Ann Arbor, Mich. — August 27, 2015 — Paramedics have always made house calls, usually with the end result being a transport to the hospital. But Huron Valley Ambulance (HVA) and Livingston County EMS (LCEMS), with the support of St. Joseph Mercy Health System and the University of Michigan Health System, have launched a 3-year Community Paramedic pilot project to change that in some cases. The goal of the program is to care for non-acute patients at home, rather than with an ambulance transport to the hospital.
The program, which began August 2nd in Washtenaw and Livingston counties, uses Community Paramedics (CPs) with advanced training to respond to non-acute 9-1-1 calls when people need medical care but have no life-threatening symptoms. At these visits, the Community Paramedics provide primary care for minor illnesses instead of a transport by ambulance to the Emergency Department. Now, when you call 9-1-1 in Washtenaw or Livingston County and there is no serious illness or emergency, the dispatcher may send a CP.
“These Community Paramedics have gone through six additional months of training, improving their assessment skills and completing clinical rotations in non-emergency settings,” states Robert Domeier, MD, the medical director for the EMS system in Washtenaw and Livingston counties who is providing physician leadership for the program. “I have a great deal of confidence in them. The CP has a video link so that the emergency physician can look at the patient, and the patient can look at the physician and ask us questions.”
In addition to their education and experience in assessing patients, CPs use technology such as point-of-care testing that provides lab results obtained from blood and urine, and a video link between the patient and the emergency physician.
CPs also carry antibiotics so they can begin to treat someone with an infection. Once the CPs have given the first dose, they will coordinate care with the patient’s primary care physician and pharmacy to make sure the patient receives and takes the remainder of the prescription. CPs will also schedule a follow up visit or phone call with the patient to make sure they are improving.
On each visit, the CP will determine whether a patient has a primary care physician, and if so, they will follow up with that provider. If the patient does not have a physician, they will be referred to resources to find one.
Many people call 9-1-1 for non-emergencies. Ambulance transports have become a solution for those who do not have a primary care physician or choose not to call them. The number of non-emergency 9-1-1 calls is increasing far faster than the population in both counties.
“Calling 9-1-1 is not the best solution for someone who has a minor medical problem and can get to their doctor,” said Dale Berry, President and CEO of HVA. “A 9-1-1 response, ambulance transport, and emergency room visit is a very costly way to take care of a minor, non-acute illness.
“But as our population ages, many older patients have problems getting into a car when they have an infection or feel terrible,” Berry continued. “Family members know mom or dad needs help but they don’t know what to do. So they call 9-1-1″.
Presently, the pilot project is being financially supported by HVA and LCEMS. Both Washtenaw County and Livingston County governments are also assisting financially. HVA will be charging patients $180 for a CP visit — which is far less expensive than the cost of an ambulance transport and hospital emergency room visit. Some insurance carriers will cover the visit because they realize the long term cost savings. Other insurers have not made a decision to reimburse for it because it is a new program.
“Our initial experience has shown that the patients seen by Community Paramedics are very satisfied,” continues HVA’s Berry.
“Whatever their problem, if we can care for them at home and avoid ambulance transport and emergency room hospitalization, it’s a win-win for them and it reduces cost for health insurance plans and even hospitals,” said Jeff Boyd, Director of LCEMS.
“This is the first program of its type in Michigan and I think it will be very successful. We are pioneering the concept.”
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Based in Ann Arbor, Huron Valley Ambulance is a nationally accredited, nonprofit community ambulance service covering Washtenaw, western Wayne and southwest Oakland counties.
Based in Howell, Livingston County EMS is a department of county government, and provides EMS and ambulance service throughout Livingston County.
The Community Paramedic program has been approved by the EMS Division of the Michigan Department of Health and Human Services in Washtenaw and Livingston counties as a 3-year special study.
