MIH-CP programs are uniquely qualified to enhance the quality of patient care at a reduced cost and improve patient outcomes. The most important first step in developing a successful MIH-CP program is to identify the needs of the community, regional hospital, healthcare system, insurance plans and caregivers so appropriate services and solutions can be provided. Here are 10 other areas that are essential for flourishing MIH-CP program models.
1. Culture shift: The EMS response agency must be willing to undertake a cultural shift from exclusive 9-1-1 response to identifying and providing preventive services to patients over-utilizing EMS. These individuals cost the healthcare system billions of dollars annually and tie up emergency responders. This culture change is extremely difficult in many municipal organizations.
2. Healthcare integration: The emergency response agency must be willing to identify the pains of the insurance plans, hospitals, skilled nursing facilities, physicians, home health and hospice organizations to ensure full integration and recognition of MIH-CP programs within the local healthcare system. It’s important to be flexible during this integration; these essential relationships will validate the MIH-CP program model.
3. Identification of high utilizers: Frequent callers and ED visitors decrease the ability of EMS agencies to respond to high-acuity calls, thereby increasing response times to these incidents. These low-acuity “super-users” also create a bottleneck in the ED, decreasing the quality of medical care, extending wait times and increasing “wall time” of ambulances.
4. Right-size your responses: Consider providing medical director-approved protocol services that allow an appropriate response to low-acuity calls where one may treat and refer patients at the point of service. MIH-CP units are uniquely qualified to manage these low-level urgencies when the configuration is correct (i.e., paramedic, physician assistant, nurse practitioner, mental health professional, registered nurse and/or social worker). This increases the quality of care at the time of need and provides for most appropriate facility destinations that will likely not include the ED. It’s recommended the advanced providers conduct a 24-hour follow-up to those treated to determine the patient’s outcome.
5. Establish partnerships: Identify federal, civic, volunteer, low-cost healthcare facilities, pharmacies and other community resources that may benefit low-acuity patients being seen by MIH-CP providers. Develop relationships with insurance plans, healthcare organizations, hospitals and physician groups that may be willing to assist with “super-users.”
6. Provide gap coverage to hospice patients: It’s costly to manage end-of-life issues and provide for palliative care. These patients often experience episodes of pain, nausea, shortness of breath and behavioral changes that alarm family members and caregivers. MIH-CP programs are capable of intervening on these patients without revocation of hospice services to manage the patient at home until a hospice team member is available to assume care.
7. Partner with home health: Partnerships with home health agencies will lead to improved patient outcomes. It’s difficult for home health team members to make appropriate visits within 72 hours of hospital discharge. Fire stations are strategically placed to provide the most appropriate service at the time of the need, decreasing response times to the most emergent patients. Urgent responses to home health patients can be wellmanaged in a timely manner from these stations.
8. Decrease hospital readmissions: About a quarter of all hospital patients are readmitted within 30 days of hospital discharge, but this number can be reduced to 15% and 5% when a recently discharged patient is seen within 72 hours and 48 hours, respectfully. The reduction in readmission will save the hospital millions of dollars of lost revenue through nonpayment and imposed Medicare penalties.
9. Address the behavioral health issue: Provide services to behavioral health patients, field medical screening and appropriate disposition away from the ED to facilities specializing in the care of these individuals. This will assure the best outcome for the patient, keep emergency response personnel available and increase the number of open ED beds to manage the high-acuity patients.
10. Be patient advocates: Most importantly, MIH-CP providers become the patient’s advocate. Polypharmacy is very common in the elderly population and adverse drug reactions may occur, leading to emergent transport to an ED. Medication reconciliation should be accomplished with each MIH-CP patient encounter. Providing for the most appropriate care and facilitating patient follow-up with their respective physician is crucial.
Gary A. Smith, MD, MMM, FAAFP, is medical director for the Mesa (Ariz.) Fire and Medical Department and medical director and assistant professor at A.T. Still University Physician Assistant Program.