1. What is the decision or change (e.g. clinical topic, practice guideline, system design, delivery of care) you are facing or struggling with where a summary of the evidence would be helpful?
The return on investment (IP and ER utilization, quality, satisfaction, costs) of urgent and emergent care (not necessarily initiated through the 911 system) done by community paramedics...excluding programs that are for planned situations...though would be interested in any programs that used community paramedics that served in a transitional care support role where they visit patients in the home who were recently hospitalized.
2. Why are you struggling with this issue?
I partnered with our local ambulance company, a very large primary care and specialty group, an ER group, an ACO, a nursing home, a home care agency and a social service agency to establish a program we called "Whatever It Takes." (This was started prior to ET3 and included ambulance that were triggered by urgent or emergent situations that came in through the 911 system or were initiated by any of the providers mentioned above.) You can get a sense of the program from this short YouTube: https://youtu.be/rbQjPQEUGUg We were able to leverage ACO data to show the significant ROI. This led to a few Michigan payers deciding to cover the services (ambulance/paramedic services and telehealth visits by PCPs or specialists or ER physicians, mobile x-rays, etc.) Of course, this ambulance company chose to participate in ET3 but that still leaves those with a potential urgent/emergent situation who likely don't need to be transported to the ER to stabilize them to get them to a point where they can follow up with their doctor. ET3 also doesn't pay for any social service agency costs that comes from the identification of any actionable SDOH that were noticed during the paramedic's visit to the home or through a conversation with that older or disabled adult . Our program initially focused on the Medicare population but then got funding to add the Medicaid and the uninsured and underinsured population so would be interested in programs that served that population as well.
3. What do you want to see changed? How will you know that your issue is improving or has been addressed?
I would like to see such a program be covered if the ROI makes it the "no brainer" that patients, worried family members, doctors and payers have concluded is extremely valuable and worth funding. Of note, like any good program, there would need to be adequate monitoring of the program for at least two reasons: 1) "do no harm" - we were very conservative in regards to who received care in the home vs who needed to be transferred to the ER. That decision is not one that can be done in a cavalier way and should be subject to clinical decision-making and not be impacted by financial incentives that could put a patient at risk, and 2) approach has great risk to be one that is overutilized by some where community paramedic visits were not indicated at all or the assessment of the patient could have occurred in a more cost-effective way (e.g., a visit to the doctor's office in the coming day or week...especially for an able-body patient with access to transportation.)
4. When do you need the evidence report?
5. What will you do with the evidence report?
All dependent on if there will be enough evidence to prove the ROI on such an approach to patient-centered urgent/emergent care for especially vulnerable populations (including those residing in nursing homes where one out of three residents admitted from a hospital to a SNF return back for unplanned reasons to the hospital - with 23% getting admitted, 11% going to the ER and then returning to the SNF.) Otherwise, either there will not be enough data to make a conclusion (ET3 will give us a great deal of informat ion about those who trigger such visits/treatments for those who go through the 911 system but we may need a further demo to also include a provider-initiated outreach to their local ambulance program), or the report can be used to advocate to change payment policy for Medicare, Medicaid, VA and commercial payers.
Optional Information About You
What is your role or perspective? Chief Medical Officer - Real Time Medical Systems
If you are you making a suggestion on behalf of an organization, please state the name of the organization? As a citizen
May we contact you if we have questions about your nomination? Yes