house calls during times when they are not responding to emergency calls, he said. More will be trained as the program progresses.

They will see only patients referred by their physicians. They may help educate patients and family members about their conditions, monitor those conditions or prescriptions and provide treatment, he said.

The service is basically intended for patients recently released from the hospital or those who have had recent surgeries, have chronic conditions or safety issues in their homes.

The paramedicine program is a higher level of care provided in between the hospital and home health services, filling the gap and perhaps working with home health care providers, he said.

"For decades, emergency medical services have focused on being reactive: you call, we come," Senecal said in a release. "This new approach is proactive: we come so you don't have to call."

The program, recently approved by the Maine Emergency Medical Services, allows the 12 pilot programs to provide non-emergency care. A bill was adopted into law in 2012.

This medical model of care is often effective in rural areas, he said, mentioning areas north of Farmington where there isn't much coverage. The service will be available throughout the county from all NorthStar locations, including Carrabassett Valley, Rangeley and Phillips.

Whether a home visit to Eustis, about a dozen miles from the Carrabassett station, is cost-effective is part of the data NorthStar will collect and evaluate over the three years, he said.

Former NorthStar Director David Robie was passionate about the model and advocated for Maine to adopt the approach starting back in 2008, he said.

During visits, the NorthStar staff may work with patients to ensure they understand their conditions and the doctor's plan for treatment. They may tell the physician about a need for more explanation, he said.

The staff may also help with prescriptions. It can be confusing as to what or how much to take. Some patients can be on a dozen prescriptions, he said.

In-home services could include vital signs, wound care, hypertension monitoring, diabetes management, medication management, ear and nose complaints, flu vaccinations and potential fall assessments. Each visit and services provided are reported to the referring physician.

Dr. Jay Naliboff will serve as the House Call medical director, acting as a liaison to area physicians. He will also work with Dr. Steve Zanella, NorthStar's medical director.

The costs for the program are minimal and during the pilot will be absorbed by NorthStar's budget, he said.

"The biggest cost is training, but we have to have staff anyway," he said.

There are times when the crew is busy and other times when they could make a house call. Emergency services would always come first, he added.

"Health care is changing," he said. "Reimbursements are reduced if people are readmitted."

Community paramedicine can save money for the community. Emergency care is the most expensive, he said.

Over the long term, studies have shown the program's costs are likely to be offset by savings in transport, hospital admissions and doctor visits, he added.



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